Nurse 12 Hour Shifts Term Paper Samples

Introduction

The practice of overtime and prolonged working hours is an all too common phenomenon seen today in most occupational settings. Due to several reasons such a practice is indeed very common in health care settings. This work provides an overview of this issue from a nursing perspective. Recent research evidence is discussed and remedial measures are suggested to deal with the issue.

Problem statement

12-hour working shift by nursing staff is a very prevalent practice in health care settings across the globe. Several reasons contribute to this practice, including, staff shortage, cost considerations, continuity of care, convenience and greater flexibility for optimizing work-life balance. Opinion on the pros and cons of such a practice varies widely, including, among the nursing staff themselves. Given the critical, life-saving nature of nursing, the subject requires careful consideration so as to minimize its detrimental effect on efficiency, patient safety and nurse’s well-being and job satisfaction. (Griffiths, et al. 2014) (Rogers, et al, 2004) (Banks, et al, 2007) (Stimpfel, et al. 2013)

Background

A plethora of studies have investigated the effect of long working hours on employee performance, health and well being. (Hopcia, et al. 2012) (Stimpfel, et al. 2013) (Rogers, et al, 2004) (Banks, et al, 2007) Both anecdotal and published evidence suggests that longer than the normal working hours, has to a large extent, become a standard practice in health care settings. This is even more applicable to in-patient and critical care departments that require around-the-clock care. As against the traditional 8-hour shift, many nursing rosters have transitioned to a 12-hour work schedule. Indeed, 24-hour duty, 12-hours shifts, overtime work and extended work over weekends, are all too commonly in vogue. (Stimpfel, et al. 2013) (Banks, et al, 2007)

Work place perspectives

Several factors have propagated this practice. From an employer’s perspective, shortage of skilled staff, continuity of patient care, reduced number of handovers and better cost efficiency entailed in longer shifts, are the usual incentives for adopting such a practice. The assertion of saved time, by virtue of a reduced number of handovers in a day, appears to have sufficient rationale. (Griffiths, et al. 2014) (Rogers, et al, 2004)

Evaluating the evidence

Nursing care demands a high level of perceptual and cognitive ability besides quality of care, alertness and reflexivity. Extended duty hours, however, may considerably impair these faculties. The potential adverse effects of 12-hour shift may include, sleep deprivation, physical fatigue, mental exhaustion, reduced technical efficiency and higher propensity for errors besides emotional and behavioral disturbances. (Stimpfel, et al. 2013) (Griffiths, et al. 2014)
Much evidence supports the view that 12-hour shift compromises patient safety. (Banks et al, 2007). Indeed, overtime work and extended shifts among nursing staff have been associated with poor patient outcomes and errors of judgement. (Griffiths, et al. 2014) (Rogers et al, 2004) Healthcare accreditation organizations, too, have from time to time voiced the adverse fall out of excessive workload and duration. (Joint Commission, 2012)
A large international survey across twelve European countries adequately captures the employee perspective on the longer duration work shifts. (Griffiths, et al. 2014) The cross-sectional study surveyed 31,627 registered nurses in 488 hospitals across 12 countries. The aim was to assess self perceived quality of care by nurses and whether they perceived a decline in quality owing to longer duty hours. More importantly, nurses working overtime, or those working in shifts in excess of 12 hours, reported their own performance as below-par in terms of quality of care as well as patient safety. The study clearly reflects that continuous 12-hour working shifts may not be desirable as the risks far outweigh the benefits. (Griffiths, et al. 2014)
Other studies have shown the hazard of extended duty hours on the nurse’s own physical safety. A case-control study by Hopcia, et al. (2012) demonstrated a robust inverse correlation between prolonged working hours and the nurse’s technical competence and physical safety. Nurses working for longer time have a higher predilection for sustaining inadvertent injuries and work place accidents (e.g., skin cuts, needle stick injuries, etc.). Lastly, it has also been shown that overworked nurse is a stressed nurse. This may not bode well for the nurse’s own job satisfaction. (Stimpfel, et al. 2013)
However, there are some studies that have produced unequivocal results. Indeed some researchers claimed that 12 hour shifts may in fact be associated with better outcomes. This is likely to be relevant in duties involving a high level of skill, e.g., intensive care units and post surgical care. Better continuity of care and lesser handovers could result in improved patient care. (NHS Evidence 2010)

Suggestions

Given the diversity of opinion and research evidence a management approach to nursing should take a holistic view of the subject. Some of the considerations are briefly mentioned below
Consideration of nurse’s personal circumstances: A number of variables effect work performance. These include age, sex, family status and health status. These factors should be factored in work scheduling.

