Twelve-hour shifts generally turn into or hour shifts. Forget dinner plans or the gym. In fact, on any workday, nothing else gets accomplished.
This is one of the most polarizing questions in health care today—and one that has taken on new significance with the emergence of data linking extended nursing shifts to safety, quality, experience and cost outcomes.
In most hospitals, hour nursing shifts are the norm. The flexibility of a three-days-on, four-days-off work week appeals to nurses, and hospital leaders believe that offering extended shifts is essential for nurse retention.
They also believe that hour shifts improve scheduling efficiency because there are fewer shift changes and fewer scheduling variables. This, they perceive, eases the administrative challenges of keeping units staffed, particularly as the demand for registered nurses outpaces the supply.
Research has consistently shown that, relative to traditional eight- to hour shifts, extended nursing shifts are associated with an increased incidence of burnout and job dissatisfaction,1 negative health consequences2 and poorer performance on safety and quality measures.
In the November issue of Health Affairs, a research team led by Dr. The authors pointed out that, although many nurses were typically scheduled for hour shifts, these actual shifts frequently extended to 13 or more hours because of the unpredictability in patient care needs, and many nurses worked on their days off to supplement their income.
The major findings of the study included the following. Increases in shift length beyond nine hours were significantly associated with increased burnout, job dissatisfaction and intent to leave. When nurses worked beyond 13 hours, job satisfaction and patient satisfaction declined significantly and intent to leave rose significantly.
These multiple associations are not surprising, particularly given the growing body of data pointing to the interdependency of health care safety, quality, patient experience and caregiver engagement outcomes.
They do, however, suggest a reason for the health care industry, individual health systems and nurses themselves to step back and evaluate whether the perceived benefits of extended shifts are, in fact, benefits at all; whether they are worth the risks; and how the risks might be eliminated.
Of course, the negative outcomes that have been associated with extended nursing shifts are not really a function of shift duration per se. Rather, they are a consequence of the inadequate sleep, fatigue and stress that go hand in hand with extended shifts, which can compromise memory, coordination, judgment, attention to detail and reaction time.
Short of eliminating hour shifts altogether, which would require a fundamental culture change that many hospitals and nurses are not yet prepared to make, health system leadership must focus their attention on improving the nurse work environment to mediate some of the negative consequences.
In fact, integrated analyses of data across multiple performance domains reported in a recent Press Ganey white paper indicate that the quality of the work environment exerts a strong influence on many of the same safety, quality, experience and engagement measures as shift length.
With respect to burnout and fatigue in particular, some of the evidence-based strategies for improving the nurse work environment and minimizing negative consequences of extended shifts include the following: It requires ongoing monitoring of performance across quality domains, evaluation of outcomes to identify areas in need of improvement and adjustments based on scientific evidence to optimize nursing work environments and outcomes.
Education and collaboration among hospital administrators, human resources managers, nurse leaders and front-line nurses are critical early steps toward achieving this goal, as is additional research looking at the range of work-pattern variables choice, shift sequence, breaks, etc.
In particular, disrupting the nurse-staffing status quo will require a groundswell of support by the people who take care of patients.
In this regard, the onus is on nurse leaders to communicate with their staff about the influence of fatigue, sleep deprivation and burnout on patient and caregiver outcomes in general and the serious safety, quality and experience issues surrounding extended shifts in particular.
Findings from a cross-sectional study of 12 European countries. An ethical dilemma for the nurse executive. Current Strategies for Prevention.Working hour shifts can benefit staff and healthcare organisations but the risks and potential adverse outcomes must be carefully considered and mitigated against.
The percentage of nurses who were dissatisfied with the job was similar for nurses working the most common shift lengths, 8–9 hours and 12–13 hours, but it was higher for nurses working shifts of 10–11 hours and more than 13 hours.
Nurses Demand Hour Shift Flexibility This issue s cover story examines the pros and cons of the hour shift. From increased schedule flexibility to sleep deprivation, nurses have long debated the costs and benefits of the longer shift.
Whether nurses working consecutive hour night shifts are more impaired by fatigue than nurses working day shifts; And whether working hour night shifts puts nurses at greater risk during their drive home than working the same length day shift.
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hour shifts have become the norm in hospitals and most nurses love them. One can work 3 days and have 4 days off, there is one less major shift change to contend with, and patients have fewer names and faces to get acclimated to in a hour period.