Long Shifts Lead to More Risk

Long shifts, often the norm in nursing, add undue risk for both the patient and the nurse compared to shorter ones.

Poor work environments have been linked to failure to rescue, increased patient mortality, nurse dissatisfaction, and poor nurse-reported quality of care. One facet of the nurse work environment is shift length. The popularity of a three 12-hour-shift work week has lead to it becoming nearly ubiquitous among hospital nurses, but recent work in this field has suggested that the traditional 8-hour shift is safer for both the patient and the nurse.

A recent study published in Health Affairs attempts to triangulate the effects of the extended shift (>12 hours) on nurse burnout and patient satisfaction. The authors constructed a secondary analysis of cross-sectional data from three sources linked by common hospital identifiers: the 2005-2008 Multi-State Nursing Care and Patient Safety Study, the 2006-2007 HCAHPS survey, and the 2006 American Hospital Association Annual Survey of Hospitals. Shift length was grouped into four categories: 8-9 hours, 10-11 hours, 12-13 hours, and >13 hours. Effect of shift length was estimated by calculating the proportion of nurses working each shift category against each outcome.

The study found a direct and significant relationship between longer nursing shift lengths and patient dissatisfaction. Other statistically significant associations with longer (>12 hour) shift lengths demonstrated worse patient perceptions of nurses communicating well, pain control, clean rooms, and receiving help as soon as patients wanted.

Additionally, nurses working shifts of more than 13 hours were up to 2.5 times more likely than nurses working shorter shifts to experience burnout (OR=2.7, 95% CI=2.32-3.15), job dissatisfaction (OR=2.38, 95% CI=2.04-2.79), and intent to leave the job (OR=2.57, 95% CI=2.10-3.15). Extended shifts appear to negatively impact nurse well-being, may result in expensive job turnover, and undermine patient satisfaction. The authors suggested stricter regulations regarding work hours for nurses and encourage workplace cultures that protect the nurse’s time away from work.

Commentary

Because of the popularity of the 12-hour shift, side-by-side comparison of varied shift lengths has become increasingly difficult, but the existing evidence regarding the safety of 12-hour shifts should prompt any executive to rethink scheduling practices.

This study is laudable in that it combines the vast amounts of pre-existing data available in a way that is meaningful and informative to nurse leaders. An analysis of work culture in hospitals that utilize a higher proportion of 8-hour shifts for nurses may be informative for leaders wishing to transition away from extended shifts.

For any one hospital to announce a return to 8-hour shifts would certainly be detrimental to staffing levels, and instituting scheduling policies that limit the number of consecutive 12-hour shifts worked will not stop nurses from working a second job. However, because nursing is a safety sensitive job, it is incumbent upon managers to stress the importance of coming to work rested, to avoid calling nurses in on their off day, and to encourage nurses to leave work on time, even if they are not “caught up.” Other best-practices include not scheduling staff meetings at the end of 12-hour shifts, ensuring adequate meal breaks, and engaging employee health in nursing wellness.

Stimpfel, AW, et al. Health Affairs. 2011; 31 (11): 2501-2509.

by

Megan Doede, RN, BSN, CEN