Nursing 12 Hour Shifts

Areas of Concern
Sleep, Fatigue, and Recovery Between Shifts One of the most prominent aspects of nurses’ lives that are detrimentally impacted by working 12-hour shifts is their sleep. Research shows that extended work schedules and sustained shift work, such as that seen in 12-hour shifts, can interfere with nurses’ abilities to achieve adequate sleep by reducing the number of hours for physical and cognitive recovery and the number of hours that can be devoted to sleeping between shifts (Geiger-Brown et al., 2011; Geiger-Brown et al., 2012). Geiger-Brown et al. (2012) found that on average nurses working consecutive 12-hour shifts were sleeping less than six hours per night and were experiencing progressive increases in their reported
sleepiness at each consecutive shift. Furthermore, as the nurses’ reported sleepiness increased progressively with each additional consecutive 12-hour shift, it was determined that nurses were failing to return to their baseline level of alertness between each of their work days and were experiencing increased levels of drowsiness during their shifts (Geiger-Brown et al., 2012). Not only do nurses working 12-hour shifts receive insufficient sleep between their shifts, but they also reported that the sleep they did receive was of a poor quality and was usually restless (Geiger-Brown et al., 2011). The researchers hypothesize that the decreased length and poor quality of sleep nurses experience after their 12-hour shifts may be due to difficulties detaching and unwinding from the emotional demands of their jobs (Geiger-Brown et al., 2011). In addition to 12-hour shifts having negative implications on nurses’ sleeping patterns and sleep quality, extended shifts have also been linked to increased levels of fatigue among nurses. In the Geiger-Brown et al. (2012) article, the data showed that greater than one third of the nurses participating in the study reported high levels of fatigue after working 12-hour shifts with their greatest source of fatigue being inter-shift fatigue. Inter-shift fatigue is defined as “not feeling recovered from the previous shift at the start of the next shift” (Geiger-Brown et al., 2012, p. 211). A more recent study also found that nurses reported higher levels of acute fatigue for 12-hour shifts than for 8-hour shifts and the average score for acute fatigue—measured using the Occupational Fatigue Exhaustion/Recovery scale—was greater for nurses working 12-hour shifts compared to nurses working 8-hour shifts (65.6 vs. 58.9, respectively) (Chen et al., 2013). The researchers argue that it is likely that the high levels of acute fatigue nurses accumulate over their extended shift hours lead to a decline in vigilance, as evidenced by increased incidences of medical errors and workplace injuries (Chen et al., 2013). Not only do nurses working 12 hours experience higher levels of acute fatigue during and following their shifts, but they also have been shown to experience moderately high levels of chronic fatigue and poor inter-shift recovery (Chen et al., 2013). Together, the increased levels of acute and chronic fatigue and the insufficient recovery between shifts indicates that nurses experience unhealthy fatigue-recovery processes as a result of their extended hours (Chen et al., 2013). The increased levels of fatigue and sleep deficiency that nurses often experience as a result of working 12-hour shifts has been shown to increase nurses’ risks of developing other cardiometabolic conditions as well (Knutson, 2010). More specifically, fatigue and insufficient sleep have been linked to disorders like hypertension, stroke, cardiovascular and cerebrovascular disease, and metabolic changes, such as glucose deregulation and obesity (Knutson, 2010). Furthermore, it has been determined that poor quality sleep has been associated with increased risk for developing depression, anxiety, and chronic fatigue (Geiger-Brown et al., 2011).
