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
