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Effect of 12 Hour Shifts on Patient Care and the Nurse: A Need for Change.

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Specializes in geriatric, psychiatric/mental illness. Has 6 years experience.

How can I bring change to 12 hour shifts on patient care?

Many nurses find it difficult to work 12 hour shifts both physically and cognitively. Research has shown working 12 hour shifts often effect nurses’ critical thinking, productivity and job satisfaction which impacts patient care and patient safety. This Article discusses a change theory which can be used to implement changes to the current practice of working 12 hour shifts.

Effect of 12 Hour Shifts on Patient Care and the Nurse: A Need for Change.

The nursing profession has evolved over the years which includes working conditions, duties, skills, educational and practice standards, technology, regulations and policies. Many of these changes occurred as the result of research and evidence-based practice. There has always been a focus on patient safety and decreasing and preventing medication errors. Research has shown working 12 hour shifts often effect nurses’ critical thinking, productivity and job satisfaction which impacts patient care and patient safety. This Article will discuss how the Lewin change model can be used to implement changes to the current practice of hospital staff nurses working 12 hour shifts. The primary people effected are hospital staff nurses, patients, nurse managers and nursing supervisors.

What are Goals of the Change?

  • Decrease nurse fatigue
  • Optimize the nurse’s critical thinking
  • Increase productivity
  • Increase job satisfaction which will result in reduced rate of medication errors
  • Improve quality of patient care

According to Kearney-Nunnery (2016) Kurt Lewin’s change model consisted of three main components: unfreezing, moving, and refreezing. “To achieve change, the restraining forces must be weakened and the driving forces strengthened” (Kearney-Nunnery, 2016, p.183). Restraining forces are forces that resist change. Pertaining to the 12 hour shifts, restraining forces for nurses include ability to “work less hours and days, and potentially have an improved work/life balance” (Rollins, 2015, p.162), (Ball, Dall’Ora & Griffiths, 2015). Restraining forces for hospitals include paying less overtime, less dependency on agency nurses and scheduling coverage for only 2 shifts. Patients and families tend to like having the same nurse for the longer part of the day and “having fewer names and faces to remember” (Rollins, 2015, p. 162). Driving forces promote change and includes “desire for more novel, effective, efficient or merely different activities” (Kearney-Nunnery, 2016, p.183). There are several driving forces indicating the need for change. Nurses often work longer than the 12 hour shift (Scott, Rogers, Hwang & Zhang, 2006). A greater number of nurses working 12 hour shifts report burnout and plans to leave their job compared to nurses working 8 hour shifts (Rollins, 2015) and often work 2 or more 12 hour shifts in a roll. Nurses, especially older nurses-who are more experienced, report physical and emotional exhaustion after working 12 hour shifts, “aches and pains, sleep deprivation” (Rollins, 2015, p. 162). Overtime and working consecutive 12 hour shifts further increases the rate of fatigue and burnout which decreases patient satisfaction with the quality of care received (Stimpfel, 2012). Nurses also report poor quality of care provided, decreased patient safety and more duties left undone when working 12 hours or more (Ball et. al., 2015). According to Stimpfel, Sloane and Aiken (2012) when a greater number of “nurses working more than thirteen hours on their last shift, higher percentages of patients reported that they would not recommend the hospital to friends and family” (p. 2506). Also studies have shown working more than 12 hours increases the risk for medication errors (Scott, 2006), nurse burnout, job dissatisfaction and intention to leave the job (Stimpfel et. al. 2012, page 2504).

How to Bring about Change

Nurses and hospital administrators must review both research and their hospital’s collected data from patient surveys, circumstances surrounding medication error reports and patient safety and nurse/employee incident reports and complaints related to quality of care filed. Executive administrators must be willing to review the financial impact of the driving forces verses the financial benefits from the restraining forces over the past several years and be open to seeing future trends. This is the unfreezing stage of the Lewin change model.

