Debate : 8 HOUR V 12 HOUR NURSING SHIFT - Quality of Care / Safety - VALUES SNAPSHOT

In todays' fast-paced health care culture, with limited staff resources and increased complex care, working a 12 hour nursing shift has become an attractive 'on the face of it' option and now the 'norm' for many managers rostering and health-care workers alike. This is especially prevelent in acute clinical areas.

This 12 hour shift pattern has replaced the normal 8 hour shift (previously worked by nurses and health care workers throughout the NHS).  In fact, it is not unusual to come across nurses who have never worked an 8 hour shift during their careers.

But is the 12 hour shift a help or an hindrance to safe , quality patient care and staff well-being?

There are many perceived benefits to working a 12 hour shift, for managers, in enabling shift cover and especially for staff members. These benefits include:

• More days off
• More opportunity to work overtime shifts so income is increased
• Continuity of care
• Staff can work another job on their days off
• More flexible for child care, as a full time equivalent would only work 3 days out of 7 (instead of 5)
• More time with family and friends

However, there are also disadvantages to working these 12 hour shifts, as well as emerging evidence which suggests a possible higher mortality rate for patients in certain groups, and burnout and fatigue prevelence. These findings were more likely to occur where these 12 hour shifts are ingrained and common-place.  Perceived disadvantages include:

• Less time to de-brief with other team members during the cross-over period
• Nurses reporting fatigue and exhaustion (blogging sites and research surveys)
• Limited sleep between shifts (5.5hrs average)
• Fragmented sleep patterns
• Less time worked with other members of the team, effecting team cohesiveness and team spirit resulting in the possibility of fragmented care and poor communication
• Less awareness of ward changes in policy, procedure
• According to Sherman, (2013) ...'there is research to support that the likelihood of a nurse making a mistake is 3 times greater for nurses who work 12 hour tours versus 8 hours.'
• [ and ]... 'recent research indicates that mortality for selected conditions like pneumonia were higher in hospitals where nurses reported longer shifts.'
• An evaluative literature review report carried out by the National Nursing Research Unit (NNRU) , 2015, commisioned by NHS England shwed that, after a review of the available evidence, on prevelance, views and impact, there was a general negative effect associated with 12 hour shifts. These negative effects mainly centred around fatigue and the subsequent effects for patients, nurses and patients alike. (Ball et al. , 2015).

Interestingly, a recent study,  (file:///Users/User/Downloads/12%20shifts%20BMJ%20sept%202015.pdf)  appeared in the BMJ - ' Association of 12 h shifts and nurses’ job satisfaction, burnout and intention to leave: findings from a cross-sectional study of 12 European countries ' Dall’Ora C, et al. (2015);  found that despite perceived benefits of 12 hour shifts, nurses working these shifts were more likey to report job dissatisfaction, increased intention to leave job and adverse well-being such as burnout. Although this study method is limited in its ability to establish a direct causal relationship, these are interesting outcome findings and are a concern in terms of potential implications.  These findings, which support other study results, consequnetially fuel the safety debate further.

What do you think?

Should 12 hour shifts be abandoned ?

What are the implications for patients and staff if the 8 hour shift returns instead ?

Sources http://www.emergingrnleader.com/12-hournursingshift/

Research References

Ball J, Maben J, Murrells T, Day T, Griffiths P (2014) ‘12-hour shifts: prevalence, views and impact’. National Nursing Research Unit, King’s College London

Dall’Ora C, Griffiths P, Ball J, et al. Association of 12 h shifts and nurses’ job satisfaction, burnout and intention to leave: findings from a crosssectional study of 12 European countries. BMJ Open 2015;5:e008331. doi:10.1136/bmjopen-2015- 008331

Geiger-Brown, J. & Trinkoff, M. (2010).  Is it time to pull the plug on 12-hour tours: Part 1. The evidence.  Journal of Nursing Administration, 40 (3) 100-102.

Trinkoff, M., Johantgen, M., Storr, C.L., Gurses, A.P., Liang, Y & Han, K. (2011). Nurses’ work schedule characteristics, nurse staffing and patient mortality. Nursing Research, 60 (1) 1-8.

Issue created by Vanessa Peutherer - VX Learning Facilitator - Ethical Awareness in the Health Care Arena.