Extended Work Shifts and Nurse Fatigue

More than 24.6 percent of healthcare care workers, including nurses, work extended shifts or experience shift work in their careers (Berger, 2006, p. 465). Although patient safety is the priority when it comes to the healthcare field, nurses who work long hours may be in harm’s way. Although the twelve hour shift and shift work are commonplace when it comes to nursing, there are many consequences to working for this extended period of time. High patient acuity levels, rapid admission and discharge cycles, and a shortage of nurses pose challenges for the administration of safe and effective healthcare in today’s world (Rogers, 2004, 202). Shift work, in addition to extended shifts, disrupts circadian regulation and familial and social life for many nurses (Admi, 2008, p. 250). There is also a host of negative physical and emotional conditions that can follow working long shifts or working a particularly arduous shift schedule. Sleep is a necessary part of our biological functionality and is just as important as eating or drinking in order to maintain life and health. Sleep lasting between seven and eight hours per night has been linked with a lower risk of obesity, diabetes, increased blood pressure, myocardial infarction, and cerebral vascular accidents (Caruso, 2013, p. 1). In addition to the physical benefits of sleep, an adequate sleep schedule also reduces the risk for injuries or errors in the workplace. Although long work hours for nurses reduces the risk of errors associated with patient hand off, the costs outweigh the risks. In the end, patient and worker health and safety is the top priority. Long shifts for nurses jeopardize both of these, so measures must be taken to reduce the risks that extended work shifts cause.

Sleep problems have been correlated to a decrease in the productivity of shift workers, including nurses.  For example, one study found that 32 percent of night-shift workers and 26 percent of rotating-shift workers suffer from long-term insomnia and sleepiness (Caruso, 2013, p. 2). Most notably, shift work disrupts intrinsic circadian cycles; one study explains that nurses often overestimate the amount of sleep they actually get, which is incited by concentration disturbances (Berger, 2006, p. 466). Chronic night shift workers also have an increased risk for sleep disturbances even years down the road (Caruso, 2013, p. 2). Extended work shifts seem to show even more drastic consequences when compared to night work shifts. Nurses that work the “normal” twelve hour shifts are more likely to sleep less. Long hours and overtime work are associated with shorter sleep duration and sleep disturbances (Caruso, 2013, p. 2). Chronic sleepiness can lead to disorders like insomnia, which can include physical effects like arthritis, asthma, chronic fatigue, and rhinitis (Caruso, 2013, p. 3). Sleep disturbance and long work hours can lead to mood disorders like depression and anxiety, and gastrointestinal complains, along with abdominal pain, gas, diarrhea, constipation, nausea, vomiting, change in appetite, indigestion, and heartburn (Caruso, 2013, p. 4, 6). One study even reported a marked increase in colon cancer in nurses who work three or more nights per month for 15 years or more (Caruso, 2013, p. 4).

In addition to work related injuries and mistakes, people who function on less sleep are more likely to exhibit poor health behaviors including shorter sleep duration, smoking, obesity, low physical activity, and higher alcohol use (Caruso, 2013, p.3). Research suggests that morbidity associated with sleep disorders that can be caused by long shift hours increases greatly when compared to people who work eight hours daily (Admi, 2008, p. 251). If these poor health behaviors are allowed to continue for extended periods of time, then they may increase a nurse’s risk of serious health problems later on (Berger, 2006, p. 467).

Decline in nightly sleep duration leads to decline in “neurocognitive performance,” which ultimately can lead to higher risks of injuries and worker errors on the job (Caruso, 2013, p. 3). Ultimately, long hours and extended shifts make many nurses susceptible to committing mistakes on the job (Nelson, 2012, p. 19). When compared to eight hour shifts, people who work ten hour shifts are 15 percent more likely to make errors and people who work twelve hour shifts are 28% more likely to make errors (Caruso, 2013, p. 3). For example, a study from Ilhan et. al shows that nurses that work more than eight hours per day are more likely to be hurt in a sharp or needlestick injury (Ilhan, 2006, p. 563). Work errors such as these will inevitably impact patient care in a negative way at some point.

