12 Hour Shifts – Pros and Cons R/T Patient and Nurse Viewpoint
Ryan Eads
Highland Community College
Nurse 292A CDIII
December 4th, 2013
Summary This paper explores the pros and cons of nurses working long shifts in regards to the nurses and patients alike. Some of the positives for the nurses include: having more days off per week, a more flexible schedule, and fewer commutes to work. In regards to the patient, there are fewer patient handoffs, which is thought to allow for better continuity of care. Some of the negative aspects of nurses working long shifts include: feeling burnt out, intending to leave their job, increased chance of making errors, impaired driving ability, health-related issues, and potential breakdowns. In regards to the negative aspects for patients, patient satisfaction suffers as the length of the shift the nurse is working increases. Furthermore, patients of nurses working long shifts also give the hospital a poorer rating overall, stating that they generally would not recommend it to family and friends. While there is no clear solution to this dilemma, it is certainly an issue that should be addressed by nurse leaders as the safety of nurses and patients is of paramount importance.
Introduction One of the most common professions where staff are often required to work long hours and deal with stressful demands related to their occupation is in the field of nursing. Many hospitals and agencies require their
A major issue in the medical career field is the demand for nurses and this, of course, means that these nurses will be working strenuous hours to meet the high demands. While this may satisfy some issues it also creates others. Longer hours results in exhausted nurses and this leads to negative patient outcomes.
The profession of nursing is usually described as high-demand job, as well as stressful. The American Association of Critical-Care Nurses believes that nurses can empower their work environments and truly make a difference (AACN, 2016). Although nurses have the ability to join committees and help make changes slowly, there are many factors in the nursing that cannot be changed by nurses. “The global increase in the aged population, the intensity of health care problems, the incidence of chronic illnesses and advanced technology, nurses are faced with a variety of work-related stressors” (Lambert & Lambert, 2008, p. 38). Regardless of nursing communication and social aspects of units, nurses need to accept some stressors as they are and
It is problematic that healthcare professions work rotating shifts because this impedes on the ability of the human body to function properly. Rotating shifts means that everyday their shifts are at different times and different lengths of time. The human body needs to be in line with the environment and when the sun is up the body naturally is awake and alert and during night time the body goes dormant to sleep, this is called circadian rhythm. The body has a circadian clock and when this is disrupted this can lead to depression and anxiety. This can lead to exhaustion and irritation that can cause someone to make mistakes. This can also lead to sleep debt and cause insomnia that can affect the mental alertness. Sleep allows the body to fight
For some nurses, mandatory overtime can be an advantage due to financial instability but mostly mandatory overtime can cause fatigue, burnout, injuries, errors, inadequate sleep and deficits in performance. According to research working long hours which consists more than 40 hours a week or over 12 hours a day leads to an increased medication errors and patient mortality. The probability of making medication errors increases tremendously when nurses work longer than 12.5 hours a day. During surveys regarding reasons of overtime, 60 % of nurses stated that overtime was obligatory as part of their job, 29 % of nurses stated that they volunteered and 41% of nurses stated that they were “on call hours” (Bae, 2012)
Nurse staffing have an effect on a variety of areas within nursing. Quality of care is usually affected. Hospitals with low staffing tend to have higher incidence of poor patient outcomes. Martin, (2015) wrote an article on how insufficient nursing staff increases workload and job dissatisfaction, which in effect decreases total patient care over all. When nurse staffing is inadequate, the ability to practice ethically becomes questionable. Time worked, overtime, and total hours per week have significant effect on errors. When nurses works long hours, the more likely errors will be made. He also argued that inadequate staffing not only affects their patients but also their loved ones, future and current nursing staff, and the hospitals in which they are employed. An unrealistic workload may result in chronic fatigue, poor sleep patterns, and absenteeism thus affecting the patients they take care of.
Does one ever think about the words “required” or “extended work shifts”? To countless nurses these terminologies or jargons mean mandatory overtime. In today’s healthcare, “required” overtime has sky rocketed, attributable to, the nursing shortages throughout the United States. Studies have revealed that working “extended work shifts or additional shifts” have a negative impact on both patient and nurse safety. The purpose of this paper is to inform and advocate for the Registered Nurse Safe Staffing Act. This author will discuss the key points, provide a critique of empirical evidence, and demonstrate the importance and impact of this Act to the nursing profession.
