The 12-hour shift: the views of nurse educators and students

Interest in 12-hour nursing shifts has been renewed in response to demands for improved cost-effectiveness in the UK National Health Service. But the effects of the shift on nursing education are unclear. We report surveys of the attitudes of student nurses and nurse educators towards 12-hour shifts. Learners are reasonably positive about 12-hour shifts, but this preference is based on social rather than professional benefits. A reported effect of fatigue on home study is evident. Very negative views about the 12-hour shift are held by the group of educators. Their criticisms appear to be primarily organizational, but they are unequivocal that learning is detrimentally affected. Thus, even if students appear to like this shift pattern, serious concerns are raised by these findings about the impact of the shift on nursing education.     

Comparison of nurse, system and quality patient care outcomes in 8-hour and 12-hour shifts

BACKGROUND: Many nurses desire 12-hour shifts. However, there are concerns about implementation. OBJECTIVE: We sought to compare the effects of 8- and 12-hour shifts on nurse, system, and quality patient care outcomes. METHODS: We used a cross-sectional design with data collected from multiple sources in 2003-2004, including a nurse survey and administrative and patient records. We studied hospital nurses and patients in general adult wards, with outcomes including burnout, job satisfaction, scheduling satisfaction, preferences, intention to stay, and employee safety. System outcomes included recruitment and turnover, staffing, absenteeism, and related costs. A variety of quality patient care outcomes were measured from the 3 different types of data. RESULTS: Thirteen New York City hospitals participated; 805 surveys were examined from 99 nursing units (response rate 42%). Compared with nurses working 8-hour shifts, those working 12-hour shifts were on average more satisfied with their jobs, experienced less emotional exhaustion, 10 times more likely to be satisfied with schedules, 2 times as likely to perceive 12-hour schedules as important, and 58% less likely to report missing shifts; units with 12-hour shifts had lower vacancy rates and weeks to fill the position (all P values < or =0.05). There were no differences in patient outcomes. CONCLUSIONS: Nurses working 12-hour shifts were more satisfied. There were no differences in quality outcomes. Flexibility and choice in shift length are important elements in a positive nurse work environment. This study represents an innovative attempt by a labor-management bargaining group to make an evidence-based decision. We encourage others to conduct similar studies.     

Challenging the myth of the 12-hour shift: a pilot evaluation

AIM: The aim of this pilot evaluation was to assess whether changing a nursing shift pattern to incorporate 12-hour shifts would have positive effects for patients and staff in a ward environment. METHOD: All nurses, night sisters and therapists in contact with the ward during the trial were asked to complete a questionnaire. Data on sickness, agency use, 'untoward incidents' and spread of unsocial hours were also analysed to see what effects a change in shift pattern had. RESULTS: The new shift pattern offered benefits for patients through improved communication, increased continuity of care and more content staff. In addition, staff complied to the Working Time Regulations (DTI 1998) with no change to their unsocial hour pay. There was also a reduced need for agency nurses. CONCLUSION: This study illustrated the potential a new nursing shift pattern involving 12-hour shifts has for patient care, as well as for staff job satisfaction and efficient management of the ward. Twelve-hour shifts are infamous in nursing and many studies cite exhausted and dissatisfied staff as a reason for the negative press (Fitzpatrick et al 1999, Todd et al 1993). In particular, Todd et al (1989) claimed that the quality of patient care was negatively affected on wards that used a 12-hour shift pattern. The study reported here challenges Todd et al's work (1989, 1993) by demonstrating the benefits a change in shift pattern to 12-hour shifts can have for patients and staff in a ward environment.     

Modernising the 12-hour shift

AIM: To evaluate a year-long trial of a nursing shift pattern involving two 12-hour and two six-and-a-quarter-hour shifts. METHOD: Twenty four nurses, four night sisters and two ward therapists were asked to complete a semi-structured questionnaire, and there was a 100 per cent response rate. Data on ward sickness, use of agency nurses, and 'untoward incidents' during the year were also analysed. RESULTS: Every nurse and therapist involved in the trial gave positive feedback regarding the new shift pattern. There was also a significant drop in sporadic sickness rates and agency nurse use during the year. CONCLUSION: A shift pattern involving two 12-hour and two six-and-a-quarter-hour shifts appears to hold benefits for nurses' health, wellbeing and job satisfaction.     

