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

Nurses Article   (8,989 Views 91 Replies 918 Words)

LindaGracie is a ADN, BSN and specializes in geriatric, psychiatric/mental illness.

4 Articles; 985 Profile Views; 18 Posts

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. You are reading page 3 of Effect of 12 Hour Shifts on Patient Care and the Nurse: A Need for Change.. If you want to start from the beginning Go to First Page.

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I agree with most of the nurses that have chosen 12 hour shifts I also think that the fatigue and errors could possibly due to the acuity of having four patients and I’m speaking about emergency room. When you’re in ER nurse and your charge nurse or your triage nurse brings you patient after patient expects you to be doing a code stroke a psych patient who needs restraints and a chest pain and then gives you a shortness of breath  and that is happening centinela hospital Southern California crazy ER and the new grads are getting beaten up and thrown out to the wolvesWhat needs to be looked at is the acuity of the patients and the nurse patient ratio and again I’m speaking for ER you’re one person expected to do many tasks at the same time and put yourself in your patient at risk it’s not fatigue it’s the management of that emergency room

Edited by diane e
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Walti is a LPN, LVN, RN, EMT-I and specializes in ICU/ER mostley ER 25 years.

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I think about 25 years of my 45 year career were spent on nights and most of them 12 hours. Circadian rhythms show the low at 4 AM. It tends to be the reason that the 4AM chest pain is usually the real one. I did find that I could nap very easily afterwards but people would keep honking their horns over the way my car was weaving! I did work in a little hole in the wall hospital in a very small community that actually ran their shifts from 4 to 4. Come 4 AM and you're hitting the wall the next shift comes on and they've had a good nights sleep and are ready to go. It made great sense.

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booter512 has 22 years experience and specializes in Diabetes, Transplant, CCU, Neurology.

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It seems most of those pushing 8 hr shifts are dayshift nurses.  I worked night shift for 30 years, my wife for 34 years, all night shift, all 12-hr shifts.  If any of the hospitals would have changed to 8-hr shifts, we would have moved to a different hospital.  Plus, I've seen some part time 8-hr shift night shift nurses, and they do it because they feel it's physically easier on some units.  At any hospital I've worked at, staffing the 3-11 shift would have been a nightmare.  I have only met 1 nurse in 30 years of nursing that enjoyed that shift.  I guess you could force people to work it, and see what your turnover rate did then. 

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There are some valid concerns with fatigue and the extended work day. I remember when I was 19 working at gp warehouse and them telling us they only did ten hour shifts because after that employees arent productive. HOWEVER I will never, ever, ever go to a job five days a week. My body needs a few days to sleep past 5:30am or Im useless.

Ive been an LPN for ten years, CNA before that. It was hard with small children and no family support, but I found a way and it works for me. Some nurses do prefer the 40 hour, five day work weeks but that should be a choice. I enjoy having three/four days off a week and Im not tired because I worked 12/13 hours.

Im tired because nurses have too many duties with too few resources and often no support from managment. My most recent skilled unit job we did all the admissions, med passes, treatments, managed two shift changes of CNAs, often worked with one nurse when we should have had two and at least one extra CNA. The longer Im in the field I realize it isnt the job I dislike, its the constant increase in responsibilities and expectations within that 12 hour period.  Try giving us the staff and help we need first, give more flexible schedule options for a work-life balance so we dont feel like we live at work and can actually enjoy the jobs we worked so hard to get. Just my half a cent.

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CGB1 specializes in CCRN.

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As a nurse who has only worked 12s, If they ever implemented a 5 day 8 hour work week I'd be looking for another job. It's funny to me that this article points to this and speaks nothing of acuity and nurse patient ratios.

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LindaGracie is a ADN, BSN and specializes in geriatric, psychiatric/mental illness.

4 Articles; 18 Posts; 985 Profile Views

Thank you everyone for your comments. It seems there are a lot of nurses who really enjoy working 12 hour shifts. I wonder how many older (age 50+) nurses prefer working 12 hour shifts. This paper was a paper I wrote for one of my courses when I was working on my BSN. CGB1, this article didn't address acuity and nurse patient ratios because that wasn't the topic addressed for the course. When I worked in hospital settings (and SNF) everyone commented on the increased acuity of the patients. It does seem that people are getting sick with chronic conditions at a younger age and many of us baby boomers do have numerous chronic conditions. It is common for a patient to have diabetes, neuropathy, obesity, hypertension, hyperlipidemia, along with the pneumonia or whatever condition they were admitted for. Unfortunately the hospitals (in my area) only focus on the one condition rather than coordinating care with the patient and the patient's healthcare providers. If these comorbid conditions where also addressed this would increase continuity of care and promote better health. I also strongly believe that nurse patient ratios need to be addressed and have read other articles on allnurses which addressed this. There are nurses advocating for change which I am in agreement with and have read that many nurses do advocate for this change however there are a few nurses who is opposed to this.

