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Discussion

That Dreaded 3-11 Shift

  • Expert

One of my patients, a hard-nosed nurse who retired from the profession after more than 30 years of duty, struck up a conversation with me not too long ago about shift work.

"What hours do you work?" she interrogated. Her New Jersey accent was notable, especially considering the fact that southern drawls are the most common intonation in the geographic region where I live and work.

I replied, "I work from 6 o'clock in the evening until 6:30 in the morning."

She chimed, "Those are hard hours, but they seem a hell of a lot better than the 3-11 shift. I worked the 3-11 shift back in the days when all TV programming would cut off at midnight. Once midnight struck, all of the channels would repeatedly play the instrumental version of the Star-Spangled Banner. Nowadays cable TV has shows and movies 24 hours a day."

"I used to work the 3-11 shift," I added. "In fact, I worked those hours at my very first nursing job after graduating from school. Personally, I wouldn't go back to working that shift unless I was about to become homeless."

"You crack me up," my patient laughed. "I got off that shift as soon as possible. It took up most of my afternoon, all of my evening, and part of my night. I was glad when the hospitals finally went to the 12-hour shifts."

This recent conversation got me thinking about shift work. Many hospitals made the conversion from 8-hour shifts to 12-hour shifts many years ago, primarily because of difficulties maintaining adequate staffing on the 3-11 shift. The main issue with going back to 8 hour shifts is keeping the 3-11 shift covered because relatively few nurses like to do it full-time anymore. This shift is simply not conducive with family life, especially if one has school-aged children. In addition, many childless singles (myself included) do not particularly like this shift.

To be fair, there are people out there who absolutely love working the 3-11 shift. Moreover, some nurses contend that they cannot handle 12-hour shifts due to fatigue during the last four hours. Also, a study or two has implied that 8-hour shifts are actually safer.

12-hour shifts have their benefits because they eliminate the need for one additional shift change per 24-hour period. This may improve continuity of care since errors due to skipped information are reduced as the result of two nurses receiving report in a day instead of three. Likewise, many nurses prefer 12-hour shifts because they enable one to have up to four days off per week. Besides, 12-hour shifts may help to simplify staffing at healthcare facilities because only two shifts need to be covered instead of three.

I now work 12-hour shifts because I prefer them since there's no way I'd want to be at the bedside five days per week. Anyhow, I was never able to establish a routine while working the 3-11 shift. If left to my own devices, I awakened at noon, slowly got ready for work, worked the shift, then arrived home sometime before midnight and watched television or did mindless internet browsing until 4am before settling down to go to sleep. I was able to create a solid routine when I worked midnights (11-7am) or days (7-3pm), but my time largely went to waste when I worked evenings.

In summary, many healthcare facilities went to 12-hour shifts for specific reasons that revolved around their struggles to staff the 3-11 shift. Countless nurses love 8-hour shifts and many others are fond of 12-hour shifts, so it would be ideal if facilities devised a happy medium to satisfy all parties.

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    I used to work a non-nursing job 3-12 Tues-Sat and I have to say that I loved it. I was young and single and would go to bed around 1, wake up at 9, work out then lay by the pool until 2 before going to work. I'd party Sat nights after work, sleep all day Sunday, do all errands on Mondays then go back to work lol. But. . .married with kids now. . .I could never do that shift.

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    I'm married with 3 young kids and work 3-11's.

    I only work part-time, so 3 shifts/week.

    The only reason I haven't applied to day shifts that have come up, is that then I am risking working 12's on my weekends/holidays, and it just isn't worth it to me!

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    My son loves the 3-11 shift as he has always disliked the mornings and loves to sleep in...:sleep:

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    I work the dreaded pm shift. I liked it for many years, but now I am beginning to greatly dislike it. What I like about it was the extra shift differential, and having some time during the morning to run errands even on work days. I like being home in the mornings with my kids (who are of preschool age). Now that I have kids, pm shift is wearing on me. It's not like I can go right to sleep soon as I get home on work nights, so my bedtime is quite late 2-3 am...resulting in a horrible lack of sleep if I have to get up with the kids at 7, or sleeping the whole morning away (if my husband is home). On my days off, my family has a hard time with me not being able to "flip" right into their sleep schedule. It is near to impossible to be expected to go to bed at 2 am for 4-5 nights in a row and suddenly go to bed at 10 the next few nights & rise at 7am. I have worked all the shifts. I guess pm shift worked for me when I didn't have kids, but now I am wanting dayshift or a much earlier pm shift, if that even existed. Night shift I have done, but I'm not a night person, and I never got any sleep on that shift either. Also, on pm shift...in med/surg units you get the lucky task of discharging a bunch of patients only to get 1-3 admits and a bunch of post ops. Good points of discussion here. I'm all in favor of getting more sleep, so that's my new agenda. More sleep & less stress in 2013. :-)

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    My vote goes to 12 hour nights. Love 4 days a week off. Nights are usually much quieter than days in the ICU. No docs, fewer family members, fewer discharges. It's not that I'm lazy. It's just that I am getting older and enjoy less chaos. My kid is grown and my husband is semi-retired so it gives us a lot of freedom to do things together. The wonderful thing about nursing is there is a shift for just about everyone.

