8-hour shifts save money?

noahsmama · Nov 30, 2011

If nurses are shifting from 3 12's per week to 5 8's per week, then each nurse is shifting from 36 hours per week to 40 hours per week. You'd be getting 4 more hours per week per nurse. I assume you would still need the same number of nurse-hours per week, so you would need fewer nurses, since each nurse would be working 11% more hours per week. You wouldn't save on hourly wages (same number of nurse-hours), but you'd save on benefits.

Daisy_08, BSN, RN · Nov 30, 2011

Mostly there are 12's where I work but, there is one 8 on day and one on eve.This is to cut down on staff from 11-7. Maybe that how they are saving money?

madwife2002, BSN, RN · Nov 30, 2011

Every thing in my facility is done by hours so for example I have 300 hours per week that equals 7.5 FTE's at 40 hours, I need .5 coverage for call off's and vacations so I need 8 RN's.

Nobody cares how I staff my unit as long as I dont use more than 300 hours per week

classicdame, MSN, EdD · Nov 30, 2011

Thanks so much, MunoRN! Very good synopsis.

I think it comes down to the nurse. The nurse who works FT here and PRN elsewhere, or volunteers for shifts or does not protect his/her sleep cycles will have problems, regardless of shift type. Our state nurses asso. talked about fatique being a care factor (and safety factor) but if we had the BON get a law passed prohibiting working more than X hours per week, who would police it? Nurses can work 40 hours here and another 40 somewhere else. It is up to the individual to protect themself and the patient.

PMFB-RN, RN · Nov 30, 2011

I am no billing expert, so I'm hoping some of you out there are. Hospitals in my state are pushing to move to 8-hour shifts claiming that they can increase revenue/save money, although they won't reveal how. (Supposedly $6 million a year at a 250 bed hospital). Does anyone know where this savings/increased revenue comes from?
It's been suggested that they can increase their medicare reimbursements by using 3 Nurses a day instead of 2, even though the total Nurse hours are the same either way, anybody know if this is true? Any other ideas how this saves money?

*** It's not going to save them money. They will find that their OT cost will go up significantly. Many hospitals have found this to be true.

PMFB-RN, RN · Nov 30, 2011

There is lots of evidence to suggest that 12 hour shifts are a safety problem
http://www.ergoweb.com/news/detail.cfm?id=2473
http://www.wsws.org/articles/1999/sep1999/shift-s06.shtml
http://www.healthleadersmedia.com/page-1/NRS-257296/Linking-Medical-Errors-Nurses-12Hour-Shifts##

*** It is very easy to come to that conclusion when they leave out many important factors. Like for example what will be the effect on patient safety of many highly experienced nurses leaving bedside nursing suddenly as can be expected when they apply one size fits all solutions.

The obvious answer, the one chosen by the best hospitals, if to have a choice of 8 and 12 hour shifts available.

allnurses Guide · Nov 30, 2011

Our hospital also initially tried to say it was a safety issue, although after going over the evidence with them even they agreed that there is absolutely no evidence to support that. If you look at safety risk factors, you'll actually find more potential danger with 8-hour shifts (greater sleep loss, more hand-offs, more fatigue/burn-out, poorer overall performance). When looking at how that translates into measurable outcomes, there's no significant difference. 8-hour shifts are safer if you're talking about three 8-hour shifts a week vs three 12-hour shifts a week, but of course in real life, switching from three 12-hour shifts a week to 8-hour shifts means working 2 additional nights per week, which more than cancels out the disadvantages of the longer 12-hour shifts when looking at most variables.

I remember when the switch was made back when Jimmy Carter was president. It was done at my hospital as another carrot to dangle to attract nurses back in the days of the real nursing shortage, along with free cruises to Puerto Vallarta, sign-on bonusses in the thousands, etc.

They experimented with a few "flex-time" options including 4 10s which have gone by the wayside along with the 8-track tape and quad stereo fads of the 70s. They settled on the 3 12s because the vast majority of nurses preferred it. You are an FT employee (with all the benefits) at 36 hrs vs 40 hours. You only have to find childcare, transportation, clean clothes, gas, etc for 3 days vs 5 days. That's 2 days per week not being able to do what you have for your entire career ie per diem work, short travel excursions, whatever. Is there any way to isolate the stress those extra burdens impose on a person vs the stress of working 12 hrs vs 8?

Would continuity of care issues come up with 3 nurses/24hrs vs 2? My experience is, if there aren't a lot of registry or temp nurses on a unit the patient care planning etc goes much more smoothly with 2 shifts vs 3 shifts.

I speculate--- bean counters know that the average age of nurses is higher now than it was then (huge number of baby boomer nurses), so the long shifts are more taxing, and that if nurses are unhappy with the 5 8s they can hit the road as replacing them now is a cakewalk compared to the days of the real nursing shortage. :twocents:

LizAnn · Dec 1, 2011

The number of nurses working does not affect the medicare reimbursement. Hospitals are paid on a DRG basis..diagnosis related.

In a LTC setting, it does make a difference in the 5 star rating, however. If they can have more RNs on duty by working everyone 8 hr shifts, as opposed to LPNs, then the rating could improve. (for example- 1 RN doing 12 hrs, another LPN doing 12. Or- 2 RN's each doing 8 hr shifts, another LPN doing 8) This could indirectly affect the financial bottom line, as more potential referrals due to the higher star rating with having more RN hours per pt day.

One more thought...it may save money for your company if they have to use agency nurses to cover call offs. It would be more costly covering 12 hour shifts as opposed to 8.

Good Morning, Gil · Dec 1, 2011

Yeah, I don't really understand that. They can staff with fewer nurses doing 12's, which means fewer nurses that need to be paid benefits, not to mention training costs (if you hire an extra nurse a day, then there are more nurses that you need to train initially). The only way it would save money is if 12 hr shifts are causing burn-out, and the majority of the nurses prefer 8 hr shifts, so less turn-over. Maybe I'm missing something, though.

lrobinson5 · Dec 1, 2011

Wouldn't it save a ton of money but not paying 4 hours of overtime to every nurse? Or is this not the way it works. The only way I can see them losing money is maybe on the benefits that would go to a 3rd employee?

TheCommuter, BSN, RN · Dec 1, 2011

Wouldn't it save a ton of money but not paying 4 hours of overtime to every nurse?

Daily overtime is nonexistent in most states. Therefore, nurses who work 12 hour shifts will not be paid overtime for the last 4 hours of the shift in most states. If I am not mistaken, California is the only state that requires employers to pay daily overtime for anything beyond 8 hours in a day.

I have worked many 12-hour and 16-hour shifts, and have not received a dime of daily overtime. In the state where I live, overtime is paid in excess of 40 cumulative hours worked in 1 week.

lrobinson5 · Dec 1, 2011

If I am not mistaken, California is the only state that requires employers to pay daily overtime for anything beyond 8 hours in a day.

Well there you have it. I live in California , and I assumed that was the way it works everywhere. Now I don't have an answer for the original question... I'm not really sure how it saves money if you already don't have to pay overtime.