During the moving stage, “change objectives must be selected with consideration of activities for progressive change” (Kearney-Nunnery, 2016, p.185). “Organizations such as the Institute of Medicine and the American Nurses Association have made or supported recommendation to minimize fatigue and improve patient safety” (Rollins, 2015, p. 164). Nurses need food, hydration and proper rest in order to maintain optimal productivity (critical thinking, alertness, and providing quality nursing care and ensuring patient safety) on the job. As people advance in age, energy level and stamina decreases. Viable options for change include limiting overtime requirements, ensuring nurses receive uninterrupted breaks, making meal options available at all times, providing eight hour shifts as well as split shifts for nurses who want to work part-time (Geiger-Brown & Trinkoff, 2010).

Nurses can work within organizations, such as the American Nurses Association to lobby for legislation to promote change. Nurses and nursing supervisors can work with hospital administrators in implementing and maintaining the changes. Over a period of time, staff and administrators will adjust to, get in the habit of and maintain (refreezing) the change. This will lead to improvements in nurses’ job performance and patient satisfaction.

In summary, nursing has evolved over the years including the scheduling of work hours for the nurse. Twelve hour shifts has become popular with both nurses and hospital administrators but research has shown working 12 or more hours has adverse effects on the quality of nursing care provided, patient safety and patient satisfaction largely as well as nurse fatigue and burnout. The Lewin change model can be used to bring about changes to nurse schedules which positively impacts the nurse’s job performance and job satisfaction which increases patient safety and patient satisfaction.

Effect of the 12 hour shift on patient care and the nurse.docx

References

Geiger-Brown, J & Trinkoff, A. M. (2010). Is it time to pull the plug on 12-hour shifts? Journal of Nursing Administrators
Kearney-Nunnery, R. (2016). Advancing your career: Concepts of professional nursing Philadelphia, PA: F. A. Davis
Scott, L. D., Rogers, A. E., Hwang, W. Zhang, Y., (2006) Effects of critical care nurse’s work hours on vigilance and patient’s safety. American Journal of Critical Care, 15, 30-37. Retrieved from https://search-proquest-com.proxy.uscupstate.edu/nahs/docview/227910762/6B8B14A8AE004F13PQ/1?accountid=28698 Last Name, F. M. (Year). Article Title. Journal Title, Pages From - To.
Last Name, F. M. (Year). Book Title. City Name: Publisher Name.

Linda Gracie RN BSN - I have been a nurse for 4 years, which is a second career. Retired counselor from the State of SC. Was a mental health counselor and vocational rehabilitation counselor.

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98 Comment(s)

OUxPhys, BSN, RN

Specializes in Cardiology. Has 4 years experience.

Our CNO hates 12 hour shifts but she knows she would have no nurses working the floors so we have them. I work at a hospital that requires 80 hours every two weeks so we do 6 12's and an 8. However, they use the threat of 5 8's or 2 12's 2 8's if you abuse the call off (they look for patterns). They also tell managers to schedule people more 2 12's 2 8's (instead of hiring more people....shocking).

I have no problem doing 8 hour shifts but it won't be on the floor. If they staff a floor with adequate nurses and nurses aids 12 hour shifts are doable. 12 hour shifts become rough when you are understaffed and are getting slammed with admissions and discharges, that's where the issues arise IMHO.

I like my 12’s. It gives me flexibility with my family. I’d rather do 3 12’s than 5 8 hour shifts.

I live in a metropolitan area so my 12 hour shifts allow me to commute I’m times that are not rush hour traffic. My child does not have to be at daycare 5 days a week either.

If I wanted 8 hour shifts I’d look at working at a clinic or something.

KarenMS

Has 4 years experience.

I find most of us just get used to 12s, and it stops feeling like an excessively long shift. I’d much rather have the extra days off than feel like I’m going in to work most of the week.

NurseSpeedy, ADN, LPN, RN

Has 18 years experience.