Mandatory overtime in the field of nursing is described as forced overtime to maintain an adequate amount of staff present to meet the needs of the hospital. With a normal work schedule, a nurse usually works 12-hour shifts, usually three times a week. With the obligatory hours that are extended with overtime due to the continuation of nursing shortages, a nurse’s shift can be continued ranging from 12 to 16 hours, with very short notice. This mandatory action is related to putting not only nurses, but also patient’s health at risk. The advantages that accompany mandatory overtime are overshadowed by the disadvantages that surpass the benefits of working extended hours, therefore, mandatory overtime should not be allowed in the nursing work place.
Throughout the years there has been more attention directed towards healthcare worker fatigue. More specifically, fatigue associated among night-shift nurses. The Joint Commission has found that lack of sleep from night shifts has contributed to increased errors, leading to poor patient outcomes (Gardner, Dubeck, 2016).
Since the early days of nursing when nurses would work extended shifts and even lived on the wards where they worked, nurse fatigue has been a much discussed issue. During the late 1800s and into the early 1900s, workers spanning several industries fought for the eight hour work day and eventually won with the passage of the US Fair Labor Standards Act in 1938 (Miller, 2011). In the years since then, the extended shift has again become popular, particularly in the field of nursing. Though many nurses and organizations laud twelve hour shifts as beneficial to staffing needs and personal lives, the risks to patient and nurse safety must be considered.
In many if not all acute care hospitals, nurses work twelve hours shifts, three days a week, including mandated weekends and holidays. Many nurses report that there is a lack of control over days off with an inability or unwillingness by management to adapt work schedules in order to help meet employee obligations (Hill, 2009). Due to management’s lack of flexibility and the limited amount of leave allotted, many nurses may seek other jobs that provide a more life-work balance.
A nurse’s typical day isn’t without stress; it is usually a lot of complex planning, critical thinking, time management, an abundance of communications with all departments of the hospital, and documenting events that have happened throughout the day on their entire patient assignment. “Nurses who are mandated following the completion of their regular shift are often ill-equipped to continue working. They have not planned for that situation with: proper advanced rest, arrangements for
Patients in a hospital and/or healthcare facilities have to be cared for all day and all night, everyday of the week by nurses. The usual way to fulfill this need is to divide up the day into three 8-hour shifts. Different shifts have been put into place to help improve nurse satisfaction, decrease the nursing shortage and save the hospital money. The 24-hour day is made up of two 12-hour shifts; 12 hours in the day and 12 hours at night. There has been quite an ongoing debate over the years regarding this issue of nurses working over 8 hours in a single day. Many people, such as hospital nursing administrators, have reason to believe that working long hour shifts causes more errors in
Limited attention has been paid to the hours worked by nurses, or the effects of these hours on patient safety (Rogers, 2008). Even though most nurses favor 12- hour shifts and overtime, it is associated with difficulties staying awake during times of duty, reduced sleep times, and triple the risk of making an error (Rogers, 2008). The most significant risk of making an error occurred when nurses were scheduled to work 12.5 hours or more.
To provide high-quality care for the patient it is essential for the nursing staff to have enough time for recovery from long hours of demanding work. Eight-hour shifts for hospital nurses have become a standard of the past. Nowadays, 12-hour shifts for three days a week have become typical in most hospitals as recommended by the Institute of Medicine (IOM) (Stimpfel, Sloane & Aiken, 2012). The length of the shifts and the working days; however, are often unpredictable due to increased demand for patient care and high census episodes. Nursing shortages, along with a weak economy, have left hospital nurses with no choice, then to work extended hours and overtime. Long hour shifts, as well as mandatory overtime, has become an increasing
The risks of making an error were significantly increased when work shifts were longer than twelve hours, when nurses worked overtime, or when they worked more than forty hours per week. (Trossman, 2009). Working longer hours in a high stress area will always increase the error rate. Designating an adequate number of RN positions to ensure nurses work an appropriate schedule without overtime and that their workload allows for breaks. Managerial staff must work to develop specific policies about the length of work times based on the setting, patient and provider needs. Those policies should limit nurses from working more than 12.5 consecutive hours. Provide education for all care providers on the hazards and causes of fatigue. Continue to document unsafe staffing conditions and work with others to change the current work culture so that it recognizes the effects of fatigue on patient safety, as well as the nurse. (Berger, et al. 2006)