That Dreaded 3-11 Shift

[TheCommuter]

One of my patients, a hard-nosed nurse who retired from the profession after more than 30 years of duty, struck up a conversation with me not too long ago about shift work.

"What hours do you work?" she interrogated. Her New Jersey accent was notable, especially considering the fact that southern drawls are the most common intonation in the geographic region where I live and work.

I replied, "I work from 6 o'clock in the evening until 6:30 in the morning."

She chimed, "Those are hard hours, but they seem a hell of a lot better than the 3-11 shift. I worked the 3-11 shift back in the days when all TV programming would cut off at midnight. Once midnight struck, all of the channels would repeatedly play the instrumental version of the Star-Spangled Banner. Nowadays cable TV has shows and movies 24 hours a day."

"I used to work the 3-11 shift," I added. "In fact, I worked those hours at my very first nursing job after graduating from school. Personally, I wouldn't go back to working that shift unless I was about to become homeless."

"You crack me up," my patient laughed. "I got off that shift as soon as possible. It took up most of my afternoon, all of my evening, and part of my night. I was glad when the hospitals finally went to the 12-hour shifts."

This recent conversation got me thinking about shift work. Many hospitals made the conversion from 8-hour shifts to 12-hour shifts many years ago, primarily because of difficulties maintaining adequate staffing on the 3-11 shift. The main issue with going back to 8 hour shifts is keeping the 3-11 shift covered because relatively few nurses like to do it full-time anymore. This shift is simply not conducive with family life, especially if one has school-aged children. In addition, many childless singles (myself included) do not particularly like this shift.

To be fair, there are people out there who absolutely love working the 3-11 shift. Moreover, some nurses contend that they cannot handle 12-hour shifts due to fatigue during the last four hours. Also, a study or two has implied that 8-hour shifts are actually safer.

12-hour shifts have their benefits because they eliminate the need for one additional shift change per 24-hour period. This may improve continuity of care since errors due to skipped information are reduced as the result of two nurses receiving report in a day instead of three. Likewise, many nurses prefer 12-hour shifts because they enable one to have up to four days off per week. Besides, 12-hour shifts may help to simplify staffing at healthcare facilities because only two shifts need to be covered instead of three.

I now work 12-hour shifts because I prefer them since there's no way I'd want to be at the bedside five days per week. Anyhow, I was never able to establish a routine while working the 3-11 shift. If left to my own devices, I awakened at noon, slowly got ready for work, worked the shift, then arrived home sometime before midnight and watched television or did mindless internet browsing until 4am before settling down to go to sleep. I was able to create a solid routine when I worked midnights (11-7am) or days (7-3pm), but my time largely went to waste when I worked evenings.

In summary, many healthcare facilities went to 12-hour shifts for specific reasons that revolved around their struggles to staff the 3-11 shift. Countless nurses love 8-hour shifts and many others are fond of 12-hour shifts, so it would be ideal if facilities devised a happy medium to satisfy all parties.

[elkpark]

GrnTea said:

I hate twelves for many reasons, none of them personal. Sure, I'd be happy to work just three shifts a week for full pay and benefits and call the rest of the week my own. But you know what? The patient care sucks. When everyone works two on, one off, one on, three off, or some variation thereof, there's no continuity of care for the long-term patients that need it the most. That leetle hint that something is about to go wrong gets missed if the patient has six different nurses in three days. Remember that horrific series of chemo overdoses in Boston a few years back? One person, a beloved columnist for the Boston Globe, died after getting a four-fold OD for four days in a row by four different nurses, IIRC, because nobody knew that her reactions were escalating and a few others (not so celebrated) got bad cardiomyopathy, which did a number on their cancer survival.