I cannot be the only person who has no way in hell to find child care for the 12 hour shifts timeframes that run the hospitals in my area. Daycare doesn’t open till 6:30am-closes at 6pm. Not everyone has family/friends that can chip in and a nanny asks for over half what I make an hour for 1 child who is self care and self motivated but too young to be alone....offer more flexible (8-10 hour shifts-find more nurses that can actually physically be there to work).

As for 12s, they have their pros and cons but the 12s or nothing approach that I’ve seen leaves the whole forced schedule with a sour taste in my mouth. I did close to 18 years of nursing. I’m not going to drive myself crazy to find child care for a 12 hour shift that is often rarely only 12 hours.

TheLiberation, ASN, BSN, RN

Specializes in Cardiac & Medical ICU. Has 6 years experience.

I in no way to to be at my job 5 days a week.

I work nights and after working even 2 or 3 nights straight regardless of the extra 4 hours I work that make a 12 hour shift, the entire next day is purely just for relaxing and gaining some normalcy and energy.

I would have no time to accomplish anything with just one true day off.

Sorry I just disagree, this isn’t for everyone.

CKPM2RN, ASN, EMT-P

Specializes in Emergency/Med-Tele. Has 3 years experience.

4 hours ago, LovingLife123 said:

If I wanted 8 hour shifts I’d look at working at a clinic or something.

Most clinics are open extended hours now as well.

HiddencatBSN, BSN

Specializes in Peds ED. Has 10 years experience.

I'd like to see the ANA stop actively campaigning against safe staffing laws before trying to speak on behalf of the nursing profession about shift length. I have zero faith or trust in them to speak to what is beneficial and safe for nurses and patients after seeing them work to torpedo campaigns to set patient ratio maximums in Massachusetts and Pennsylvania.

*edited for clarity

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

The article leaves out the bulk of relevant research on shift length, and misrepresents the research it includes.

There is clear evidence that there is a sharp increase in adverse risks to both patients and nurses when shift length exceeds 13 hours, with the most common shift length exceeding 13 hours being the 16 hour shift, which is far more common in 8 hour staffing models.

When comparing 8 to 12 hour shifts, the majority of research shows an increase in the rate of errors, fatigue, burnout, etc with 8 hour shifts vs 12 hour shifts.

This is primarily due to the need to staff for 24 hours a day and the effect of working an increased number of nights on nightshift workers. For instance, due to the need for weekend coverage, a full time 8-hour nurse will need to work a long and shorter stretch of consecutive nights on a typical every-other-weekend coverage schedule, the shortest possible length of the longer stretch is 7 consecutive nights (in order to at least keep the available nights off as two periods of two consecutive nights). And after that 7 night stretch, there are only 2 nights for recovery before working again. While a single 12 hour shift is definitely more fatiguing than a single 8 hour shift, the overall increase in shifts worked in an 8 hour shift schedule clearly cause more fatigue and fatigue related events than a 12 hour system with it's increased availability of meaningful fatigue recovery.

JadedCPN, BSN, RN

Specializes in Pediatrics, Pediatric Float, PICU, NICU. Has 15 years experience.

12s work for some point and not for others, as 8s work for some and not for others - that is the beauty of it.

The first facility I worked at gave you the option (while balancing staffing too, of course) of whether you wanted to do 8 hour shifts or 12 hour shifts, and it seemed like staff morale was much higher.

Every facility I have worked at since then have required 12 hour shifts. Even 13 years later, I still love my 12 hour shifts overall. I'm sure I will reach a point when 8s sound more appealing.

nursebert, BSN

Has 25 years experience.

I am thinking of going back to 12hrs shifts, either night or day. I am working mon thru fri 8 hours plus with a one and one half commute home. I am a manager and rarely work just 8 hours. I have worked evenings, nights and weekends and do not get overtime.

I will be looking to go back to 12hrs in acute care if things do not change.

MSO4foru, ADN

Specializes in Hospice Home Care and Inpatient. Has 16 years experience.

My 3 12s work great for me. Those 8 hrs sound great in theory but you have to be in the right situation for that to work.

buttercup9, ASN, BSN, MSN

Has 13 years experience.

