30nursingnthriving-blog

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What is the controversy and why is it relevant?

There is a lot of controversial issues relating to healthcare today especially in the area of nursing. One of the popular controversy is the debate for the long shifts with nurses.

According Amy Witkoski at the University of Pennsylvania School of Nursing, “the regular 8 hour shifts for hospital nurses is starting to become extinct”. But why is this the case now?

Long shifts are becoming more popular due to the following reasons:

Hospitals are understaffed with nurses

Long shift schedules are easier to manage

Work life balance (for some nurses)

Lower cost in terms of staff salary

As a student nurse myself, I am certainly interested to know more about this topic to prepare myself from working in the hospital. As we all know pilots, construction workers, truck drivers, and other public service workers are protected by working hour laws.

The case is not the same for our nurses, each state has different rules about working laws for nurses and some depends on the Institution’s policies.

So lets take a look about what a long shift entails along with the benefits and disadvantages.

What are the available working schedules for nurses?

The “perfect shift” still depends on the nurses’ need depends on their need and preference but as it shows in the pie chart above the top two models in North America belongs to the longer shifts. Some nurses also talks about how shifts can easily become a 13-14 hour shifts.

The long shift in particular is a hot topic because not only it affects both nurses and patients, in addition there is a lack of national hour work policies for registered nurses. To give you an idea of the PROS and CONS of working long shifts, I will give you the breakdown of all view-points in this blog post.

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What are the advantages of 12-hour or longer nursing shifts?

It is easier for efficiency and work life balance when working long shifts

Working 12 hours or more help nurses with work life balance

12 hour shifts give nurses the opportunity to work at night and helps with travel staying away from “Peak hours”.

For nurses who have kids, it is easier to manage child care.

With longer shifts, there are less hand offs and scheduling headache for management

Nurses working long shifts mentioned that less hand offs help with maximizing their time in the floor with patients.

Less hand-off between nurses means less training required and errors due to shift change.

Studies suggested that working 12 hours or more increase both work continuity and accountability

Long shifts for nurses help with recruitment and retention strategies.

With long shifts time differential really does make a difference

In California nurses in hospitals earn $10 more per hour to work overnight.

In some settings, the workload is much less at night and more pay.

Fresh graduate nurses prefer night shift to pay off student loans.

What are the disadvantages to working 12-hour or longer nursing shifts?

-a nurse testimony on burnout

Working long shifts has been linked to burnout and patient dissatisfaction

According to health affairs, “nurses who works more than ten hours” are likely to leave their jobs than those who work shorter shifts.

In a study conducted involving ICU nurses patients reports dissatisfaction with the nurses.

Patient reports the lack of pain management  with the nurses who work 12 hours or more.

Working Long shifts has been associated with health risk and cancer

Working night shifts disrupts circadian rhythm where melatonin is created which inhibits cancer cell growth.

Female night shift workers were 41% more likely to get skin cancer, 32% more likely to get breast cancer and 18% more likely to get gastrointestinal cancer.

According to the CDC, there is a correlation between miscarriage among women who works night-shift. Long hours are also linked to preterm delivery, menstrual disorders and hormone irregularity.

-Short video about the Risk of Long Shifts for nurses

Long shifts for nurses has been associated with vehicular accidents

According to U.S. Army studies, staying awake for 17 hours is functionally equivalent to having a blood alcohol concentration (BAC) of 0.05%.

Sleep deprivation and fatigue are linked to unsafe driving practices among nurses.

Needle-stick injuries increased significantly in nurses working 12-hour shifts compared to those working 8-hour shifts.

Medical errors account for 98,000 preventable patient deaths annually.

-Article and video about a nurse in Ohio who died in a vehicle accident after working 12 hour shift.

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What are the reactions of the actual nurses in the field about the 12-hour or longer nursing shifts?

To take the research and data gathering further, I interviewed some nurses coming from different departments from different hospitals and ask them the following questions:

Do you work long shifts (more than 12 hours)?

Are you a PRO/ANTI 12-hour or longer nursing shift model?

Why are you Pro/Anti working 12-hour or longer shifts?