Compassion fatigue in nurses

Compassion fatigue, trigger situations, and coping strategies were investigated in hospital and home care nurses. The Professional Quality of Life Scale measured compassion fatigue, compassion satisfaction, and burnout. Narrative questions elicited trigger situations and coping strategies. Compassion fatigue scores were significantly different between nurses who worked 8- or 12-hour shifts. Fifteen percent of the participants had scores indicating risk of the compassion fatigue. There were significant differences in compassion satisfaction, depending on the unit worked and time as a nurse. The most common category of trigger situations was caring for the patient. Work-related and personal coping strategies were identified.     

护士延时下班对日周性疲劳及满意度影响的研究

目的探讨临床护士不同程度的延时下班对日周性疲劳及工作满意度的影响,为科学合理配置人力提供依据。方法通过整群抽样,调查了浙江省杭州市3所三等甲级医院479名临床护士的延时下班程度、日周性作业疲劳程度、护士工作满意度。结果工作前,各组疲劳度与工作满意度差异均无意义(P>0.05);一个工作日结束时,两两比较得出:按时下班组(编号1组)与延时下班<1 h组(编号2组),疲劳度与工作满意度差异均无意义(P>0.05);延时下班1~2 h组(编号3组)与第1、2组比较,疲劳度与工作满意度差异均有显著性意义(P<0.01);延时下班>2 h组(编号4组)与第1、2组比较,疲劳度与工作满意度差异均有显著性意义(P<0.01),与第3组比较,疲劳度与工作满意度差异均无统计学意义(P>0.05)。结论延时下班不足1 h,对护士日周性疲劳度与工作满意度影响不明显;延时下班1 h以上,则显著影响日周性疲劳度与工作满意度。     

Pioneering the 12-hour shift in Australia – implementation and limitations

Twelve-hour shift rostering offers an alternative to the traditional 8- and 10-hour shifts usually worked in Australian nursing practice. This paper outlines the implementation process involved in introducing 12-hour shifts in a Melbourne hospital intensive care unit. The process was instigated by the nursing staff. After extensive consultation with the union and hospital management, a roster pattern of two 12-hour days, followed by 12-hour night shifts then days off, was introduced. Independent researchers were engaged to evaluate the impact of the 12-hour shifts on staff well-being and work performance. Effects on staff retention, sick leave and inservice education were examined. The researchers found that well-being and work performance were minimally affected by the 12-hour shift roster, while staff retention and sick leave were unaffected. Further, the pattern of 12-hour shifts, which was democratically implemented, was preferred by the nursing staff and did not diminish their well-being and work performance.     

轮班制对ICU女护士昼夜活动节律与疲倦的影响

目的 比较ICU女护士不同工作时长(8h和12 h)昼夜活动节律相关指标与工作前后疲倦的差异,并分析疲倦程度的影响因素.方法 采用便利抽样法选取北京市3所三级甲等综合医院228名ICU女护士,通过一般资料问卷、李氏疲倦量袁(Lee's Fatigue Scale)进行调查,使用活动记录仪实施客观测量.结果 护士昼夜活动...     

Self-assessed quality of sleep, occupational health, working environment, illness experience and job satisfaction of female nurses working different combination of shifts