I'm another person who has always preferred 3-11 shifts, for all the reasons noted by others -- but I'm glad someone else already brought up the issue of how 12s affect client care (which I was going to do). I work in psych, and, back when we all worked 8s and worked 5 days/week, all the nurses knew what was going on with all the clients on the unit. Now, with 12s and working just 3 days/week, spread out pretty randomly, on any given shift, there may be no one who has any significant experience or rapport with any of the individual clients. You come in to work, there is a whole new "crop" of clients since the last time you worked, it takes nearly the entire shift to work out who's who, what each client's story is, and what's going on with them today, and then you leave and someone else goes through the same process the next day. No one ever gets familiar enough with the clients to move past the introductory phase of the therapeutic relationship and do any real work with them. When things start heating up on a psych unit, the therapeutic alliance/relationship that someone (staff) (already) has with the client makes a big difference. And clients don't like that they see a constant parade of different faces from day to day, with little continuity or consistency.

Also, I now work on a psych consultation-liaison service in a large general hospital (where the nurses work 12s). Nearly every time I'm trying to find out something about how a client has been doing over the last few days, not the VS or meds or stuff I can look up in the chart, but mood, how well s/he has been sleeping, interaction with staff and family members, etc., the answer I get is, "Gee, I don't know, I've only had this person since this morning. Never saw her/him before today" (and, apparently, nothing I'm interested in gets staffed through in report ...)

I realilze that many (most?) nurses prefer working 12s, but I agree that it is detrimental (in several different ways) to the care we provide to clients.

[mastiffmom]

In the 27 years since my graduation, I've worked both 8 and 12 hour shifts. The first hospital job I had was 3-11. I was single and childless and it was great for my body. At that time, my friends all worked pm's too, so we'd all get together after work if we wanted and party til 3 then go home to bed and get up just in time to get ready for work. Since then, I've mostly worked 12 hour night shifts. For a long time when I was younger, my favorite was to do 3 on 2 off 3 on six off. But now I not only can't do 3 12 hour shifts in a row anymore, I was having more trouble with 12's. Not nearly enough sleep. Tired all the time which made me more susceptible to illness. I left a job I love to be able to go back to 8 hour shifts. We'll see if I end up liking this job as well when I've been there longer. I do love how quick the shifts seem to go by though.

[jrinct]

I'm another 2nd shifter who works 5 evening shifts a week. In the long New England winter especially, working evenings lets me get enough sunshine (or at least daylight) during my hours off.

[noyesno, MSN, APRN, NP]

I wonder if people who want 8-hr shifts have actually worked them.

I remember 3-11. Day shift discharges the patients, and evenings are spent with admissions.

Or, at my hospital, days holds onto their discharges and leaves the discharges for the 3-11 nurses. So, you get to discharge 3 or 4 patients at the beginning of your shift, while an admission is rolling up. One of the main reasons I can't stand 3-11.

Also, I feel like I have no life. Can't fall asleep until 3 am. Need at least 8 hours of sleep. Wake up at 11 am. Eat breakfast, work out. Head back to work. Repeat times 5.

[wanda_j]

Hi. I have worked 12 hour night shifts most of my career and love it. Most of the Mom's I have worked with handled the trip to school after working all night by having a neighbor/parent car pool. They take your children on those mornings and you take them on the alternate mornings. Once they are old enough they can ride the bus to and from school. The Mom/Nurses then take a nap while the children are at school and are rested and ready for when the children get back home. Being organized is helpful so you will have time for a short nap prior to going back into work, but the second nap is not always possible.

[HazeKomp, BSN, RN]

Facilities realized that this new pattern could save them money. So they stuck with it, regardless of the studies that say that this is dangerous for the patients.

For young nurses, nurses with families, and some others, 12's allow more time off and flexibility in scheduling. For some, working 12"s allows them to work TWO full-time jobs!! Whew!

For many, that "wall at 10 hours" is a reality! Observe and listen to your peers and note how many comments are made about fatigue, difficulty concentrating, physically uncomfortable, loss of compassion, and loss of patience happens around that time. I know in my unit, admits at 6:30 are met with moans and grumbling quite frequently.

Reality: We work 12's because it is cheaper for the hospitals!

Proven in multiple studies: 12's are more dangerous for patients!

(would YOU want YOUR elective surgery at 8am or at 6pm?? Think about it....)

