The 12-hour workday in nursing is nothing new. For decades, nurses have worked long hours. In many hospitals, staffing guidelines routinely offer 12-hour shifts as the norm, with some nurses working even 16 hours or more. Actually, nurses who work longer days may appropriate having more days off in between shifts, but they can face some challenges as well. As a nurse, it is time to reconsider whether 12-hour shifts are ideal for ensuring safe patient care and helping nurses achieve a life-work balance. This is one of the greatest debates in healthcare today because this issue has significant effects on nurses, healthcare organizations, and even the patients. In fact, although nurses express satisfaction with 12-hour shifts, working long hours is associated with more nurse burnout, a greater intention to leave their positions and decreased patient satisfaction.
Historically, nurses have worked various shifts. Traditional 8-hour shifts for hospital nurses are becoming a thing of the past. Today, 75% of hospital nurses work 12-hour shift. Nurses’ work schedules are based on the needs of the patient population. Research showed that more than 80% of the nurses are satisfied with scheduling practices at their hospital, but little is known about how such long hours working affect the care that patients receive or the well-being of nurses. Furthermore, nurses working long shifts experience burnout and job dissatisfaction and intend to leave the job. Therefore, this issue impacts negatively patient, nurses, and even healthcare organizations. In fact, a study conducted by the National Institute of Nursing Research found that nurses who work long shifts are 2.5 times more prone to burnout and job dissatisfaction compared to nurses who work 8 or 9 hours.
Eventually, longer shifts can increase fatigue and interfere with normal sleep patterns. In fact, nurses working 12 hours need to stay awake for up to 17 hours or more. This problem can disturb the body-clock leading to sleep deprivation. As a result, nurses are likely to have poor sleep quality and shorter sleep duration. Lack of sleep adversely affects nurses’ health, especially mental health linking to decrease in memory, information processing, and decision making. In Townsend and Anderson’s (2013) article, “Are extended work hours worth the risk? “, the authors demonstrated that “Loss of even one night’s sleep can lead to short-term memory deficits and impaired cognitive functioning”. Moreover, nurses who work longer hours might suffer physically from it. For example, there is an increased risk of developing musculoskeletal disorders, diabetes, and other serious health issues. Along with sleepiness, disturbances to sleep also promote mood disturbances and gastrointestinal complaints (Sack, 2010). Shift workers commonly complain of gastrointestinal symptoms including abdominal pain, gas, diarrhea, constipation, nausea, vomiting, change in appetite, indigestion, and heartburn.
In addition, long shifts also impact on the quality of the care they provide to patients. Because the high intensity of the job and long shifts lead to fatigue, nurses are more likely to make mistakes leading to harm patient care. Actually, when nurses work long hours, they are not functioning at their best. As a result, patients are at a higher risk for injury or compromised care. Besides that, lack of awareness from inadequate sleep reduces a nurse’s ability to respond to patient’s needs and may lead to failure in maintaining patient safety and satisfaction. According to a study by Australian researchers, there is a 3.4% chance of an error occurring when nurses obtain six hours or less of sleep during a 24-hour period. Importantly, researchers found that sleep-deprived participants did not recognize how poorly they were performing: they tended to think they were doing better than they were.
Finally, due to negative effect of nurses’ health and patient care, nurses working shifts of 12 hours or more experience job dissatisfaction and intend to leave their job. Plus, when there is a shortage of nurses, the work for the others increases. This situation leads to more stress to staff, and even organizations. Also, shift work and long work hours are linked to a wide range of health risks which can lead to more sickness absence. Employers are also at risk for loss of nurses because they become disabled and unable to work. This can lead to higher insurance and workers compensation rates. Failure to retain nurses increases costs for healthcare organizations: shift work and long work hours were major reasons for leaving the nursing profession in a study by Peter D. Hart Research Associates (2001). Specifically, patients reported that nurses were not communicating well, their pain was not controlled, they did not get help as soon as they wanted, and they would not recommend the hospital.
Besides that, some nurses prefer 12-hour working shifts. As a result, instead of having to work 5 days a week, nurses who work 12-hour shifts generally work a 3-day schedule. This allows them to maintain a better work-life balance, which is especially important when raising a family. By having a 12 hour shift for each nurse, it indirectly means that there are only two shift changes in a day as compared to the eight hour shift which need three shift changes. Thus, nurses are more likely able to reduce the probability of communication errors while handing over the report at the end of the shift as there is less changes in shift instead of passing around the client’s medical report around three times. Hence, longer working hours will let you know your patient’s condition more holistically.
In conclusion, those results suggest that shifts of more 12 hours in length and overtime may impact patient care as well as nurses’ well-being, which is relevant to healthcare organizations. Nurses need to consider their prefer schedule based on certain factors. Otherwise, employers, nurse managers, and staff nurses all share in the responsibility of adopting strategies to reduce these risks. The key strategy to reduce these risks is making sleep a priority in the employer’s systems for organizing work and in the nurse’s personal life. To promote progress, education and training programs for managers and staff nurses would help increase their appreciation and knowledge about the demands of shift work, long work hours, and related sleep and fatigue issues.