AIM: The aim of this study was to describe and compare the self-assessed quality of sleep, occupational health, working environment, illness experience and job satisfaction among female nurses working different combinations of shifts. BACKGROUND: Evidence from several studies indicates that there is an association between the disruption of the circadian cycle caused by shift work and adverse health effects. METHODS: A cross-sectional design was used with a sample of 348 nurses drawn from the registry of the Icelandic Nurses' Association, representing 17% of the workforce of Icelandic nurses. A self-administered questionnaire, measuring occupational health, quality of sleep, the illness experience, job satisfaction and working environment was used. Data were analysed according to type of shift (days only, rotating days/evenings, rotating days/evenings/nights) by use of analysis of variance and chi-square. RESULTS: No difference was found between participants based on type of shift with regard to the illness experience, job satisfaction and quality of sleep. Nurses working rotating day/evening/night shifts reported a longer working day, more stressful environmental risk factors, more strenuous work and that they were less able to control their work-pace. In general, the nurses reported low severity of symptoms; however, nurses working rotating days/evenings shifts experienced more severe gastrointestinal and musculoskeletal symptoms when compared with others. This was explained by the short rest period provided for between evening and morning shifts. CONCLUSIONS: In general Icelandic nurses are satisfied with their work and their shift assignment does not seem to pathologically disrupt their circadian cycle. Nevertheless, nursing directors are advised to look more closely at the organization of nurses' work during night shifts, as well as the rest period for nurses changing from evening to day shifts.     

Work-related fatigue and recovery: the contribution of age, domestic responsibilities and shiftwork

AIM: This paper reports a study of the relationship between age, domestic responsibilities (being partnered and having dependents), recovery from shiftwork-related fatigue and the evolution of maladaptive health outcomes among full-time working female nurses. BACKGROUND: Several studies have suggested that full-time working women with family responsibilities are at greater risk of developing work-related fatigue problems than single women without these responsibilities. METHOD: A questionnaire was distributed in 2004 to 2400 nurses at two hospitals in Australia, and 1280 responses were obtained (response rate 54%). The data from a purposive sample of 846 full-time working nurses are reported here. FINDINGS: Domestic responsibilities were not related to differences in fatigue and recovery. Our results suggested that for full-time shiftworking nurses, being part of a family structure, may actually be protective against the development of maladaptive fatigue. The most important factor determining maladaptive fatigue outcome was shift pattern worked, particularly rotation including night duty. The effect of age was equivocal. The youngest age group reported the highest fatigue and poorest recovery compared to the oldest group, who reported the best characteristics. However, this latter group may represent a particularly well-adapted 'survivor cohort'. The relationship between age and fatigue was partly confounded by older, experienced, nurses with greater job responsibilities, working fewer multiple shifts including night duty. In general, increasing age was not associated with poorer recovery or higher maladaptive fatigue. CONCLUSIONS: Unpredictable internal shift rotations, including night duty, which are traditional and typical in nursing, are inimical to maintaining nurses' health. More creative approaches to rostering for nurses working multiple shifts are a necessary step towards reducing wastage from the profession due to chronic work-related fatigue. Younger nurses in particular, may need more support than is currently recognized if they are to be retained within the profession.     

对我院护理班次改革前后的满意度调查与分析

目的调查轮班护士对两种夜班方式的满意度,从而制定更为合理的夜班排班方式。方法采用自行设计问卷调查表,对112名工作5年以上轮班护士进行调查。结果轮班护士对改革后夜班方式满意度高于改革前夜班方式,差异具有统计学意义(P<0.01)。结论为改善轮班护士身心健康,提高护理质量,临床护理管理者应尽量采用先小夜班后大夜班的夜班排班方式。     

Emergency Medicine Residents'' Shiftwork Tolerance and Preference

OBJECTIVES: To determine the shift lengths currently worked by emergency medicine (EM) residents and their shift length preferences, and to determine factors associated with EM residents' subjective tolerance of shiftwork. METHODS: A survey was sent to EM-2 through EM-4 allopathic EM residents in May 1996. This questionnaire assessed the residents' shift length worked, shift length preferences, night shift schedules, and self-reported ability to overcome drowsiness, sleep flexibility, and morningness-eveningness tendencies. When providing shift length preferences, the residents were asked to assume a constant total number of hours scheduled per month. RESULTS: Seventy-eight programs participated, and 62% of 1,554 eligible residents returned usable surveys. Current shift lengths worked were 8 hours (12%), 10 hours (13%), 12 hours (37%), combinations of 8-hour, 10-hour, or 12-hour (34%) shifts, and other combinations (4%). Seventy-three percent of the respondents indicated that they preferred to work 8-hour or 10-hour shifts, and only 21% preferred a 12-hour shift. Shiftwork tolerance was recorded as: not well at all (2%), not very well (14%), fairly well (70%), and very well (14%). The EM residents' eveningness preference, ability to overcome drowsiness, sleep flexibility, younger age, and having no children at home were all associated with greater shiftwork tolerance. CONCLUSIONS: Emergency medicine residents generally tolerate shiftwork well and prefer 8-hour or 10-hour shift lengths compared with 12-hour shift lengths. Emergency medicine residencies with 12-hour shifts should consider changing residents' shifts to shorter shifts.     

