Nurses and 12-Hour Shifts - How to Make the Best of Them

[Brian]

Whether you love them or hate them, 12-hour shifts are here to stay. For many new nurses, the thought of working a 12-hour shift can be overwhelming, intimidating and nerve-racking. But don't panic. Here are a few things you can do to make the most out of your 12-hour shift.

Get Enough Sleep

Sleep is one thing most nurses don't get enough of, and yet it is one of the most important things a nurse should do. Getting adequate sleep will make you more alert, recharged, and feel better all around, which will make your 12-hour shift a lot easier to manage. Adequate sleep is a key part of a healthy lifestyle, and can benefit your heart, weight, mind, and more.

Eat a Nutritious Meal

Whether your 12-hour shift begins in the morning or at night, eating a nutritious meal before your shift is vital. It is also important to remember to eat a meal during your shift instead of just snacking. Make sure your meals consist of foods that give you energy with healthy carbs and lean proteins such as Greek yogurt, whole grains, blueberries, eggs, nuts, and lean meats. Don't forget about vegetables. Dark leafy greens are a great source of vitamins and fiber.

Drink Enough Water

Because you are constantly moving, it is easy to become dehydrated during a 12-hour shift. Although your bladder may not appreciate this, it is important to drink water throughout your shift . With all the hustle and bustle of being a nurse, it might be hard for you to find the time to drink water, so we recommend that you keep a water bottle near by if you can.

Buy Good Shoes

Although good supportive shoes do cost a pretty penny, your back and feet will thank you for investing in a good pair of shoes! Healthy feet are among a nurse's most important assets. Working long hours on your feet make proper footgear not only helpful, but essential. Do your research before buying shoes. Ask your fellow nurses what brand and type of shoe they like best for work. When shopping for shoes, go to a shoe store with knowledgeable staff such as Scheels, Sports Authority, Dick's Sporting Goods, or Foot Locker. Sometimes, gel inserts or orthotics are necessary for comfort as well. This is especially true if you have flat feet, pronounced arches, or bad knees. The right shoes can help nurses focus solely on their patients instead of on tired and achy feet.

Take Breaks

One of the biggest concerns over the length of a 12 hour shift is fatigue, and its effect on safety and patient care. To alleviate fatigue, make sure you take your breaks. Sometimes, it is difficult to do, however, simply walking outside around the block, going off the floor and doing deep breathing, grabbing a yogurt or a protein snack, all helps to keep you alert.

Look on the Bright Side

You are doing the career of your dreams - the career you worked hard for in nursing school. Most of all, you are helping people that need your care. Let the knowledge that you are caring for people who are in great need of the skills that only a nurse can provide carry you through your shift. For those 12 hours they are under your care, be proud of the fact that you are their nurse.

Your first 12-hour shift may be a lot to handle at first but if you follow these tips, you may find in the future that you prefer 12 hour shifts over 8 hour shifts.

Do you have any advice for a nurse that is new to 12-hour shifts?

[j0yegan]

I cannot imagine working 5 days a week. I don't want to feel like I'm working most of my life. LOL.

[MunoRN, RN]

I am so happy that ar least you say "everybody is different." No way would I get more sleep and be less fatigued working 12's vs 8's. Up at 5 to shower and get ready. Need to be on the road at 6. IF and that is a big if, I get off on time at 1930, drive home get there at 2030. Go straight to bed, up at 5 again. IF that were possible, it is 8.5 hours of rest/sleep. Of course, that leaves no time at all for anything else....no lengthy relaxing soak, no chores, no meals and certainly no family time.

i am one who needs 8 good hours of sleep and it is proven that "catching up" later doesn't mean you are properly rested.

I am gald

The benefits of 12-hour schedules aren't as obvious from a day-shifters point of view, and the balance of pros and cons is more likely to favor 8 hour shifts than for those who work nights. It's night shifters that experience the more extreme effects of working 5 nights a week every week.

[MunoRN, RN]

Depending on whose numbers you look at medical mistakes are a significant cause of death in the US. Are you really going to argue fatigue isn't a role in this? Interns used to work long hours in their training until there was the recognition that just because we always worked interns a 100 hours a week maybe that wasn't a good way to deliver safe care. Every commenter here has focused on their personal likes. What about patients?

My first introduction into the power of unions in nursing was in 1988 in San Francisco. I participated in a strike in which the main issue was management trying to shove 12 hour shifts on us. My bargaining unit voted 99 to 1 ( I was there when the ballots were counted) to authorize a strike in which the main sticking point was the 12 hour shift. If the nurses didn't feel so strongly about this I doubt they would have walked a picket line for 4 weeks. Management even brought in a lawyer from Chicago who bragged on the local media how she was going to break the California Nurses Association. Over 12 hour shifts.

