March 28, 2011

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Are 12-hour shifts safe?

Welcome to guest blogger Donna Cardillo!

Donna Cardillo, MA, RN

12-hour shifts have become the norm in hospitals and most nurses love them. One can work 3 days and have 4 days off, there is one less major shift change to contend with, and patients have fewer names and faces to get acclimated to in a 24-hour period. It all makes sense on the surface.

But is working 12 consecutive hours in a fast-paced, high stress, physically and mentally demanding environment a good idea? Does it support the clear judgment, quick thinking and reflexes, and life and death decisions that we must make in the acute care setting?

I know a few nurses who do three 12-hour shifts a week, at least two of the shifts on two consecutive days. Some nurses do three consecutive 12s. Factor in commuting time, shift transition (it can sometimes take 1-2 extra hours to actually finish up), time to get ready for work—never mind making time (if at all) for family or self and they’re lucky to get 5-6 hours of sleep if that. Compound that with the fact that many nurses no longer take meal breaks or even short breaks during their shift to rest and refresh because they believe they don’t have the time or they don’t make the time. This is a recipe for disaster.

A recent survey commissioned by CareerBuilders shows that nurses are one of the top ten professionals who depend on coffee to get through their workday. Is it acceptable to have to ply ourselves with stimulants to do our jobs? Caffeine is an addictive substance. It stays in our system for up to 10 hours and can cause insomnia or can reduce the effectiveness of the precious little sleep we get.

I once heard from a nurse who was irate when a new director of nursing came to her facility and ended the practice of working two 16-hour shifts on Saturday and Sunday. I don’t even want to think about that nurse’s ability to do her job well, especially on the second day. Fortunately, the practice was stopped against protest but I know it still exists in other facilities.

In addition to the issue of our fitness to practice while on duty, what about our degree of alertness while driving to and from work while working 12-hour shifts? Then there’s the issue of the long-term wear and tear on our physical and mental health. We are not machines and we are not indestructible. Yet we are pushing ourselves, and those who work for us, beyond the limit of what humans are capable of short-term and long-term.

Many studies have been done over the years to support my assertions and my concerns. A recent study done by the University of Maryland concludes that the odds of making patient errors increases three-fold when nurses work 12-hour vs. 8.5-hour shifts.  But how many studies need to be done, how many patient errors need to be made, how many nurses need to get sick, injured, burnt out or worse before we consider alternative work schedules? The health and safety of both nurses and patients hangs in the balance.

Donna Wilk Cardillo is the Career Guru for Nurses and “Dear Donna” columnist for Nursing Spectrum, NurseWeek, and www.nurse.com. Donna is also an ‘Expert’ Blogger at DoctorOz.com. She is author of The ULTIMATE Career Guide for Nurses, Your 1st Year as a Nurse, and A Daybook for Beginning Nurses. Ms. Cardillo is creator of the Career Alternatives for Nurses® seminar and home-study program. You can reach her at www.dcardillo.com.

76 thoughts on “Are 12-hour shifts safe?”

  1. h2cm says:

    I now work on the community 9-5, but remember such shifts and split days. My son does 7 – 7. Safety is an issue, it also depends upon breaks and staff nos. to allow breaks to be taken. Thanks for this Donna I’ll visit this using the lens of the health care domains model http://hodges-model.blogspot.com/
    As you note here I must include physical, mental, + social and political. Locally some staff have had to be re-deployed due to extended shifts.
    Peter Jones
    http://hodges-model.blogspot.com/

  2. Sean says:

    I think anything in moderation. I do however believe a 16 hr shift – especially scheduled is pushing the limit!
    The pace of the environment does not allow for safe practice. I don’t care how much caffeine you decide to consume.
    We as professionals need to understand and accept a limit regardless of how convenient the shift may be with scheduling.

  3. Sean says:

    I think anything in moderation. I do however believe a 16 hr shift – especially scheduled is pushing the limit!
    The pace of the environment does not allow for safe practice. I don’t care how much caffeine you decide to consume.
    We as professionals need to understand and accept a limit regardless of how convenient the shift may be with scheduling.