The impact of long work hours and shift work on cognitive errors in nurses

Aim

Pilot study to examine the impact of long work hours and shift work on cognitive errors in nurses.

Background

Twelve‐hour shifts are more commonly used in hospital settings and there is growing concern over the impact that extended and irregular work hours have on nurses’ well‐being and performance.

Method

Twenty‐eight nurses working different shifts (8‐hr days and 12‐hr rotation) participated in this study. Nurses were assessed at the beginning of four consecutive shifts using actigraphy, a sleep diary and an after work questionnaire.

Results

Nurses working 12‐hr rotations had less total sleep time and less sleep efficiency than 8‐hr day nurses. Twelve‐hour rotation nurses also napped more than their counterparts. There were no differences between the two groups with respect to cognitive errors.

Conclusions

Twelve‐hour rotations have a negative effect on nurses’ sleep patterns. There is no evidence indicating 12‐hr rotations increased errors.

Implications for nursing management

Nurse managers can implement specific strategies, such as greater shift work flexibility and designated quiet time, to reduce the effects of disturbed sleep patterns in nurses.     

精神科轮班护士心理健康状况的调查分析及其健康维护

[目的]了解精神科轮班护士心理健康状况，探讨维护其心理健康的措施。[方法]采用症状自评量表（SCL-90）厦疲劳量表-14（FS-14），对30名精神科轮班护士及32名综合科轮班护士进行调查。[结果]轮班护士总体心理健康水平高于常模；精神科轮班护士除人际关系、敌对外，SCL-90总分及各因子分均高于综合科护士，其中强迫、抑郁、焦虑差异有统计学意义（P〈0．05），且FS-14总分高于综合科轮班护士，差异有统计学意殳（P〈0．05）；精神科轮班护士心理健康水平与护龄相关（P〈0．05）。[结论]精神科轮班护士存在明显的心理健康问题，应加强精神科轮班护士特别是护龄较长的轮班护士的心理健康维护.     

Physiological and behavioural response patterns at work among hospital nurses

chen j. , davis l.s ., davis k.g ., pan w. & daraiseh n.m . (2011) Journal of Nursing Management 19, 57–68
Physiological and behavioural response patterns at work among hospital nurses Aim The aim was to determine whether hospital nurses are experiencing physiological strain at work by examining their physiological and behavioural response patterns over 12-hour shifts. Background Excessive workload for nurses may lead to poor quality of care and high nursing turnover rates. Energy expenditure (EE), heart rate (HR) and work pace (WP) can be used to examine the physiological impact from the workload. Methods A total of 145 nurses wore monitors for one 12-hour day shift to record HR and WP, which were used to calculate EE. Individual and work-related factors were assessed through questionnaires and work logs. Results Energy expenditure accumulated over the 12 hours reached the EE level of 8-hour shifts in which individuals work at a moderate physical intensity level. The HR data indicated a moderate cardiac stress level throughout the shifts, despite which WP decreased after 15.00 hours. Inadequate work break and sleep, family care-giving responsibility and aging may challenge work recovery. Conclusions Nursing workload of 12-hour shifts has a negative physiological impact on hospital nurses. Implications for nursing management Nurse managers need to be aware of the physiological strain experienced by staff nurses, and focus on ensuring sufficient breaks and proper work accommodations for older nurses.     