    And I do think that continuity of care is improved with just 2 nurses giving report.

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    I actually like the 3-11 shift but only cos my my OH can pick up kids from after school care. I can drop them at school, get some errands done, walk dog and sleep if I want. Mind you I am only casual(prn) and pick my shifts. I have spent 20 yrs doing 12 hrs (3 per week) and pre kids loved it. Now I am in NZ doing 8 hr shifts and feel so much better for them. I get 1/2 hr lunch and 20 mins tea in a 8 1/2 hr shift. Crap pay but better conditions!

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    Hi, I love this shift too. And I dream I will find a job with 3-11 shift next year. I get up at around 10 a.m. and go in bed at 2 a.m. I can hardly work 8-5 shift - it is a nightmare for me. I learned this when I agreed to work these hours some years ago. I was tired and frustrated all the time ( in the morning and in the evening).

    So, I hope 3-11 shift won't disappear from our life )))

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    For 12 hour shifts I have started using personal assistants at home.

    I do prefer 8 hr shifts. . .no drain on you.

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    Just thought I'd chime in. I worked 4-1230 at a previous job and absolutely fell in love with the second shift lifestyle. This was pre-kids. Now with kids (if I had a job), 2nd shift would still work great. I could get up early and do volunteering in classes, field trips, be home all day for summer vacation and not have the tricky time of trying to have 2 kids running around all day while I just worked all night. Or I could get up, get them to school, and go back to bed for another couple hours. I'm fairly lucky in that when I got home at 1am, I'd take a shower, read for a little while and would be out before 2:30am. For a while I worked a second job from 7:30am -11:30am while working he 2nd shift. That wasn't too bad either, I just had a cycle of napping that kept me fresh.

    When I graduate and get a job I'm hoping for 3-11!

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    I've worked 3-11 with previous careers, and I detest this shift for the same reasons you mention, Commuter. Such a waste of my life! No time for anything substantial, and too late to plan much of anything at midnight. It's either days or nights for me.

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    12 hour shifts forced me to "retire" from my beloved Labor and Delivery job. LTC has 8 hour shifts and that works so much better for me, and although I miss the excitement of L&D the exhaustion of those last four hours was not a good thing. When you're that tired, it's easy to miss subtle changes or trends that may be important.

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    • Expert
    GrnTea said:
    I hate twelves for many reasons, none of them personal. Sure, I'd be happy to work just three shifts a week for full pay and benefits and call the rest of the week my own. But you know what? The patient care sucks. When everyone works two on, one off, one on, three off, or some variation thereof, there's no continuity of care for the long-term patients that need it the most. That leetle hint that something is about to go wrong gets missed if the patient has six different nurses in three days. Remember that horrific series of chemo overdoses in Boston a few years back? One person, a beloved columnist for the Boston Globe, died after getting a four-fold OD for four days in a row by four different nurses, IIRC, because nobody knew that her reactions were escalating and a few others (not so celebrated) got bad cardiomyopathy, which did a number on their cancer survival.

    I'm another person who has always preferred 3-11 shifts, for all the reasons noted by others -- but I'm glad someone else already brought up the issue of how 12s affect client care (which I was going to do). I work in psych, and, back when we all worked 8s and worked 5 days/week, all the nurses knew what was going on with all the clients on the unit. Now, with 12s and working just 3 days/week, spread out pretty randomly, on any given shift, there may be no one who has any significant experience or rapport with any of the individual clients. You come in to work, there is a whole new "crop" of clients since the last time you worked, it takes nearly the entire shift to work out who's who, what each client's story is, and what's going on with them today, and then you leave and someone else goes through the same process the next day. No one ever gets familiar enough with the clients to move past the introductory phase of the therapeutic relationship and do any real work with them. When things start heating up on a psych unit, the therapeutic alliance/relationship that someone (staff) (already) has with the client makes a big difference. And clients don't like that they see a constant parade of different faces from day to day, with little continuity or consistency.

    Also, I now work on a psych consultation-liaison service in a large general hospital (where the nurses work 12s). Nearly every time I'm trying to find out something about how a client has been doing over the last few days, not the VS or meds or stuff I can look up in the chart, but mood, how well s/he has been sleeping, interaction with staff and family members, etc., the answer I get is, "Gee, I don't know, I've only had this person since this morning. Never saw her/him before today" (and, apparently, nothing I'm interested in gets staffed through in report ...)

    I realilze that many (most?) nurses prefer working 12s, but I agree that it is detrimental (in several different ways) to the care we provide to clients.

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