And here is what they have to say:

1. “Not working long shifts regularly But sometimes if needed, I’m anti with this, because long hours opens room for errors. It is Physically tiring and mentally draining. Physical and mental plays a big role to nurses in order to stay focus and give the best care possible. “

- (GL, Hospice Nurse, 4 years of service)

2. “I work 8 hour shifts in a med-surgical/telemetry unit specializing in stroke patients. I personally am not in favor of working more than 12 hours. With the intensity of nursing care in an acute setting, extended shifts may lead to fatigue and burnout, which may compromise patient care. The risk of adverse effects is possibly greater as well because of mental and physical exhaustion. Nursing is a career that is extremely demanding and the strains of long shifts can manifest mistakes in great consequences.”

-(PG, Med-Surgical/Temetry Nurse, 7 years of service)

3. “I am pro-12hr shifts (that includes off in between days, 2days on then off,back for 1) i think it may decrease nurses' burnt out. I firmly believe it helps with the continuity of care and less confusing hand offs.”

-(SA, GI Motility Nurse, 3 years of service)

What does recent studies say about 12 hours or longer nursing shifts?

-A video about a study conducted in Washington comparing day and night shifts as well as their effects.

Recent studies shows that long shifts is associated with sleep deprivation which is also linked to family stressors.

Long shifts are associated with sickness absences among nurses.

A study in Europe propose that long shifts reduce education opportunity and discussion of patient care which may “jeopardize the quality and safety of care for patients.

Resources

1. Battle, C., & Temblett, P. (n.d.). 12-Hour nursing shifts in critical care: A service evaluation. Journal of the Intensive Care Society, 19(3), 214–218.         https://doi.org/10.1177/1751143717748094

2.Clissold G, Smith P, Accutt B, & Di Milia L. (2002). A study of female nurses combining partner and parent roles with working a continuous three-shift roster: the impact on sleep, fatigue and stress. Contemporary Nurse: A Journal for the Australian Nursing Profession, 12(3), 294–302. https://doi.org/10.5172/conu.12.3.294

3. Ericksen, K. (2016, March 8). Retrieved from                        https://www.rasmussen.edu/degrees/nursing/blog/nursing-debate-8-hour-shifts-vs-12-hour-shifts/

4.Gaines, K. (2017, December 20). The Pros And Cons To Working “Only” 3 Days A Week. Nurse.org. Retrieved from https://nurse.org/articles/nurses-three-days-a-  week/

5.Hansen, J. (2017). Night Shift Work and Risk of Breast Cancer. Night Shift Work and Risk of  Breast Cancer. doi: https://doi.org/10.1007/s40572-017-0155

6.Harris, R., Sims, S., Parr, J., & Davies, N. (2015). Impact of 12 h shift patterns in nursing: A scoping review. International Journal of Nursing Studies, 52(2), 605– 634. https://doi.org/10.1016/j.ijnurstu.2014.10.014

7. Ingstad, K., & Amble, N. (2015). Less job stress with 12-hour shifts. Nordic Journal of Nursing Research, 35(3), 152–157. https://doi.org/10.117/0107408315584705

8.Miranda , M. (2017, June 12). Farmington / Nurse avoids jail in fatal accident . Farmington / Nurse Avoids Jail in Fatal Accident . Retrieved from https://www.twincities.com/2007/06/12/farmington-nurse-avoids-jail-in-fatal-accident/

9.NIOSH. (2010) Risk of Long Shifts for nurses. (2010). Retrieved from        https://www.youtube.com/watch?time_continue=84&v=grQASOagynA&feature=emb_title

10. Parkinson, J., Arcamone, A., & Mariani, B. (2018). A pilot study exploring rehabilitation nurses’ perceptions of 12-hour shifts. Nursing, 48(2), 60–65.           https://doi.org/10.1097/01.NURSE.0000529817.74772.9e

11. REPRODUCTIVE HEALTH AND THE WORKPLACE. (2019 28). Retrieved March 31, 2020, from https://www.cdc.gov/niosh/topics/repro/workschedule.html