The Nursing Debate: 8-Hour Shifts vs. 12-Hour Shifts

The length of a nurse’s shift is a hot button topic and one that doesn’t appear to have many clear-cut answers. However, 12-hour shifts have been gaining popularity among nurses and hospitals for quite some time now.

The 12-hour nursing shift dates back to the 1970s when it was used as a way to retain staff during the national nursing crisis. It allowed nurses more time at home and allowed hospitals to use fewer agency nurses. It has continued to gain popularity ever since. A study done by the University of Pennsylvania School of Nursing found the most l2-hour nursing shifts in teaching and high-technology hospitals.

One of the biggest concerns over the length of a nurse’s shift is fatigue, and its effect on safety and patient care. A study from the University of Maryland School of Nursing  looked at nurses who worked three consecutive 12-hour shifts and found a pattern of sleep deprivation and slower reaction time. It found the problem was the same regardless if nurses worked the day shift and night shift.

Dr. Joan Rich, vice president of Rasmussen College’s School of Nursing, says those concerns are addressed in many formats with Rasmussen nursing students. “I tell our nurses to make sure they get their breaks whether it is an eight or 12-hour shift,” says Rich. “Sometimes, it is very difficult to do, however, simply walking outside around the block, going off the floor and doing deep breathing, grabbing a yogurt or a protein snack, all helps to keep you fresh.”

Other studies have found the problems are more prevalent when shifts extend past 12 hours. Research from Oklahoma University School of Nursing says nurses who work 12.5 hours or longer are three times more likely to make an error in patient care, but found no difference in fatigue between eight and 12-hour shifts. However, many in the industry say a 12-hour shift can quickly spill into overtime, whether voluntary or not. And despite regulations on shift length and cumulative working hours for resident physicians and workers in other industries, there are no national work-hour policies for registered nurses.

On the flip side, some argue it is not the actual shift that is the problem, but how nurses spend their time in between shifts that may contribute to fatigue. Many nurses like working a 12-hour shift because it allows them more flexibility with their family life and allows them the opportunity to work a second job if they choose. But both can drain their energy and keep them from getting enough sleep. It is also harder to get into a regular sleep pattern when your schedule varies so drastically during the week.

Another concern in the University of Maryland study was the long-term effects a 12-hour shift had on a nurse’s own health. It claims they are at a greater risk for obesity, heart disease, stroke, hypertension, glucose regulation, GI disorder and reproductive problems.

On the positive side, several studies claim 12-hour shifts improve staff morale and reduce absenteeism, because it gives nurses a better work-life balance and a shorter work week. “I liked 12 hour shifts when I worked in NICU,” says Dr. Rich. “I feel more connected when I can see my patients and their families over a longer day.” 

Rich believes there is also better continuity of care during a 12-hour shift. She says communication is better when patient information and assessments are being passed between two people instead of three in a day. However, she does believe there is more room for error in a 12-hour shift. Not only are nurses on the job longer, but as they grow more tired she says they are prone to pay less attention to details.

While pros and cons have been documented for both an eight and 12-hour shift, it is evident there is a very fine line in which the benefits can quickly turn into consequences. Many have suggested hospital administrations may play a key role in drawing that line with how they handle staffing and the policies they draft surrounding it.  Regardless, it is surely an issue we have not heard the last on.

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