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30 Aug 2017 1 Respondent
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By Vanessa Peutherer
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QUALITY IMPROVEMENT - 8 Hour V 12 Hour Shift - Nursing

QUALITY IMPROVEMENT - 8 Hour V 12 Hour Shift - Nursing

In today's fast-paced health care culture, with limited staff resources and increasingly complex care, working a 12 hour shift has become an attractive 'on the face of it' option and is now the 'norm' for many managers in charge of planning duty rotas for healthcare professionals working these shifts . This 12 hour shift pattern is especially prevalent in acute clinical areas.

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

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

There are many perceived benefits to working a 12 hour shift. For managers it enables easier shift cover, for example. Benefits for staff 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, in some cases,  as a full time equivalent would only work 3 days out of 7 (instead of 5) normally.
  • More time with family and friends

However, there are also disadvantages to working these 12 hour shifts, as well as emerging evidence which suggests an associated,  potentially higher mortality rate for those in certain patient groups, along with higher levels of burnout and fatigue prevalence. These findings are more likely to occur where these 12 hour shifts are ingrained and common-place.  Perceived disadvantages of working 12hr shifts 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, showed 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,  that 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 likely to report job dissatisfaction, increased intention to leave the 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 findings and may have potential negative implications. 

Question  -   It is proposed that the 12 hour shift should be discontinued on day shifts, and health care professionals should return to 8 hour shift patterns - do you agree ?

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 cross - sectional 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.

It is proposed that the 12 hour shift should be discontinued on day shifts, and health care professionals should return to 8 hour shift patterns