Effects of Working Long Hours in Nursing
Betsy Martinez
NUR 4130: Professional Nursing Practice
Professor Kilts
New York City College of Technology
April 3, 2019
There have been many advances in the healthcare system over the past few years. One of the major transitions in the healthcare system has been the replacement of eight-hour nursing shifts with twelve-hour shifts. About 60% of nurses in the United States work twelve-hour shifts (AMN Healthcare, 2019). It has become a controversial topic among nurses because some are in favor of this transition while others believe it can produce negative outcomes. Some of their concerns include higher stress levels, the increase of fatigue, increase in medical errors, quicker burnout, and work dissatisfaction. People in favor argue that there is not much difference in working a few more hours and that it allows for more days off. All these factors affect patient care as well as self-care for nurses. It is important to evaluate what interventions can be implemented to provide overall better outcomes for both the patient and the healthcare team.
Working longer shifts can produce many negative outcomes. It is important to evaluate the effects of these shifts because eight-hour shifts are not as common as they once were before. One negative outcome is the impact of increased fatigue on nurses. Although most nurses are working the same amount of hours per week, the number of hours in a day is much greater. In addition, many times nurses stay longer than their intended work shift because of unprecedented events. Working long hours with high demands can make nurses more tired than those who work fewer hours.
As a result of increased fatigue, there is a greater chance for work-related injuries and medical errors among nurses. A study conducted by Trinkoff, Le, Geiger-Brown, and Lipscomb (2007) examined the association between extended work hours and specifically needlestick injuries. They conducted a longitudinal survey where 4,229 nurses from Illinois and North Carolina participated. They analyzed work schedule factors such as hours worked per week, working more than 13 hours per day, and working weekends. The results showed that the number of hours worked per day and week were strongly associated with a higher risk of needlestick injury.
Higher levels of burnout and patient dissatisfaction are other negative outcomes that can result from longer shifts. Burnout is often described as physical, mental, and emotional exhaustion. Many nurses may experience burnout once or a few times in the workplace. It can result from the physical and emotional demands of the job. Burnout can lead to a lack of motivation and eventually can cause nurses to detach from work. This can make nurses lose focus on the nursing profession which is based on providing care to all patients. Their focus will mainly be to get through the day.
According to Stimpfel, Sloane, and Aiken (2012), “Nurses working shifts of ten hours or more were up to two and a half times more likely than nurses working shorter shifts to experience burnout and job dissatisfaction.” Consequently, patients reported dissatisfaction with care at hospitals where nurses worked longer shifts. The results also showed that nurses who worked longer shifts said they intended to leave their jobs soon. Many nurses underestimate the impact of working longer shifts because working fewer days is more appealing to them (Stimpfel, Sloane & Aiken, 2012).
Despite the major concerns with working long hour shifts, many nurses prefer them. The findings from a study conducted by Dall’Ora, Griffiths, Ball, Simon, and Aiken (2015) show that nurses preferred the longer shifts because it helped create a balance between work and personal commitments. There is more flexibility with working longer hours. Working twelve-hour shifts allow nurses to have multiple days off in comparison to working eight-hour shifts. The number of work days is cut down to three days as opposed to five days. This could be an advantage for nurses that have families, other jobs, or if they are pursuing further education.
Another reason nurses might advocate for twelve-hour shifts is that there are fewer patient hand-offs. Inadequate hand-offs are a longstanding problem especially when there is high frequency like in hospitals (The Joint Commission, 2017). With fewer shifts during the day, there is a decrease in hand-offs resulting in lower chances for miscommunication and medical errors. In addition, this allows nurses to get comfortable with the patient and establish a trusting relationship. Patients will spend more time with the same nurse rather than switching nurses every few hours. This can help alleviate some stress and fear that is often associated with being in the hospital setting. Another benefit is that the nurse can get a better understanding of the plan of care for the patient and how it affects the patient. Overall, resulting in better patient outcomes.
Looking at both sides is essential in order to create effective solutions. Analyzing why nurses prefer the extended shifts and why others don’t can help highlight the areas that need necessary change. For example, some nurses prefer them because there are decrease handoffs reducing the chances for errors. However, studies revealed that despite some of the benefits, there are still adverse effects compromising patient care. Therefore, it is important that potential solutions are created to prevent them from occurring. A collaborative approach within the healthcare system can help reduce possible negative outcomes.
One way the issue of working extended hours has been managed is by the ban on mandatory overtime. Before July 1, 2009, employers could mandate nurses to work overtime which led to a compromise in patient care (New York State Nurses Association, n.d.). New York State along with 14 other states joined this movement to help improve patient care and reduce the stress on nurses. Before this ban, many nurses were required to work overtime as frequent as every shift. There are some exceptions to this ban such as unforeseeable emergencies that require staff available to stay longer than their shift. Nonetheless, this ban now allows nurses to decline to work overtime without facing retribution from their employer.
