For decades, nurses have worked long hours and extended work shifts. Recently, especially in a hospital setting, shifts of 12 hours or longer are the most common practices. In fact, 75% of hospital nurses work 12-hour shifts today (Townsend & Anderson, 2013). Many nurses are in favor of working 12-hour shifts due to the fact that the longer shifts give them only a three-day workweek and allow them more time at home (University of Maryland, 2010). In addition, employers prefer 12-hour shifts because of the lower staffing costs (Nelson, 2012). However, despite their popularity, the long hour shifts can have adverse effects on both nurses and patients (Keller, 2009). These adverse effects can result in severe damages or death and shouldn’t be ignored.
According to an article by the University of Maryland (2010), instead of the standard 8-hour shifts, 12-hour shifts started in the 1970s and 1980s when it was implemented to retain staff during a serious nursing shortage. Schedules shifted from 5 days per week to 3 days per week and therefore nurses started to appreciate having more time off and also saving on their commuting expenses (Sherman, n.d.). Hospitals started to provide nurses more benefits and bonuses and all this eventually lead to a predominance of 12-hour shifts (University of Maryland, 2010). The long shifts have continued to gain popularity over the years (Nelson, 2012). Sherman n.d warns that although 12-hour shifts may benefit nurses, they can also have negative effects on nurses’ performance that could lead to negative patient care outcomes (Sherman, n.d.).
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Consequences of extended work hours on the nurse
As Keller (2009) has noted, studies indicate that 12-hour shifts affect nurses’ health and well-being negatively. Nurses are more likely to experience fatigue and are at greater risk for making errors, incidents, and accidents (Keller, 2009). Since the productivity of a worker falls notably after the first 10hours of working, the nurse become more prone to mistakes as the time goes by. Due to fatigue the nurse is most likely to experience sleep deprivation, reduction in memory, vigilance, reaction time, information processing and decision making. A tired nurse will often be distracted, interrupted, communicate ineffectively and deviate from the acceptable standards of practice. This will in turn lead to system failure and incompetency at the work place including preventable deaths. In addition, nurses who take longer than 12 hours per shift run a risk of temporary memory deficits and diminished cognitive functioning (Townsend and Anderson, 2013).
Furthermore, Keller (2009) reports that 12-hour shifts have more adverse effects on nurses’ health other than just fatigue. Extended work hours make nurses more prone to chronic diseases such as diabetes, cardiovascular disease, and hypertension. A predisposition to having these chronic diseases could lead to disabilities that may require early retirement. The nurses may also experience gastrointestinal disorders, minor psychiatric issues, sleep disorders, and social. In addition, some studies have found a relationship between extended work hours and depression of the body’s immune system (Keller, 2009).
Consequences of extended work hours on the patient
Keller (2009) noted that nurses who work in excess of 8 hours report more medication errors, difficulty staying awake and actually falling asleep during work hours, a decrease in productivity, and increased risk of errors and near errors associated with decreased vigilance. Studies report that approximately 98,000 annual patient deaths that are preventable occur because of medication errors (Townsend and Anderson, 2013). According to Reece (2011), a population-based longitudinal study indicated the likelihood of needle-stick injury remarkably increased when nurses worked 12 or more hours versus 8 hours a day. Two studies reported a widespread occurrence of Staphylococcus aureus infections, which related to frequent mistakes and procedural errors caused by nurse fatigue (Reece, 2011).
Reece (2011) also cites another study that reported patients cared for by overworked nurse were more likely to visit the emergency department after discharge due to a lack of quality in the discharge planning and teaching. Another study pointed out, in hospitals where nurses worked shifts of 12 hours or longer without adequate breaks, deaths of pneumonia were more likely to occur. In addition to that, the extended work hours were closely linked to more patient deaths from heart failure during recovery from abdominal aortic aneurysm repairs (Townsend & Anderson, 2013).
Individual Accountability among the Nursing Professionals
In order to provide quality nursing care, patient safety should always come first and it is an essential and vital component. Nurses always play an important role in delivering quality care and providing patient safety. Individual accountability is also important in order to provide safe patient care and professional nurses must be accountable for their own actions. Many studies show 12-hour shifts cause nurses more fatigue than 8-hour shifts, which puts them at risk of making errors that jeopardize patient safety (Nelson, 2012). As health care professionals, nurses must strive to improve patient care and safety and decrease the risk. In order to enhance patient- centered care, nurses have to take some responsibility to recognize their professional responsibility not to work beyond what is reasonable even though extended work hours may be more preferable for them (Nelson, 2012).
Conclusion
12-hour shifts were introduced to hospital setting back in 1970s and 1980s (University of Maryland, 2010). Ever since then, nurses have worked extended work shifts of 12 hours or longer and the 12-hour shifts have been gaining popularity among nurses and hospitals because of their social, economical, and employment benefits (Nelson, 2012). However, despite the popularity, there is a big downside for both nurses and patients and many studies have shown and confirmed that there are serious negative effects associated with extended work hours (Nelson, 2012). Shifts beyond the traditional 8 hours increase nurse fatigue that decreases alertness and productivity and puts nurses at greater risk for making errors, incidents, and accidents (Keller, 2009). The evidence is clear that 12-hour shifts present significant risks to patient and nurses and the risks shouldn’t be overlooked.
References
Keller, S. M. (2009). Effects of extended work shifts and shift work on patient safety,
productivity, and employee health. AAOHN Journal, 57 (12), 497-502. doi: 10.3928/08910162-20091124-05
Nelson, R. (2012). Long work hours for nurses. AJN, American Journal of Nursing, 112 (5), 19-20. doi: 10.1097/01.NAJ.0000414310.10965.f4
Reese, S. M. (2011). 10 ways to practice evidence-bases staffing and scheduling. Nursing Management, 42 (10), 20-24. doi: 10.1097/01.NUMA.0000403286.72991.4c
Sherman, R. O. (n.d.). The dilemma with the 12-hour nursing shift. Emerging RN Leader .
Retrieved from http://www.emergingrnleader.com/12-hournursingshift/
Townsend, T. & Anderson, P. (2013). Are extended work hours worth the risk? American Nurse Today , 8 (5), 8-11.
University of Maryland. (2010, June 8). Study reveals widespread fatigue, risk for errors with 12-hour nursing shifts . Retrieved from http://www.oea.umaryland.edu/communications/news/?ViewStatus=FullArticle&articleDetail=955