Differences in Paramedic Fatigue before and after Changing from a 24-hour to an 8-hour Shift Schedule: A Case Report

Emergency medical services (EMS) clinicians often work 24-hour shifts. There is a growing body of literature, with an elevated level of concern among EMS leaders that longer shifts contribute to fatigued workers and negative safety outcomes. However, many questions remain about shift length, fatigue, and outcomes. We describe a case of a 26-year-old male paramedic who switched shift schedules during the midpoint of a randomized trial that addressed fatigue in EMS workers (clinicaltrials.gov identifier: NCT02063737). The participant (case) began the study working full-time with a critical care, advanced life support EMS system that utilized 24-hour shifts. He then transitioned to an EMS system that deploys workers on 8-hour shifts. Per protocol for the randomized trial, the participant completed a battery of sleep health and fatigue surveys at baseline and at the end of 90 days of study. He also reported perceived fatigue, sleepiness, and difficulty with concentration at the beginning, every 4 hours during, and at the end of scheduled shifts, for a total of ten 24-hour shifts and twenty-four 8-hour shifts. We discuss differences in measures taken before and after switching shift schedules, and highlight differences in fatigue, sleepiness, and difficulty with concentration taken at the end of all 34 scheduled shifts stratified by shift duration (24 hours versus 8 hours). Findings from this case report present a unique opportunity to 1) observe and analyze a phenomenon that has not been investigated in great detail in the EMS setting; and 2) address an issue of significance to employers and EMS clinicians alike.     

How long and how much are nurses now working?

OBJECTIVE: Extended work schedules-those that vary from the standard eight hours per day, 35 to 40 hours per week-are common in nursing and contribute to problems with nursing recruitment and retention, in addition to compromising patient safety and the health and well-being of nurses. This study describes the nature and prevalence of such schedules across nursing settings. METHODS: Quantitative survey data collected as part of the Nurses Worklife and Health Study were analyzed. The sample consisted of 2,273 RNs. Demographic data, information about respondents' primary jobs (position, workplace, and specialty), and specific work schedule variables were analyzed, including data on off-shifts, breaks, overtime and on-call requirements, time off between shifts, and how often respondents worked more than 13 hours per day and on scheduled days off and vacation days. Respondents were also asked about activities outside of work, commuting time, and other non-nursing activities and chores. RESULTS: More than a quarter of the sample reported that they typically worked 12 or more hours per day, as did more than half of hospital staff nurses and more than a third of those with more than one job. A third of the total sample worked more than 40 hours per week, and more than a third worked six or more days in a row at least once in the preceding six months. Nearly a quarter rotated shifts.Almost one-quarter of nurses with more than one job worked 50 or more hours per week, and they were more likely to work many days consecutively, without sufficient rest between shifts, and during scheduled time off. Single parents were as likely as those with more than one job to work 13 to 15 hours per day, 50 to 60 hours or more per week, and many days consecutively. Seventeen percent of all nurses worked mandatory overtime, as did almost a quarter of the single parents. Nearly 40% of the total sample and more than 40% of hospital staff nurses had jobs with on-call requirements. CONCLUSIONS: The proportion of nurses who reported working schedules that exceed the recommendations of the Institute of Medicine should raise industry-wide concerns about fatigue and health risks to nurses as well as the safety of patients in their care.     

Critical care nurses--perceptions of 12-h shifts

BACKGROUND: Twelve-hour shifts have been illustrated in the literature as being a highly contentious shift pattern. However, it has also been highlighted that there is a distinct paucity of literature solely related to such a shift pattern in critical care areas, where there is high activity and a requirement for multiple and highly significant decision-making situations. It was therefore identified that such an area deserved further exploration. AIM: This study aimed to elicit critical care nurses' perceptions of working 12-h shifts. METHODS: Fifty-four nurses from three critical care areas within a large local NHS teaching hospital currently working 12-h shifts completed a self-administered questionnaire on their perceptions of 12-h shifts. Following on, a focus group interview was conducted to complement this questionnaire in an attempt to further explore these perceptions. RESULTS: From the results of the questionnaire, patient care, job satisfaction, off duty and family life achieved the most positive responses, whereas communication, fatigue and education achieved the most negative. The focus group explored these issues with added comments on work-shy staff, suggestions on shift patterns, breaks and staffing levels. CONCLUSIONS: Twelve-hour shifts in critical care areas are suitable shift patterns for nurses, patients and management, provided that they are fundamentally well-managed.