Better scheduling: Optimally planned work and leave days to provide sufficient time between duties.

In critical care and other in-patient settings, 12-hour shift may have definite advantages. Staff selection for key positions should be carefully done in light of job demands.

Further, timely handover and relieving of duties after a 12-hour shift may help the comfort level of nurse.

Frequent and regularly spaced breaks should be accommodated in order to ameliorate work stress.
Good management and ergonomic support for ensuring a safe and nurse-friendly working environment.
Staff facilities (like staff rooms, refreshments, etc.) can go a long way in improving staff morale
Open communication between supervisors and supervisees can improve job satisfaction, and thereby, improve performance.
Additional contractual staff may help by assisting nurses in sundry tasks
Conclusion
Given the critical nature of nursing role, the issue of duration of duty shifts should be considered in an impassioned manner. The ethical principle of non-maleficence should be manifested in all aspects of health care. An overworked and tired nurse is a hazard for both the nurse and the patients. Extended working shifts are more prone to cause errors of omission as well as errors of commission. The profession of nursing requires good physical, mental and social health. Under ideal circumstances, 8-hour work schedule should be the norm as shifts of longer duration are likely to be harmful to the patient and the nurse’s own well being. However, due to several reasons listed in this review, there is enough merit in adopting 12 hour shifts in certain settings. In less than ideal situations, like in settings with human resource shortage, financial constraints, etc, it may be better to adopt a 12 hour schedule. The decision should be made in consultation of all stakeholders. Technical competence, attributes and personal circumstances should be taken into consideration while preparing work schedules.

References

Banks S, Dinges DF. (2007). Behavioral and physiological consequences of sleep restriction. Journal of Clinical Sleep Medicine. 3(5):519–28.
Caruso, C C. (2006). Possible broad impacts of long work hours. Industrial Health; 44(4):531-6.
Griffiths, P, Dall’Ora, C, Simon, M, Ball, J, Lindqvist, R, Rafferty, A-M., Aiken, L H (2014). Nurses’ shift length and overtime working in 12 European countries: The association with perceived quality of care and patient safety. Medical Care, 52(11), 975–981. doi:10.1097/MLR.0000000000000233.
Hopcia, K, Dennerlein, J T, Hashimoto, D, Orechia, T, & Sorensen, G (2012). A case-control study of occupational injuries for consecutive and cumulative shifts among hospital registered nurses and patient care associates. Workplace Health & Safety, 60(10), 437–444. doi:10.3928/21650799-20120917-39
NHS Evidence. (2010). Moving to 12-hour shift patterns: To increase continuity and reduce costs. Basingstoke and North Hampshire NHS Foundation Trust.
Rogers A E, Hwang W T, Scott L D, Aiken L H, Dinges D F. (2004) The working hours of hospital staff nurses and patient safety. Health Affairs. Jul-Aug;23(4):202–12. [PubMed]
Stimpfel, A W, Lake, E T, Barton, S, Gorman, K C, & Aiken, L H (2013). How differing shift lengths relate to quality outcomes in pediatrics. The Journal of Nursing Administration 43(2), 95–100. doi:10.1097/NNA.0b013e31827f2244.
Stimpfel, A W, Sloane, D M, & Aiken, L H (2012). The longer the shifts for hospital nurses th the higher the levels of burnout and patient dissatisfaction. Health Affairs. 31(11), 2501–2509. doi:10.1377/hlthaff.2011.1377.
The Joint Commission. (2012). Sentinel event alert #48 Health care work fatigue and patient safety. [Internet] Oakbrook Terrace, IL: 2011. (Accessed Jan 25, 2014). Available from: http://www.jointcommission.org/assets/1/18/SEA_48.pdf.