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.
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.
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).
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
1 hour ago, 2BS Nurse said:For those of you advocating for 12's, don't they turn into 14 -16 hour shifts? You would have to find extremely flexible child care in that situation.
Child care is an issue no matter what the length of shift. The strategy that we used was a baby sitter who stayed "over night" with our homeschooled son from the age of around five until around 17 (we both worked 12 hour night shifts and we worked together). This meant that we only needed "to pay" for childcare three days per week. This was from around 2005-2016 and believe it or not we would get over 100 applicants for this modest pay (central Florida) when we needed a new provider from a few online/newspaper adds (once every couple of years on average). We paid about $60.00 per day (yes we were lucky/cheap) and allowed the babysitter to bring her child and or pet (depending upon the person). Sometimes we provided a "free room" and food as an add on incentive (given that we rent a six bedroom house and there were only three of us made this feasible). Sometimes we provided rides home and or too our house. Of course circumstances and challenges will vary. However, I have asked about twenty nurses at my hospital on this issue and at least 70% have said they would outright quit nursing if they had to do eight hour shifts and the five day per week schedule this would entail The 12 hour shift is literally a major reason many do this job.
I am am over 50 nurse and come from the horse world where you work 6-7 days a week and the days are often over 15 hours. Plus you were responsible even if you were not there, making it a 24-7 type of job. Nursing is great and 12 hours is a breeze! The best part is not having any responsibility after giving report. I would definitely not do 8s in any way shape or form. Having 3-4 days off a week is fabulous! I have done both day and night and even though they are different in many ways, I would never do eight hour shifts and have to be there 5 days a week! I have fond that eight hour shifts leave no time for anything else and you are tired all of the time! I would certainly balk if 8 hour shifts became the norm!
I also am an older single mom, he is 12 right now, with no family support. I was easily able to find appropriate child care for him with no issues. Childcare is not an excuse in my opinion!
10 hours ago, 2BS Nurse said:For those of you advocating for 12's, don't they turn into 14 -16 hour shifts? You would have to find extremely flexible child care in that situation.
Why would it turn into 14-16 hour shifts? Nursing is 24/7. When the next shift comes in, report is given and off I go. 730-8.
On 10/16/2019 at 7:04 PM, nursebey said: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.
Well said. My coworkers are advocating for 12 hour shifts. On my unit, we are there sometimes 2 hours after the doors close because we can't predict how many patients will walk through the doors at closing time. Our 12s could potentially turn into 14s. The acuity is getting higher because patients don't want to pay for the ER. The rapid response team includes me, one MA and one provider. My coworkers are already whining about how exhausted they are. I can't imagine the complaints if the shifts were longer.
5 hours ago, CGB1 said:Why would it turn into 14-16 hour shifts? Nursing is 24/7. When the next shift comes in, report is given and off I go. 730-8.
Sometimes that "next shift" doesn't show, and if there isn't a float pool, or the float pool is already taken, then you may be stuck waiting for a replacement to come. Sometimes charting needs completed if your shift goes down the toilet. Thank goodness it doesn't happen often, but it always happen on the worst occasions: you feel I'll, your daycare can't watch your child 1 extra minute, etc
6 minutes ago, Hoosier_RN said:Sometimes that "next shift" doesn't show, and if there isn't a float pool, or the float pool is already taken, then you may be stuck waiting for a replacement to come. Sometimes charting needs completed if your shift goes down the toilet. Thank goodness it doesn't happen often, but it always happen on the worst occasions: you feel I'll, your daycare can't watch your child 1 extra minute, etc
There is that one nurse who likes to chronically call in sick and gets away with it.
12 hour shifts make sense in that you want to minimize the amount of handoffs given. Every handoff potentiates the loss of information --> more errors.
The only trouble though is that night shift is always short staffed/inexperienced, though I don't see how moving to 8 hour shifts or anything else would solve that issue.
CKPM2RN, ASN, EMT-P
330 Posts
And that is my ideal shift!