A Nursing Student Needs Your Help!

KelRN215, BSN, RN · Feb 22, 2012

Question #1: Do you feel that 12 hour shifts are more beneficial to you as a nurse or better for the patients? Briefly explain your rationale.

There are pros and cons. I like 12 hour shifts because it means I only have to be there 3 days a week, so in that sense they're beneficial to me. Plus, management leaves 8 hours into the shift if it's a day shift so you at least get 4 peaceful hours. On the flip side, they are exhausting and when you take the commute/public transportation into consideration, I usually get home 14 1/2 hours after I left my house... if I'm lucky. I do think they're better for the patients in that the patient only has 2 nurses during the day instead of 3 (or 4 if they have one nurse from 7-3, someone working a 12 hr day takes over from 3-7, someone working an evening takes over from 7-11 and then a night nurse from 11-7) but I believe there is some research out there that says errors are more common after 8 hours.

Question #2: If a HCP ordered a patient to receive an abortion pill would you administer the medication to the patient? (This was a question given to us in first semester - interesting results).

This isn't really a nursing question to me, but one of personal convictions. If the patient was pregnant and wanted to terminate, I would, with no reservations provided a medical abortion with RU486 was appropriate for this patient. I assume this question is referring to RU486 (Mifepristone) and not Plan B since the latter is not an abortifacient. I do not work in GYN and I doubt that the pharmacy at my institution even carries RU486 and the patients I work with are so fragile that I doubt that any of them would even be good candidates for this.

Tuesday17 · Feb 22, 2012

Thanks for your comments. I agree on the second question, but it has always baffled me that it was brought up in first semester after the instructor made it clear she was pro-life. Only 2 of us raised our hands after her soap-box speech.

HouTx, BSN, MSN, EdD · Feb 24, 2012

One of the most important things that we all need to do is clarify our own values... figure out how you stand on important issues. Do you value quantity of life over quality? Do you value patient autonomy over beneficence? Do you believe in a higher power? Do you understand how religious beliefs may influence health care decisions? What are your beliefs about the beginning of life? The end of life? These are not multiple choice or True/False questions and there is no "right" answer.

As a care provider, you will be faced with 'values-based' issues on a regular basis. You will need to understand your own positions in order to guard against forcing your own beliefs (consciously or unconsciously) on your patients. Your instructors are wise to introduce ethical issues very early in the curriculum to begin to encourage dialogue among their students.

My answers

#1 - 12 hour shifts are beneficial to nurses and hospital operations, not to patients. There is evidence to support this - negative effect of fatigue on patient safety. Don't you wonder why the FAA does not allow pilots to fly for 12 hours? Truck drivers are not allowed to drive for 12 hours... but we can???

#2 - termination of a pregnancy is a decision that is entirely up to the woman. My job as a nurse is to support my patients and ensure that their care is the best that I can provide, not to direct their decisions or make choices about their care based upon my own belief system.

pecanpies · Feb 24, 2012

Question #1: Do you feel that 12 hour shifts are more beneficial to you as a nurse or better for the patients? Briefly explain your rationale.

In a perfect world, 12-hour shifts benefit the patient through fewer shift changes and greater continuity of care. In the world we live in...it's still debatable. Studies have given us various answers to this question. I disagree that 12-hour shifts benefit the nurses & hospitals rather than the patients; I think the evidence suggests that patients can benefit, too. Some research has shown that the greatest number of accidents & errors occur around shift change. It follows, then, that fewer errors might be made if each day had only 2 shift changes and not 3. By this premise, 12-hour shifts actually benefit patients.

As HouTX says, though, some research shows fatigue results in a greater number of errors being made. This alone doesn't mean that 12-hour shifts are to blame. Simply because a nurse works 12 hours doesn't mean he or she is fatigued. I would say the greater culprits, rather than the shift length itself, are the nurse-to-patient ratios and the ability (or lack thereof) to take sufficient rest and meal breaks. I can work a 12-hour shift and not be fatigued, if I can have at least 1 meal break and a couple of short rest breaks. Actually getting those breaks is another story. Still, to point the finger at the shift length and ignore the other factors at play is short-sighted.

Question #2: Frankly, I find the question itself offensive (and I understand it's not you asking it, so that's certainly not directed at you!). The question insinuates that there's a possibility that I would refrain from providing needing nursing care to a patient if I had a moral disagreement with that patient's choices. I find even the thought of that repulsive. Individuals who would seriously consider refusing to care for a patient if they disagreed with their life choices should not be in nursing.

BigMama3 · Feb 25, 2012

First off, congrats for heading towards the finish line!

