12 hour shifts safe?

[docomo]

I've been reading a lot recently about people who claim 12 hour shifts are not safe because nurses are over fatigued in the last 2 hours of their shift, and they don't get enough rest when working back to back shifts.

How many think that's a valid argument for doing away with 12 hour shifts?

My counter argument to that point is:

1. Endurance varies from person to person and with age. Nurses should know and respect their own limitations.

2. Most errors in patient care occur during turn over. Communication of any kind, but especially verbal communication, is very prone to errors. Having 3 turn overs per day instead of 2 would raise the chance of patient errors much higher. Frankly, I'm surprised that patient turn over is still done verbally.

[sauconyrunner]

I actually do think that people get fatigued with 12 hour shifts. BUt I imagine most of us will reply that they will give up the 3 day work week when you pry it out of our cold dead hands.

A lot of floors have tried over the years to change pt report and assumption of care to a taped format, or a written format. People tend to like verbal because we can then ask questions and get a general feel for the patient. Some things about a patient just can not be adequately expressed via tape recorder or in writing....

Bedside report has been a fad for a while, but I find if any real jargon is used that the family gets more confused and is less reasssurred....

[MunoRN, RN]

In general, the evidence says 12 hour shifts are safer for both patients and Nurses. The claims that supposedly refuted the perviously established overwhelming evidence that 12 hours shifts are less likely to produce errors and injuries are best described as "bogus".

The mostly commonly quoted "evidence" is that 12-hour shifts are 2-3 times more likely to produce an error, which comes from Rogers et al. Their study came up with this claim by comparing errors per shift in 8 hour shifts without excess of shift to 12 hour shifts with excess of shift, even though we know excess of shift by itself is a strong predictor of errors, essentially comparing apples to oranges. If we compare apples to apples and look compare 8 hour shifts to 12 hours shifts, both without excess of shift, we actually find slightly less errors per shift. Of course "per shift" is not an equal denominator since 12 hour shifts are 50% longer and therefore offer 50% more chances for errors, so if we look at error rates per hour, we find that 12 hour shifts have a risk of error per hour that is half that of 8 hour shifts.

Other evidence referenced to support 12-hour-shift-bashing don't actually refer to direct evidence, but infer increased error and injury risk based on risk factors for fatigue. If you compare a single shift to a single shift, then there's no arguing a 8 hour shift is less fatiguing. But in the real world, Nurses work more than one shift before retiring. Given the same FTE, 12 hour workers actually get more sleep overall, get less behind on sleep, and are less fatigued as they approach the end of their work weeks. There is a well established factor often referred to as the "consecutive day" factor, where by risk of error and injury increases with each consecutive day worked. So while fatigue does increase on the last 4 hours of 12 hour shift, the effect of the increased workweek among 8-hour workers exceeds the effected of the extended shift length of 12-hour workers. In terms of sleep, most studies show 12-hour workers get less sleep, although not all that much less. So while the 12-hour worker is farther behind on sleep on day 3 than an 8-hour worker, the 8-hour worker still has two days to go and will be farther behind on their last shift, plus, the 12-hour worker has more recovery time.

While I agree report should not be solely verbal, it should involve "data", verbal communication is widely considered to be the safest way to ensure that a full understanding of the patient is communicated. In my state, all reports must have a verbal component (other than just "did you get the report sheet?"), otherwise it is considered abandonment.