[HazeKomp, BSN, RN]

12 hour shifts forced me to "retire" from my beloved Labor and Delivery job. ...the exhaustion of those last four hours was not a good thing. When you're that tired, it's easy to miss subtle changes or trends that may be important.

As a 30 year veteran in Labor & Delivery, I often wonder how much longer my old bones can handle the 12+ hour shifts! Where I work there is a high epidural rate which equates to a great deal of physical lifting; our charting is to be done at the bedside, standing; and there is a high C/S rate which means moving beds with patients frequently as well as standing in the ORs. On busy days towards the end of the shift, I cannot sit down for fear I could not get back up again, my knees, legs and feet hurt so much!

I often contemplate where would I go when L&D is no longer an option.......... sigh.

[maelstrom143]

Love my 12h shifts. tired out at the end but so worth it. tried a few 8h shifts. often forgot I was scheduled to leave at 3pm and no one reminded me so kept going till the end and then laughed when seeing my mistake. did 3-11 years back, but too used to 12h now, love to get my hours in and call it a day and feel like I have more time for stuff.

[Orca, ADN, ASN, RN]

My first employer out of school had eight-hour shifts. I requested 3-11. I wasn't an early morning person, and I didn't care to drive home after my shift with the rising sun glaring in my face. I am working ten-hour shifts now and want to keep them.

[billyboblewis]

I do not like working 12 hours and would work 3-11 anytime. You can do anything you want during the day and stay up late. If you do over time it is no big deal. 12 hour shifts are very wearing on the mind body and soul and 3 days in a row of them is torture. I actually work swing 12 hour shifts now if you can believe that.

[pat8585]

I like 3-11 pm well enough, BUT

i miss out on a TON of activities! have had to miss many evening things, church related things, community related things because I have to work in the evening.

Also, it is the very dreaded shift where I work. It is very difficult to find people to work for you.

If I had to choose, I guess I would stick with 3 - 11 pm. I am NOT a morning person!

[MedChica]

I don't like 3-11...but I will work 3-11 over 7-3 or 7a-7p any day. Any time. Any place. LOL

It's not that bad. When I did xray, we had some the suckiest shifts that ever sucked.

You think you can't do anything on a 3-11 swing?

Try 11a to 7p. You get to sleep, but where'd your life go?

Now, I pull doubles on the w/ends and that's rough because of the wakeup. If my day began at 9a, it'd be fine. But it's not.

7a-11p.

No matter how much sleep I get, if I have to wake up to go anywhere at 5 and 6 in the morning? I'm groggy and sleepy-eyed.

Only reason I do this shift? I get 5 days off...to shop, sleep, do nothing, piddle about, work another job....

I'm looking for a second job and basically? I'm just trying to work any shift that DOESN'T require me waking up at the buttcrack of dawn.

3-11. 11-7. 7p -7a. 12's are rough any way you cut it, but I'm more awake on nights. I even sleep less on the night-shift.

I'll probably go home and hit the sack at 12p. Get up at 6:15p. Go to work.

When I hit the hospital, I'll take what I can get but I hope that I can land a spot on nights. There's always someone on nights who doesn't like working nights.

It's something that I've always known but starting my new nursing career has made me acutely aware of the fact that I'm just a 'night person'. I'm no good on your typical day shift and I guess I'm in luck. Most nurses at the facilities in which I've worked are the exact opposite of me. They run to the 'banker hour' type shifts. Everyone wants 7-3.

No, thanks.

Love my 12h shifts. tired out at the end but so worth it. tried a few 8h shifts. often forgot I was scheduled to leave at 3pm and no one reminded me so kept going till the end and then laughed when seeing my mistake. did 3-11 years back, but too used to 12h now, love to get my hours in and call it a day and feel like I have more time for stuff.

I have this same issue. I've been working 16-hr shifts for close to a year now (as an aide and nurse) and I'm just 'used' to pulling doubles now. LOL I sometimes work the regular 8 hr shifts PRN and I think to myself, 'Oh, it's 3 o'clock already?"

I don't know whether that's a good or bad thing, though.