Those who are enthusiastic about 12 hour shifts have the full support of management. That fact alone should give nurses pause because management would never risk patient safety, would they?

Any hard data to support this? Because fatigue is accumulative. If you start a shift sleep deprived that mistake you make could occur in the first 5 minutes and not after 12 hours.

There's a wealth of research on shift length, both specific to Nursing as well as across various occupations. There is an argument to made that shifts scheduled to exceed 13 hours are unsafe (compared to shifts of fewer hours given the same FTE), but the evidence doesn't say that a schedule based on 12.5 hour shifts are less safe than one based on 8.5 hour shifts, and they might actually be even more safe.

There are various ways to measure fatigue, one is sleep deficit. There is a nursing specific study, by Ann Rogers, that quoted a decrease of 30 minutes less sleep when working 12 hours shifts compared to 8 hour shifts (prior to working). The larger (OSHA) studies actually didn't show that people generally got sleep when working 12's and actually showed that people frequently get more sleep, which it attributed the fact that many 12 hour workers don't try, or are just unable, to try and accomplish other tasks on day worked. But even if you take the 30 minutes less sleep figure, overall sleep debt is still less because you are only accumulating sleep debt for 3 days instead of 5, and you have 4 recovery days instead of 2.

In terms of errors, there are actually fewer errors associated with 12 hour shifts. You will find some claims that this isn't the case based on a Rogers/Scott study but this only true if you ignore basic math. The claim is that their study showed an increase in errors with 12 hour shifts because there were more errors "per shift" in 12 hour shifts than in 8 hour shifts. It's a bit tricky, but you have to remember that a "per shift" error rate in 12 hour shifts of, say, 5 actually represents a lower risk of error than a per shift error rate of 8 hour shifts of only 4.

I haven't found that management prefers 12 hour shifts from a purely administrative perspective, and there's actually been a push recently to transition to 8 hour shifts to improve staffing efficiency. My facility recently faced a full restructure to 8 hour shifts based on a recommendation from a consulting firm, who stated they make this recommendation to every hospital they consult for. In the end, even management agreed there were too many problems with universal 8 hour shifts.

[tntrn, ASN, RN]

The benefits of 12-hour schedules aren't as obvious from a day-shifters point of view, and the balance of pros and cons is more likely to favor 8 hour shifts than for those who work nights. It's night shifters that experience the more extreme effects of working 5 nights a week every week.

I used a day shift 12 because night shift 12 is not better. In fact would be worse, because sleeping during the day would eve harder.

I worked most of my career on 3-11's which I found to be the best for me. I did a few months of 11-7, but was so chronically fatigued that a chest cold turned into near pneumonia. And I did some day shifts, too. But 3-11 was awesome for me. Not only was I able to get a good night's sleep nearly every night, I had time in the day to do other stuff before I went to work. I worked full time for several years doing that. I found after a day shift I just didn't feel like doing anything else...and the night shifts were crappy for me.

[MunoRN, RN]

I used a day shift 12 because night shift 12 is not better. In fact would be worse, because sleeping during the day would eve harder.

I worked most of my career on 3-11's which I found to be the best for me. I did a few months of 11-7, but was so chronically fatigued that a chest cold turned into near pneumonia. And I did some day shifts, too. But 3-11 was awesome for me. Not only was I able to get a good night's sleep nearly every night, I had time in the day to do other stuff before I went to work. I worked full time for several years doing that. I found after a day shift I just didn't feel like doing anything else...and the night shifts were crappy for me.

I also prefer evenings 1500-2330, although 1100=2330 would be even better (only 3 days a week instead of 5).

I worked full time 8 hour nights when I first started Nursing, it was definitely not better than 12 hour nights, and studies/surveys show that the majority of night shift workers agree. The problem that many experience is progressively increasing fatigue: I started each new work week only slightly less fatigued than when the last work week ended, I never could return to a "baseline" fatigue level before the next work week started.

There's no arguing that a single 8 hour night shift is better than a single 12 hour night shift, but that's not a very realistic comparison since people typically need to work more shifts if they work 8 hour shifts. Whether you're working 8 or 12 hour shifts, sleeping during the day produces poor quality sleep, so then it basically comes down to: would you rather sleep during the day 5 days out of every week with only 2 nights to recover, or would rather sleep 3 days out of the week with 4 days to recover?

[Chisca, RN]

Both the National Institute for Medicine and the American Association of Critical Care Nurses recommend limiting the use of 12 hour shifts due to the danger they pose for patients. I trust their judgement.

Effects of Critical Care Nurses' Work Hours on Vigilance and Patients' Safety

[tofu-tofu]

12 wins for sure! After doing 12s, I can't imagine having to go to work 5 times a week. Man, that'd be rough. Just remember to hydrate, hydrate, hydrate!