I read this article with great annoyance. One of the things I love about nursing is the flexibility. The best staffing options that I ever had was a floor with a mix of 8's and 12's. While it may have been a headache for staffing (no sympathy, your job is staffing) it allowed for less disruption on the floors during change of shift and it allowed those who wanted 8's and/or 12's to have them.

I can say I am just as tired after 8's as I am after 12's (and I almost never work past 12- unless its a code or something). I did 4 8's for a few years. My work life balance is significantly better with 12's than 8's My hospital did not offer 5 8's, so you only worked 32hrs weekly. Also, I have don't 5 8's in a week and by the end I am more tired and my frustration tolerance is much lower. Obviously an n of 1 is not statistically significant, but it is significant to me

I wont get into the sources cited, but on first reading it seems like your articles are fairly cherry picked to fit your conclusion.

If you don't want to work 12's, then don't. Advocate for mixed shifts instead and staffing solutions that work for your facility. Broad based solutions usually lead to everyone being unhappy.

tinyRN72, BSN

Specializes in Cardiovascular Stepdown. Has 8 years experience.

One of the things that keep me working in hospitals is the ability to work 12-hour shifts. I love the freedom of having 4 days off every week, or to be able to pick up a day, enjoy overtime, and still have 3 days off.

I can make more money with less stress in other careers. If I were forced to work 5 8-hour shifts, I would look at other options.

Snatchedwig, ADN, CNA, LPN, RN

Specializes in Medsurg. Has 13 years experience.

On 10/14/2019 at 9:24 AM, OUxPhys said:

Our CNO hates 12 hour shifts but she knows she would have no nurses working the floors so we have them. I work at a hospital that requires 80 hours every two weeks so we do 6 12's and an 8. However, they use the threat of 5 8's or 2 12's 2 8's if you abuse the call off (they look for patterns). They also tell managers to schedule people more 2 12's 2 8's (instead of hiring more people....shocking).

I have no problem doing 8 hour shifts but it won't be on the floor. If they staff a floor with adequate nurses and nurses aids 12 hour shifts are doable. 12 hour shifts become rough when you are understaffed and are getting slammed with admissions and discharges, that's where the issues arise IMHO.

Wow require? Your place sounds tough

mmc51264, ADN, BSN, MSN, RN

Specializes in orthopedic; Informatics, diabetes. Has 9 years experience.

I love 12 hour shifts. With traffic and getting ready, an 8 hour day is not that much shorter. I drive 40+ miles to my job. I don't want to do that 5 days a week and spend more time each direction because of rush hour traffic.

I worked a hour shifts my first job and never got to see my kids, it seemed.

I have been able to do my BSN and MSN because of working 3 days a week. I am old, too. I'm 55 and 12 hours, to me, seems easy. I used to work with horses and that was a tougher, 16-18 hour day, 7 days a week.

Lachel

Specializes in Geriatrics. Has 21 years experience.

Not only do they work 12 hour shifts, but are mandated often too. Threatened with their employment, because many don’t know they have laws that actually protect them from the cutting back management so they can get a big bonus at the end of the year! These nurses need to stand up and protect their livelihood! Management will move right along as if you never existed after they ruin your life, and blame you for their errors and hire someone else to manipulate without a second thought! So, it is important that you read your handbooks and know your state and federal laws about issues that threatens your livelihood, and causes patients to get inadequate, neglectful care! Always remember protect your patients’ and your own assets! It’s a man’s eater world in the health care field! It’s all about management making sure they and corporate see the increase of the mighty dollar at any cost!

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience.

When I started my current job I worked 0.8 FTE, 8 hour 2300-0730.

I LIVED TIRED.

I’m not exaggerating.... if I was awake I was tired. I could possibly do day shifts.... or 1500-2330 if I didn’t have school-age kids who are home in the evening.

But there is no way in hades I will ever work that many 8 hr night shifts again..... talk about increased fatigue!!