  4. Older RN says:

    I understand younger nurses wnat to have more days off per week but what I don’t understand is having one’s kids in daycare so many hours a week to accomodate the 12 hr schedule. When my kids were preschool age, I worked a 15-23 shift and my kids were in daycare about 3.5 hrs per day/4 days per wk = 14 hrs/wk vs 12-14 hrs/day in day care 3 days/wk. When they started school, I moved to day shift and was able to get home in time to meet them off the bus. 12 hrs are LONG shifts & hard to work…

  5. Older RN says:

    I understand younger nurses wnat to have more days off per week but what I don’t understand is having one’s kids in daycare so many hours a week to accomodate the 12 hr schedule. When my kids were preschool age, I worked a 15-23 shift and my kids were in daycare about 3.5 hrs per day/4 days per wk = 14 hrs/wk vs 12-14 hrs/day in day care 3 days/wk. When they started school, I moved to day shift and was able to get home in time to meet them off the bus. 12 hrs are LONG shifts & hard to work…

  6. starby says:

    I have worked 8 hour shifts for years, and recently got hired at a facility that is only 12 hour shifts for the RN’s (CNA’s and some LPN’s have 8 or 10 hour shifts). I LOVE it! I am able to do everything I need to do, AND have time to simply sit and spend time with my patients and their families. The difference, we have a nurse-patient ratio of about 3-4 per nurse. LESS errors are made, better quality of care is given, and ALL the nurses at my facility LOVE their job.

  7. starby says:

    I have worked 8 hour shifts for years, and recently got hired at a facility that is only 12 hour shifts for the RN’s (CNA’s and some LPN’s have 8 or 10 hour shifts). I LOVE it! I am able to do everything I need to do, AND have time to simply sit and spend time with my patients and their families. The difference, we have a nurse-patient ratio of about 3-4 per nurse. LESS errors are made, better quality of care is given, and ALL the nurses at my facility LOVE their job.

  8. senior nurse says:

    This article puts blame on the nurse for the terrible working conditions in US hospitals. The issue is hospital management understaffing so severely that conditions are not safe for nurses to take breaks. ANA must advocate for staffing that allows for an extra nurse to take over the care of the patient while the nurse is away from the bedside. With rest breaks and meals 12 hours shifts are safe. Hospitals make money on understaffing, don’t continue to blame the bedside nurse.

  9. senior nurse says:

    This article puts blame on the nurse for the terrible working conditions in US hospitals. The issue is hospital management understaffing so severely that conditions are not safe for nurses to take breaks. ANA must advocate for staffing that allows for an extra nurse to take over the care of the patient while the nurse is away from the bedside. With rest breaks and meals 12 hours shifts are safe. Hospitals make money on understaffing, don’t continue to blame the bedside nurse.

  10. llou says:

    There is a problem with some of the research. It simply compares shift lengths as they are currently found — with no consideration of the amount of break time allowed, etc. Perhaps 12-hour shifts would be safer if there were sufficient staffing to take a break. We also need to look at the number of 12’s in a row. A lot more studies need to be done before we will have enough data to make broad decisions. There are more questions to be asked and answered first.

  11. schnattchen says:

    I’ve been working for over twenty years in a German hospital with more than 2000 beds in a three-shift-system on an ICU.I think no one could work a 12 hour shift due to the amount of work and the severity of diseases.Sometimes I would like to do for more leisure time in between but in the reality it wouldn’t be an option. I think it depends on the requirements and more flexibility would be an option

  12. Marie says:

    Let’s go with the evidence. I know that many nurses find working 12-hour shifts vastly more convenient, but if well-designed, rigorous studies show that it’s less safe for our patients and less healthy for ourselves, then let’s stop — and figure out ways to ensure that our 8-hour shifts really are 8 hours long, instead of 8 hours plus time to finish up those last tasks. Or maybe there’s some third alternative – 10-hour shifts, with some overlap of personnel between shifts? 6-hour shifts?

  13. Anonymous says:

    I have worked as an RN for 35+ years. There have been numerous studies on circadian rhythms, yet when a nurse has difficulty adjusting to work the night shift it would be the exception if they were pulled to the Day shift. We are all individuals. Having worked 8 hr shifts and 12 hr shifts I prefer a 12 hr shift.New nurses working 8 hr shifts usually stay 2 hrs more UNPAID to complete their tasks.We are professionals treat us as such, let us decide what schedule works best!

  14. Anonymous says:

    In May of this year my 40 year old plus colleagues and I were forced to work 12h shifts. Our only option was to quit.We attempted to discuss it with our VP of nursing, but she refused to speak with us. Now everyone is miserable, not to mention tired and exhausted and experienced nurses are looking for other jobs. If hospitals want to be marketable its just not Magnet status that makes them employers of choice, they have to offer choice and flexibilty to their most valuable assets, their nurses.

  15. Jean says:

    I’ve been working in the nursing profession for 16 years, and I have to agree with the tone of this story. I find a 12 hour shift is tiring, and that mistakes are still made, the computeritzed charting has not improved patient care all that much, and the basic problems that abound during the shift; medications and errors, family members in that they are easily forgetting that nurses still have a ratio of 4 to 6 patients to care for, especially, since the pt turnover is tremendous…

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