[wellcoachRN]

Great article! I would add that it is important to practice daily self care every day. It could be as simple as listening to your favorite music on your commute, watching your favorite comedy or YouTube videos when you don't have time. On your days off, do something you love.

[MunoRN, RN]

Both the National Institute for Medicine and the American Association of Critical Care Nurses recommend limiting the use of 12 hour shifts due to the danger they pose for patients. I trust their judgement.

Effects of Critical Care Nurses' Work Hours on Vigilance and Patients' Safety

The IOM didn't recommend not using 12 hour shifts, they recommended not using shifts longer than 12 hour shifts.

• HCOs and labor organizations representing nursing staff should establish policies and practices designed to prevent nurses who provide direct patient care from working longer than 12 hours in a 24-hour period and in excess of 60 hours per 7-day period.
  

They recommend "limiting the use" of 12 hour shifts only in that they recommend limiting the number of hours per week, although this is regardless of shift length. They also suggest studying the effects of consecutive shifts, again both in terms of 8 and 12 hour shifts.

The AACN has never recommended not using 12 hour shifts either. The study you mentioned (which you'll notice is the same faulty study I referred to earlier) was published in the AACN journal but was by no means an AACN recommendation.

At best it offer some counter evidence to the many studies (mostly cross-occupational) that show either no difference or even an advantage in terms of safety to 12 hour shift scheduling, although I don't think it can really be considered even an outlier. This is the study that has been widely quoted as showing a risk of error that "almost doubled when nurses worked 12.5 or more consecutive hours", which reflects a level of math inability that should be considered negligent.

Their rates were based on a "per shift" percentage. When gauging risk of error, you look at the number of errors in relation to a common opportunity for error, which mean using a constant period of time since there is more opportunity for error in 12 hours than in 8 hours. So if we look at the errors found in this study based on a per hour measurement rather than per shift, it's actually 1 error per 116 hours of work compared to 1 error per 114 hours worked, clearly not really twice this risk.

And this doesn't even take into account that the authors played with their numbers in the same way a crooked accountant would. The same authors had already established in previous studies that "excess of shift" was a strong predictor of errors, not surprising since excess of shift represents an over-saturated workload. Yet when comparing 8 and 12 hour shifts, they compared 8 hour shifts without excess of shifts, and yet combined 12 hour shifts with and without excess of shift.

[Chisca, RN]

The study I referenced relied on self reporting of errors and if you have ever worked in an environment where punitive action is taken for reporting errors it is easy to see how nurses would under report errors. The 100,000 deaths per year from medical mistakes must be adressed by our profession and fatigue is an issue. No one works a 12 hour shift. My employer requires me to report at 0645 and I work until 1915. I may or may not get a lunch break. Only 1 out of 502 respondents in the study ever got off in time so that means nurses are really working 13 hours or longer. I have personally known two colleagues who died after falling asleep on their way home after 12 hour shifts and I wish their deaths could have somehow been prevented, but let's keep kidding ourselves that fatigue and 12 hour shifts are somehow not related.

And this doesn't even take into account that the authors played with their numbers in the same way a crooked accountant would

Funny the editors of the American Journal of Critical Care didn't notice this before publication. Maybe you should offer to be on their editorial board.

[MunoRN, RN]

The study I referenced relied on self reporting of errors and if you have ever worked in an environment where punitive action is taken for reporting errors it is easy to see how nurses would under report errors. The 100,000 deaths per year from medical mistakes must be adressed by our profession and fatigue is an issue. No one works a 12 hour shift. My employer requires me to report at 0645 and I work until 1915. I may or may not get a lunch break. Only 1 out of 502 respondents in the study ever got off in time so that means nurses are really working 13 hours or longer. I have personally known two colleagues who died after falling asleep on their way home after 12 hour shifts and I wish their deaths could have somehow been prevented, but let's keep kidding ourselves that fatigue and 12 hour shifts are somehow not related.

Funny the editors of the American Journal of Critical Care didn't notice this before publication. Maybe you should offer to be on their editorial board.

I agree that's another reason not to put too much faith in that study, although it wasn't based on errors/near errors reported to employers, the tracking was based on anonymous surveys the nurses sent directly to the authors of the study.

You are correct that 12 hour shifts often go beyond 12 hours, and 8 hour shifts often go beyond 8 hours. This "excess of shift" has been associated with increased risk of adverse events, and it's much more common with 8 hour shifts than with 12 hour shifts. Breaks are important for reducing adverse events regardless of shift length.

Driving home after night shift in particular is also an issue, but not necessarily more so with 12 hour shifts. Sleep deprivation is the main risk factor, and we know that an 8 hour schedule actually produces more sleep debt.

[tntrn, ASN, RN]

and how do we know that? It was certainly not the case in my personal experience.