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- by MunoRN Nov 29, '11I am no billing expert, so I'm hoping some of you out there are. Hospitals in my state are pushing to move to 8-hour shifts claiming that they can increase revenue/save money, although they won't reveal how. (Supposedly $6 million a year at a 250 bed hospital). Does anyone know where this savings/increased revenue comes from?
It's been suggested that they can increase their medicare reimbursements by using 3 Nurses a day instead of 2, even though the total Nurse hours are the same either way, anybody know if this is true? Any other ideas how this saves money?
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- Nov 30, '11 by MunoRNQuote from I<3NursingOur hospital also initially tried to say it was a safety issue, although after going over the evidence with them even they agreed that there is absolutely no evidence to support that. If you look at safety risk factors, you'll actually find more potential danger with 8-hour shifts (greater sleep loss, more hand-offs, more fatigue/burn-out, poorer overall performance). When looking at how that translates into measurable outcomes, there's no significant difference. 8-hour shifts are safer if you're talking about three 8-hour shifts a week vs three 12-hour shifts a week, but of course in real life, switching from three 12-hour shifts a week to 8-hour shifts means working 2 additional nights per week, which more than cancels out the disadvantages of the longer 12-hour shifts when looking at most variables.That's an interesting claim. We just went to all 8s but it was based on patient safety due to research against 12 hr shifts. Having to staff 3 nurses a day instead of two you would think costs more, I'd be interested to hear how it is so cost saving.
- Nov 30, '11 by VICEDRNI am no HR expert but I have been told that 8 hour shifts means a unit needs fewer people on staff because each person works more often. As a result, the cost of benefits goes down. Thus, a cost savings.
- Nov 30, '11 by TheCommuter8-hour shifts are more costly in my neck of the woods due to the sky-high employee turnover rate of the evening shift (3 to 11pm or 2 to 10pm). Many nurses do not like this shift because it interferes with family life, social life, and so forth. Also, this shift consumes the early afternoon, evening, and part of the night.
Management and HR must also factor in the costs of constantly having to orient and train new hires for the evening shift.
- Nov 30, '11 by madwife2002There is lots of evidence to suggest that 12 hour shifts are a safety problem
- Nov 30, '11 by MunoRNQuote from madwife2002There's certainly no lack of anti 12 hour shift articles, but they don't have much of anything to back them up. The first article; http://www.ergoweb.com/news/detail.cfm?id=2473 sounds persuasive at first but it only cites two main studies, neither really holds up. The first found (in a relatively small sample group) that 12-hour workers get about 5.5 hours sleep for day shift and 5.2 at night. They did not study 8-hour shift workers. This is a bit lower than the bulk of similar studies show, but the main thing is that studies that do compare 8-hour shift sleep patterns to 12 hour sleep patterns find little to no difference in amount of time slept. Particularly for night shift workers, the short sleep duration is due to day-sleeping, not the amount of time available to sleep. Studies also show significantly more sleep on days/nights off, meaning more overall sleep and less sleep deprivation while at work due to a shorter stretch on.There is lots of evidence to suggest that 12 hour shifts are a safety problem
The review mentioned is from a group of small scale Dutch studies in the 70's.
The last study is actually basically the same study done by the same author two years apart, one specifically on ICU Nurses. The studies did find that shifts greater than 12.5 hours (including a substantial number of 16 hour shifts and even up to more than 23 hours) were more error-prone than 8.5 hour shifts, but when strictly 8.5 hour shifts were compared to 12.5 hour shifts, the odds of an error were actually equal to slightly higher in 8-hour shifts. The needlestick and injury studies were from the same group, and also found significant differences only with shifts greater than 13 hours.
The second article; http://www.wsws.org/articles/1999/se...hift-s06.shtml is about "shift-work", aka evenings/nights work, not 12 hour shifts. I'm sure we can all agree that working night shift is fatiguing, so why do it more by working 8 hour shifts?
The third refers to no evidence.
What the evidence does show is that for the most part there is no difference in performance, fatigue, errors, or safety; both shift lengths have risk factors for each of these but they appear to cancel each other out in the end. The evidence also shows that neither a strict 8 hour structure or strict 12 hour structure is ideal, instead a mix is best to accommodate Nurses who find either shift to be excessively fatiguing. I know of Nurses who can't physically do 12-hours straight so 8's work for them, there are also Nurses such as myself who can't tolerate the cumulative fatigue of 5 nights a week. For the most part, Nurses will naturally chose a schedule that is the least fatiguing, accommodating that is what guarantees less fatigued nurses and better patient care.
- Nov 30, '11 by Ashley, PICU RNQuote from Emergency RNCare to explain this? I would think it would be the opposite. During 8's, the employee is commuting 10 times per week. During 12's, they are commuting 6 times per week. So it would seem like 12's decrease commuting expenses.Going to 8's from 12's increases the commuting time and costs of the employee by 66%.
I'd also think 8 hour shifts would cost more in overtime pay. If you're an hour late on just one overtime shift then it's overtime. But on 12's, you have to work 4 extra hours to start making overtime. In 8 hour shifts, you have 21 shifts to staff each week. In 12's, it's only 14. So you can have less nurses on staff.
I really can't see where 8's would be cheaper, especially 6 million dollars cheaper. Overall, since the number of nursing hours is the same there can't be too much difference either way.