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

BrandonLPN, LPN · May 22, 2013

Isn't having only 2 nurses is a 24 hour period (ie 12 hour shifts) better for continuity of care?

MunoRN, RN · May 22, 2013

Hospitals would love to claim that they want to switch to 8's for safety reasons, which sounds much better than saying it's for money reasons. Yet even though these studies have been around since 2002 and earlier, Hospitals haven't been able to make that case, there's just no evidence when you look at it hard enough, even though the filter that hospital administrators are apt to use. In the end, the rationale always comes down to cost, despite really hoping the evidence would support a safety claim.

DoGoodThenGo · May 22, 2013

Isn't having only 2 nurses is a 24 hour period (ie 12 hour shifts) better for continuity of care?

In theory yes, fewer handovers are better in many fields including nursing. When working perfectly the same two or group of nurses are handing off to each other for the same patient

DoGoodThenGo · May 22, 2013

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.

And I thank you for that!

However here is the one fly in the ointment.

There is considerable research that shows "making up" for lost sleep is not the best way to go and that set patterns of sleep and waking are best. Shift workers and or those that inconsistent sleep patterns have been shown to have a host of problems including at least according to some studies an increased risk of certain cancers.

MunoRN, RN · May 22, 2013

And I thank you for that!
However here is the one fly in the ointment.
There is considerable research that shows "making up" for lost sleep is not the best way to go and that set patterns of sleep and waking are best. Shift workers and or those that inconsistent sleep patterns have been shown to have a host of problems including at least according to some studies an increased risk of certain cancers.

Shift work (night shift work) is known to cause cancer due to reduced melatonin production which results from being awake at night, particularly between 0200 and 0600. More night shifts per week increases the cancer risk, 8 hour shift schedules produce more night shifts per week.

The difference between sleep duration for 8 and 12 hour shifts is less than 30 minutes, while the overall "sleep deficit" over the course of a work week is much more significant for 8 hour workers and produces a difference that has been more positively associated with fatigue.

CapeCodMermaid, RN · May 23, 2013

I got rid of 12 hour shifts because if someone calls out, it's harder to fill the shift AND if I have to mandate, someone can stay an extra 8 but never an extra 12, barring, of course, a state of emergency.

Tait, MSN, RN · May 23, 2013

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.

Yeah I found this after completing my capstone project on 8 vs. 12 hour shifts and medication errors. After 12.5 hours errors did increase, but there wasn't much evidence for clear error increase when people went over 8. In addition errors could be decreased simply by making sure nurses got their breaks in uninterrupted.

MrChicagoRN, RN · May 23, 2013

It usually doesn't save money because you still need to have the same number of HPPD per 24 hours.

Most nurses would then be working 72 hours instead of 80, so you'd need more employees to fill the holes, leading to more costs for training, insurance benefits.

However, some places consider a 0.9 FTE employee to be part-time, meaning the employer can save money on insurance, PTO accrual, etc. There'd still be additional training costs involved however.

The main reason many facilities offer 12 hour shifts is that some employees ask for them, often younger employees. Supposedly this helps with employee recruitment and retention.

MatrixRn · May 23, 2013

Shift work (night shift work) is known to cause cancer due to reduced melatonin production which results from being awake at night, particularly between 0200 and 0600. More night shifts per week increases the cancer risk, 8 hour shift schedules produce more night shifts per week.
The difference between sleep duration for 8 and 12 hour shifts is less than 30 minutes, while the overall "sleep deficit" over the course of a work week is much more significant for 8 hour workers and produces a difference that has been more positively associated with fatigue.

Then why not consider 10 hour nights? We NEED nights! Or why not consider 3-3 shifts? There are many options that can be offered to nights to bring them on board.

In the facility I worked at I changed folks from 12 hour shifts to 8 hours for the days and evenings. The overnights were changed to 10 hours and they overlapped one hour with the eves and day shift. This allowed the nights to work either 3 or 4 10's and also gave additional support to the other two shifts.

At first the day and evening folks pushed back until they worked it a month or so; it was then that many realized they could go home after 8 hours and see and be with their family.

MatrixRn · May 23, 2013

I got rid of 12 hour shifts because if someone calls out, it's harder to fill the shift AND if I have to mandate, someone can stay an extra 8 but never an extra 12, barring, of course, a state of emergency.

Yes this is huge! It is much easier to fill an 8 hour shift. It can be done with 2 4's even, but a 12 wow ...now that is a challenge.

MatrixRn · May 23, 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.

And here is another reason to not fully embrace 12 hours shifts for ALL of the staff. In this example the nurse works 7 and is off 7.

Two things jump to mind. First how tired is this nurse who is working 7 days in a row, and how much investment does she have in her fellow nurses and the hospital is she is gone every other week?

There are many discussions on this board about how unhappy nurses are with their current state of affairs. However, until we invest in our environment, by being present and demanding change nothing will happen.

[Applewhitern...I read the rest of your post and understand that is not what you do. I am using this as an example for a larger picture discussion.]

MatrixRn · May 23, 2013

Isn't having only 2 nurses is a 24 hour period (ie 12 hour shifts) better for continuity of care?

It certainly is easier for scheduling, but questionable on continuity of care.

It is easier for scheduling in that the scheduler can schedule 4 -12 's one week for 48 hours and 3 -12 's the next week for 36. This gives 40 hours per week and accounts for the every other weekend schedule. EASY for scheduling!!

Of course there is the 8 hours of OT that is generated every other week that would be a challenge to defend to finance. AND this 8 hours of OT cannot be a worked around as it is the law.

Continuity of care....you assume the patient will only be in the hospital for the length of your work week. OR that you will get the patient on admit from day 1 and release him prior to the end of your work week. This is often not the case.