I work in an LTAC. The nurses (of which someday I hope to be one) all work twelve hours shifts. I think it's great because they see the trends in their patients, are more familiar with their patients and the problems they have and more apt to give a more accurate report to the next shift (so things get lost less). Also, the nurses seem to be a bit happier because it's one less day in work and away from home.

I would give the antiabortion med to the patient, if the doctor ordered it and it was necessary.

I am in my last five weeks of nursing school (YEAH)! Have one class left which includes posting a couple of questions on a professional site in order to receive feedback from my peers. Questions are for current nurses as well as nursing students.
Question #1: Do you feel that 12 hour shifts are more beneficial to you as a nurse or better for the patients? Briefly explain your rationale.
Question #2: If a HCP ordered a patient to receive an abortion pill would you administer the medication to the patient? (This was a question given to us in first semester - interesting results).
Thanks to all for helping me out with this project!
Tuesday from Idaho, USA

BigMama3 · Feb 25, 2012

pecanpies,

Years ago, I worked in an E.D. as a UC in a Catholic owned and operated hospital. A patient came in and for whatever reason, the doctor needed to give her a script for the morning after pill.

The doctor's hands were almost tied because of where he worked. He did write the script but worried about what if any disciplinary actions would be taken (there weren't any).

Currently I work with a Jehovah's witness who constantly has to provide blood transfusions for patients...of course he does. It is his job. He is professional and always keeps his religious beliefs seperate.

There are however, those that would opt to not give say a transfusion or pill based on their personal believes...I'd like to think that those people would ask to be removed from that particual patient's in lieu of jeopartidizing the patient.

Tuesday17 · Feb 25, 2012

Clarifying our own values is critical is this profession. I agree, there are no wrong or right answer to this question. I have currently read about problems and increased safety issues regarding the 12 hour shifts. However, all that are willing to work them like working 3 and being off for 4 days. I'm on my second 13+ hour shift right now and I'm exhausted....two more to go! :-)

I support and advocate for my patients as well. I hope I never get "burned" out or lose sight of that...very, very important. I try to NEVER direct their decisions based upon my personal beliefs!

Thanks for your comments I really appreciate it!

Tuesday17 · Feb 28, 2012

I agree. Claifying our own values is critical and not to judge others or influence patients decisions based upon us reflecting our values and beliefs in order to do so. I agree!

Just getting off a 4 day 12 hour schedule with my preceptor, I am shot (emotionally and physically). I too believe that these schedules are NOT in the best interest of positive patient related outcomes (safety, etc). Good question about pilots and long-distance drivers.

Thanks for your help!

Tuesday17 · Feb 28, 2012

You make very good points. After my four 12's I wasn't so fatigued that my patients did not receive good care - they DID! And yes, I agree, the patients (5/6) I had for these four days loved that I was their nurse every day. We built good relationships and that has to facilitate better healing, etc. As a student, I usually am not given a break or lunch unless I request it. That is my fault alone. However, I am learning that I need the 30 minute downtime just to regroup and prioritize my care once I return to the floor.

I too, found the question very offensive! The lecture was not about the issue, nor was the information provided accurate or complete. In fact, the lecture was on doseage-calc....this particular instructor was (in my opinion) spouting off her own beliefs/values to a bunch of vunerable first semester nursing students who would do ANYTHING to please. I am a non-traditional student and held my ground in raising my hand. However, as mentioned above there were only two of us. Sad really. That goes to show us how we can influence others (especially when they are vulnerable: students, patients, etc.) by our own personal opinions/values/beliefs. Very frustrating. Now, in retrospect I wish I would have called her out on how inappropriate it was.

Tuesday17 · Feb 28, 2012

Thanks for your comment! I too agree that the 12 hour shifts are better for patient continuity; however, I am questioning it now after working 4 twelve hour shifts (I talked my instructor into letting me do so....wrong move). I am not questioning my patients care or safety for me....I am questioning if it is too much for the nurse in a stressful environment (been working in CPU - cardio pulmonary unit) so I have taken care of seriously ill patients (5-6) each day. I am personally exhausted and fatigued. However, I know that my patients loved it and received great care!

Tuesday17 · Feb 28, 2012

I appreciate the comments Dawn! These past few days I worked with a patient who would not receive blood; it is their religion, their choice, and their outcome. I cannot judge nor would I try to influence them otherwise. The doctor tried...to no avail. Me, I am just the nurse and patient advocate! :-)

A Nursing Student Needs Your Help!

Do you feel that 12 hour shifts are safe for your patients?