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myoglobin has 11 years experience as a ASN, BSN, MSN and specializes in ICU, trauma, neuro.

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12 hour shifts and the three day work week they foster is one of the primary reasons I became a nurse. Consider that with a two hour round trip commute you would be working an extra 200 hours per year for free (in driving). Also it might mean an extra $500.00 spent on gasoline per year and higher carbon emissions.

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BlueShoes12 is a BSN, RN and specializes in Stepdown ICU, Trauma.

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I don't love working 12-hour shifts, but as long as I'm at the bedside, I absolutely would not want to be at the hospital more than three days/week. My ideal schedule would be two twelves and one eight. The flexibility of having a three day work week is wonderful. 

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NewOncNurseRN has 1 years experience as a BSN, RN and specializes in BMT.

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I started out doing 2 12s and 2 8s. The method to survival was always taking a lunch, meaning that you definitely did not accomplish all of the tasks needed that day. I definitely preferred my days that were 12s- which is why I now work 3 12s. It’s also frustrating for patients to get woken up at midnight to be assessed.

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kbrn2002 has 25 years experience as a ADN, RN and specializes in Geriatrics.

2,973 Posts; 29,191 Profile Views

On 10/16/2019 at 10:57 AM, beekee said:

Absolutely no way I’d stay in acute care if I was forced to do 5-8 hr shifts instead of 3-12 hour shifts. I agree there should be an option for those who want it, however. I’d quit in a hot second if I had to work 8s again. 

Way more problematic I think is the rotating shifts. My employer requires most to work day and night shifts. Absolute hell on the mind, body and spirit. 

Totally agree about the insanity of requiring rotating shifts. Every hospital around here requires them and that's a huge part of the reason I have zero interest in acute care.  I really don't get how anybody could adjust to working a mix of nights and days. Plus the hospitals here only offer 8 hour shifts and I do currently work 12's and have no interest in going back to 8's.

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kbrn2002 has 25 years experience as a ADN, RN and specializes in Geriatrics.

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On 10/17/2019 at 8:28 PM, LindaGracie said:

Thank you everyone for your comments. It seems there are a lot of nurses who really enjoy working 12 hour shifts. I wonder how many older (age 50+) nurses prefer working 12 hour shifts. This paper was a paper I wrote for one of my courses when I was working on my BSN. CGB1, this article didn't address acuity and nurse patient ratios because that wasn't the topic addressed for the course. When I worked in hospital settings (and SNF) everyone commented on the increased acuity of the patients. It does seem that people are getting sick with chronic conditions at a younger age and many of us baby boomers do have numerous chronic conditions. It is common for a patient to have diabetes, neuropathy, obesity, hypertension, hyperlipidemia, along with the pneumonia or whatever condition they were admitted for. Unfortunately the hospitals (in my area) only focus on the one condition rather than coordinating care with the patient and the patient's healthcare providers. If these comorbid conditions where also addressed this would increase continuity of care and promote better health. I also strongly believe that nurse patient ratios need to be addressed and have read other articles on allnurses which addressed this. There are nurses advocating for change which I am in agreement with and have read that many nurses do advocate for this change however there are a few nurses who is opposed to this.

Count me as one of the over age 50+ nurses that prefer 12's. The trade off of more days not at work more than makes up for the longer hours the days I am at work.  I do work an AM/PM  shift with a set schedule and my PM/NOC partner has the same set schedule which for us works beautifully. 

Edited by kbrn2002

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ocean.baby has 25 years experience and specializes in corrections and LTC.

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My favorite schedule was when I worked two 12 hr shifts and two 8 hour shifts per week.  That gave me three days off and I enjoyed the two 8 hour shifts as I had time to do other things.

I wonder how many nurses that insist on 12 hour shifts actually use some of their 'days off' to pick up extra shifts or to work a second job.  Where I live that is very common, so who is getting 4 days off?  I realize that is their choice, but it still has a negative effect on their patients. 

I detest split days off, I would rather have Tues and Wed off than split days.  However, I know that doesn't work for many who have spouses/sig others who have weekends off, or the many nurses who have children.  That, to me, is the worst part of five 8 hr shifts - the split days off. 

Some nurses do great working 12 hr shifts, others not so much.  A blend of hours seems to be the best option. 

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