Nurses’ Performance and Patient Satisfaction Closely related to the consequences of sleep deprivation, increased fatigue, and lack of intershift recovery that 12-hour shifts tend to have for nurses, such extended shift lengths seem to also negatively impact nurses’ overall performance in terms of the nursing care they administer and their patients’ satisfaction with their care. In terms of nurses’ ability to perform accurately and efficiently during a 12-hour shift, one study found that extended work schedules often adversely affected nurses’ abilities to sustain continued vigilance, resulting in a limited ability of the nurses to notice unfavorable changes in their patients in an appropriate amount of time to address these changes (Trinkoff et al., 2011). Trinkoff et al.’s research (2011) also provided evidence that deficits in neurobehavioral functioning, including delayed reaction time, reduced memory, impaired psychomotor coordination, impaired information processing, and reduced decision-making ability negatively impacted nurses’ performance and care given as a result of the sleep deprivation associated with 12-hour shifts. Similarly, a more recent investigation discovered that errors, which were measured as anticipation responses using the Walter Reed Psychomotor Vigilance Test—a validated measure of neurobehavioral functioning and reaction time—were committed more frequently both at the end of a 12-hour shift and once the shift extended past twelve hours compared to the beginning of the nurses’ shifts (Geiger-Brown, et al., 2012). Furthermore, Geiger-Brown et al. (2012) found that performance during 12-hour shifts was also detrimentally affected by inadequate sleep between shifts as evidenced by more frequent episodes of inattention displayed by the nurses working these extended shifts. Another investigation additionally discovered that nurses’ performance suffered during the course of 12-hour shifts as they commonly worked more slowly and required more breaks towards the end of their shifts (Chen et al., 2013). The neurobehavioral functioning deficits associated with 12-hour nursing shifts and these deficits’ deleterious impacts on nurses’ job performance and ability to administer appropriate nursing care ultimately have direct consequences for patients in terms of their safety and health (Trinkoff et al., 2011).
In addition to the damaging effects 12-hour shifts have on patients’ safety and health, these extended shifts also have a direct bearing on patients’ satisfaction with their nursing care. As one study showed, patient dissatisfaction with the care they received increased proportionately with the number of nurses in the facility that had been working shifts longer than 13 hours; conversely, patient satisfaction with their nursing care increased incrementally with higher quantities of nurses who had worked 8-9-hour or 10-11-hour shifts (Stimpfel et al., 2012). In the cases in which the patients were dissatisfied with the nursing care they received, they most commonly complained about poor communication, inadequate pain management and pain assessments, and a delay in the nurse answering their calls for help (Stimpfel et al., 2012), highlighting other specific areas of nurses’ performance being detrimentally
impacting.
Job Satisfaction and Burnout Despite the many downsides to working 12-hour shifts, many nurses report a preference for less frequent and longer shifts (i.e.
three 12-hour shifts per week) rather than more frequent and shorter shifts (i.e. five 8-hour shifts per week), as a three-day workweek provides the nurses with more flexibility in terms of their work-life balance (Stimpfel et al., 2012). The perceived benefits associated with a 12-hour shift (i.e. more days off per week, better work schedule flexibility, and in some cases, more time off between shifts) ultimately result in increased freedom and time for socialization or other household responsibilities (Chen et al., 2013). In a recent study conducted by Stimpfel et al. (2012), it was found that greater than 80% of the nurses interviewed were satisfied with the scheduling practices, which included 12-hour shifts, utilized at the hospitals at which they were employed. However, despite this reported scheduling satisfaction, it was also discovered that the percentage of nurses reporting job burnout, overall job dissatisfaction, and intention to leave their current jobs increased incrementally as the shift length increased (Stimpfel et al., 2012). More specifically, the research shows that job burnout and dissatisfaction and the intention to leave a nursing position is 2.5 times greater among nurses who work shifts longer than 8-9 hours compared to nurses who work shifts that are shorter than 8-9 hours (Stimpfel et al., 2012). It is thought that the
discrepancy between nurses’ reported scheduling satisfaction and job satisfaction may be due to nurses underestimating the significant impact of working fewer, but longer shifts, especially when unplanned overtime or on-call shifts, shift overruns, or successive 12-hour shifts, are involved (Stimpfel et al., 2012). Thus, backed by the evidence presented in the Stimpfel et al. article (2012), it seems that yet another detrimental impact of the 12-hour shifts on nurses is overall decreased job satisfaction, which ultimately may result in burnout in their nursing career and an intention to leave the field of nursing.