How do Hospitals save money changing 12 hr shifts into 8 hrs?

TheCommuter, BSN, RN · May 22, 2013

I'm not a manager, but I applied at a hospital in California that recently converted to 8 hour shifts (which turned me off because I prefer 12 hour shifts).

Anyway, most of the California hospitals that have made the conversion to 8 hour shifts are scheduling nurses for 32 hours per week, which is four 8 hour shifts in a one week period.

The hospital systems save big money if floor nurses are working 32 hours per week instead of 36 to 40 hours per week. In addition, a nurse can pick up one additional shift per week without going into overtime.

PrayeRNurse, ASN, RN · May 22, 2013

When a hospital looks at the bottom line ($$) they consider many factors. The largest percent of a hospital budget is in staffing with nursing taking the largest of that. So indeed that is a consideration. However they also look at compliance with codes, reimbursements, litigation risk etc.

Evidenced based research has shown that after the 8th - 9th hour on duty the risk of nurse error especially in medication administration. To reduce this high risk of error and the high cost of settlements many are returning to the 8 hour shift. You can research this subject on the ANA, JACHO, and CDC website for more information.

classicdame, MSN, EdD · May 22, 2013

Let us assume that more employees will be needed to cover on 8-hr shifts vs. 12-hours. The cost of benefits will be increased as that is a fixed number for each employee. So the way to save is to decrease overtime and decrease the skill mix. Fewer aides and other ancillaries. For the record, it is getting very difficult for hospitals to make a profit. Ours collects about 27-29 CENTS on every dollar billed and I have been told some facilities collect less. I would not want the bean-counters job.

MunoRN, RN · May 22, 2013

When a hospital looks at the bottom line ($$) they consider many factors. The largest percent of a hospital budget is in staffing with nursing taking the largest of that. So indeed that is a consideration. However they also look at compliance with codes, reimbursements, litigation risk etc.
Evidenced based research has shown that after the 8th - 9th hour on duty the risk of nurse error especially in medication administration. To reduce this high risk of error and the high cost of settlements many are returning to the 8 hour shift. You can research this subject on the ANA, JACHO, and CDC website for more information.

The evidence doesn't show an increase after in errors after 8 hours, it shows an increase after 13 hours, some studies actually show more errors in 8 hour schedules than 12's.

There is an Ann Rogers study that people incorrectly claim showed an increase risk of errors in 12 our shifts compared to 8's, the problem though was bad math. The Rogers study looked at errors per shift rather than errors per equal amount of time such as per hour. If you look at their data using a common measurement, such as per hour there were actually more errors in 8 hour shifts. Errors do increase in hours 8 through 12 of a 12 hour shift, but they increase even more in the additional workdays required of an 8 hour schedule which in the end accounts for more errors, injuries, and near misses than the additional 4 hours, but fewer actual shifts, of a 12 hours schedule.

MunoRN, RN · May 22, 2013

8 hour shifts is the new fad thanks to at least one consulting group and some articles in Health management magazines. Our hospital made the switch to 8's but it didn't last long, as it turned out it cost us much more money. The idea is that with 8 hour shifts you can up-staff and down-staff more frequently. In theory, it also means that it's easier to get people work extra shifts since it's a shorter shift. As it turns out, it's much harder to get someone working 5 or even just 4 nights a week to pick up a 5th or 6th. Nights in general are nearly impossible to hire for. And the primary problem was that Nurses were feeling "burnout" even at an FTE they had tolerated as a 12 hour schedule which produced a a large demand to reduce FTE's, which required hiring more Nurses which costs money.

The additional 30 minute overlap (typically more like an hour especially with 8 hour shifts), and less time that could be counted as unpaid breaks ended up adding to the cost as well.

DoGoodThenGo · May 22, 2013

I'm a RN in the Bay Area, CA and there is a trend in the past 3 yrs that I've noticed. Hospitals are getting rid of 12 hr shifts and converting them to 8 hrs; can anyone tell me why? Does this save money from the Hospitals in the log end?
A Managers insight would be great!
- ER RN, "You're here for what?"

These should get you going on your research:

Medical Errors and Nursing - NYTimes.com

Study Reveals Widespread Fatigue, Risk For Errors With 12-Hour Nursing Shifts

Long story short the increased error rates and or other performance downgrade from fatigue are causing facilities to take another look at 12 hour shifts.

In a perfect world nursing service staffing would be generous enough so those working 12 hour shifts have all their 30 minute and meal breaks along with support and staffing levels so they can leave on time. That rarely happens.

Often nurses work on average one hour over their shift either on or off the books to complete things (often paperwork)that wasn't done during the previous shift. So now you've worked 13 hours (or more), and only have 11 hours to get home and deal with what has to be done there, sleep, then get up and do it all over again. If the 12 hour shifts are spaced so there is at least one full day off between then things aren't so bad, but doing two or three such days in a row is often pure hell mentally and physically.

The other frequent problem happens when the oncoming shift is short (someone calls out, etc..) and you have to remain on overtime for a full or partial shift. You've just worked 12 hours and now you're going to put in several more? At some point your body and mind are going to say "sorry hun, we're not having it", and start shutting down.

MunoRN, RN · May 22, 2013

These should get you going on your research:
Medical Errors and Nursing - NYTimes.com
Study Reveals Widespread Fatigue, Risk For Errors With 12-Hour Nursing Shifts

Geiger-Brown showed that errors increase after 12.5 to 13 hours, not 8. Both shift lengths had a significantly increased risk of errors when shifts extend beyond their scheduled duration, which is actually more likely to happen with 8 hour shifts.

Their comparative study of 8 and 12 hours shifts looked at a single 8 hour shift vs a single 12 hours shift, it did not address the additional risk of errors that occurs as a result of the longer workweeks involved in an 8 hour schedule which we know from other studies cancels out and even exceeds the risks of the extra hours in a 12 hour shift.

Their study on sleep duration actually found that 12 hour worker get more sleep in total . They get a bit less sleep when they work compared to 8 hour shift workers, but both groups get more sleep on days off, which means in their extra days off 12 hour workers not only make up the lost sleep time but actually get almost 2 additional hours of sleep per week compared to 8 hour workers.

applewhitern, BSN, RN · May 22, 2013

I've been working 8 hour shifts for years now, and I love it. I don't feel rushed. I get 8-9 hours of sleep per night, so I always feel rested.

applewhitern, BSN, RN · May 22, 2013

When I worked 12's, they always scheduled them back to back to back, and that was the problem for me. When you accounted for driving, getting out late, etc., I would end up with absolutely no time for anything else. I never got enough sleep. They took 30 minutes out of our day for our unpaid lunch, then I had to drive 45 min. each way. Then count on the "late in the shift" admission. I feel so much more rested working 8's.

netglow, ASN, RN · May 22, 2013

Lots of wrangling in trying to figure out how to drop people from receiving healthcare coverage.... look for that number to drop under 30.... they won't tell you up front. I see a huge effort to "use" this as a way to eliminate healthcare coverage for many more employees than you may think. Those who currently have it, too might be on that list very soon.

applewhitern, BSN, RN · May 22, 2013

One job I had worked seven 12's in a row, then had 7 off. The off-time was great, of course, and most of the other nurses liked it for that reason. I, however, ended up working five 12's on, 2 off, 2 on, 5 off, because I never felt safe with so little sleep. I remember one time I literally fell asleep during a history-taking session. And once driving home. If I ever have to go back to 12's, they won't be back-to-back.