Another possible solution to help decrease the negative effects is to focus on fatigue prevention. A simple effective solution can be encouraging nurses to take breaks. Breaks can help increase productivity and relieve stress. Breaks are mandated by the Occupational Safety and Health Administration, but many nurses fail to take them because of the workload. As stated by Geiger-Brown and Trinkoff (2010), workplaces need to make it a cultural norm to take completely relieved breaks. Many workplaces do not encourage break time because of limited staff to cover them when they are on break. In addition, this can be an effective solution for increasing job satisfaction. When nurses feel like their employers and staff support their efforts to decrease fatigue, take breaks and eat properly, their job satisfaction can increase (Geiger-Brown & Trinkoff, 2010).
The Joint Commission released a sentinel event alert in 2011 discussing the impact of adverse effects of fatigue. They provided some actions for organizations to consider such as assessing off-shift hours and consecutive shift work (The Joint Commission, 2011). They suggested assessing the hand-off process in the facility to identify any areas that can compromise patient care. Providing education courses on the effects of fatigue on patient safety can be beneficial by bringing more awareness to the issue.
Lastly, creating an open environment for nurses to express their feelings regarding fatigue or stress is crucial. Often times nurses will not express their feelings because they believe it is part of the job or they do not have proper social support. The accumulation of these feeling can significantly contribute to a faster process of burnout. Checking up on nurses and encouraging them to voice any concerns by nurse managers requires proper leadership skills. Nurse managers should not dismiss any feelings or belittle their thoughts but instead, help work with them to create solutions.
Educational courses that provide nurses with proper sleeping and relaxation techniques can be organized within the facility. Creating a sleep routine can help nurses get better rest before, in between, and after shifts. Some ideas can include eliminating electronic use before time such as television or phones. Limit caffeine intake during the night to avoid staying awake long hours. In addition, napping can be beneficial when done strategically. Short naps during the day can help increase alertness that is diminished by fatigue.
It is evident that extended work hours are not being eliminated any time soon. Instead, more hospitals are shifting over to twelve-hour shifts making this an important issue in the nursing profession. Working longer shifts can produce negative effects on nurses. Consequently, these negative effects will then contribute to a decrease in the quality of care provided for patients. Increasing the awareness of this issue within the organization can create opportunities for a collaborative approach to fixing the problem. Expressing concerns and implementing solutions can help decrease workplace injuries, burnout, job dissatisfaction, and, as a result, increase the quality of patient care. At the end of the day, it is important to take care of not only patients but the well-being of nurses too. Working together is necessary to help improve the healthcare system.
References
AMN Healthcare. (2019). Love-Hate Relationship: Nurses & the 12-Hour Shift. Retrieved from https://www.amnhealthcare.com/latest-healthcare-news/love-hate-relationship-nurses-the-12-hour-shift/
Dall’Ora, C., Griffiths, P., Ball, J., Simon, M., & Aiken, L. (2015). Association of 12 h shifts and nurses’ job satisfaction, burnout and intention to leave: Findings from a cross-sectional study of 12 European countries. BMJ Open, 5(9), E008331.
Geiger-Brown, J. M., & Trinkoff, A. (2010). Is It Time to Pull the Plug on 12-Hour Shifts?: Part 3. Harm Reduction Strategies if Keeping 12-Hour Shifts. JONA: The Journal of Nursing Administration, 40(9), 357-359.
Stimpfel, A. W., Sloane, D. M., & Aiken, L. H. (2012). The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Health affairs (Project Hope), 31(11), 2501–2509. doi:10.1377/hlthaff.2011.1377
The Joint Commission. (2011, December 14). The Joint Commission Sentinel Event Alert. Retrieved from https://www.jointcommission.org/assets/1/18/SEA_48.pdf
The Joint Commission. (2017, September 12). Sentinel Event Alert. Retrieved from https://www.jointcommission.org/assets/1/18/SEA_58_Hand_off_Comms_9_6_17_FINAL_(1).pdf
Trinkoff, A. M., Le, R., Geiger-Brown, J., & Lipscomb, J. (2007). Work Schedule, Needle Use, and Needlestick Injuries Among Registered Nurses. Infection Control & Hospital Epidemiology,28(02), 156-164. doi:10.1086/510785
New York State Nurses Association. (n.d.). Mandatory Overtime. Retrieved from https://www.nysna.org/mandatory-overtime#.XKP4lq2ZPos