As shift hours increase, nurses’ levels of alertness decrease and is impaired. This results in decreased cognitive skills, impaired psychomotor skills, delayed reaction time, and decreased coordination (Berger, 2006, p. 467). Patient safety can be compromised when workers struggle to stay awake, especially during shifts at nice (Berger, 2006, p. 467). One study by Rogers et. al shows that work duration, overtime, and number of hours worked weekly has a significant impact on errors that are made during shifts (Rogers, 2004, p. 206).  The incidence of errors increased with longer work hours; it was three times higher when nurses worked shifts that lasted more than 12.5 hours (Rogers, 2004, p. 206). More than half of these errors involved medication administration, while others included procedural errors, charting errors, and transcription errors (Rogers, 2004, p. 206). The data gathered suggest that there is a trend for even more risks when nurses work overtime following longer twelve hour shifts (Rogers, 2004, p. 206). Though reported risks are rare, this marked increase in errors in the groups of nurses that worked twelve hours or longer is a heavy burden to consider when prioritizing patient health and safety.

There are studies that suggest that the eight hour shift is much safer than longer shifts; in one study, a relationship was found during the duration of a shift and performance scores (Keller, 2009, p. 499). Ultimately, this study found that nurses that worked a shift of eight hours or less scored higher on overall performance evaluations than their counterparts who worked twelve hour shifts or more (Keller, 2009, p. 499). There are positive impacts of long shift work, however. Working extended shifts introduces the possibility of having extra days free to work a second job or to spend time with family and friends (Keller, 2009, p. 499). Nurses tend to have more time for leisure, social, and domestic duties and usually have less travel time to and from work compared to workers in other fields (Keller, 2009, p. 499). Extended shifts also mean that nurses do not have as much pressure to complete all of their assignments in a regular eight hour work day (Keller, 2009, p. 499).

Because it does not seem as though the long grueling shifts for nurses will be cut short any time soon, it is important that nurses train their minds and bodies to be able to handle these difficult work schedules. Even though shifts may be long, it is important that nurses try their best to obtain at least six hours of sleep every night in order to take a proactive role in establishing a regular pattern of sleep (Berger, 2006, p. 468). To strengthen this routine, nurses should go to bed at a regular and consistent time, as well as establish a regular and consistent time to wake up (Berger, 2006, p. 468). To ensure restful sleep, individuals should avoid food, alcohol, and caffeinated drinks at least six hours before going to sleep (Berger, 2006, p. 268). In addition to avoiding these, nicotine should also be eliminated (Berger, 2006, p. 268). When it comes to food and diet, the meal eaten right after waking should be the largest and should be high in protein (Berger, 2006, p. 268). Light meals should be eaten throughout the remainder of the day and before bed (Berger, 2006, p. 268). These are just a handful of steps that nurses can take in order to maximize their productivity when working long twelve hour shifts or engaging in shift work on a regular basis.

There are many costs and benefits to the extended shifts that many nurses work throughout their careers. Nurses that work twelve hour shifts are able to spend more time with their patients,  which streamlines patient care and can reduce the risk for mistakes. For example, in an emergency room setting, nurses that reach the end of their shifts must hand their patients off to other nurses and trust that they will receive the same level of care that they provided on their shift. If nurses work longer hours, the chance that they will have to hand their patients off to another nurse decreases. Changing nurses for a patient is not necessarily a negative issue, however a nurse that gets a new patient that has been in the emergency room for some time must acclimate himself or herself to the new case. If a nurse can stay with a patient for the duration of his or her stay, the patient will ultimately feel more comfortable and mistakes will not be made in the process of the “patient hand off.”

Ultimately, the risks of extended shifts for nurses outweigh the benefits, however. There are numerous adverse health effects that are associated with extended periods of no sleep, as well as social and psychological impacts. Longer shifts mean that nurses will be getting fewer hours of sleep, which can jeopardize patient safety, the main concern in the healthcare field. Nurses who work extended hours have been found to commit more workplace mistakes, such as the misadministration of medication. These mistakes are extremely serious and are more important than mistakes that can be made in other professions.  Nurses are responsible for the safety and health of their patients, and extended work hours make it more difficult for them to perform their jobs to the best of their abilities. Nurses are the workers that drive the healthcare field forward, and without their minds and bodies at their sharpest, patient safety and health care professional efficacy decreases, leaving nurses and their patients in danger.

 

References

Admi, H., Tzischinsky, O., Epstein, R., Herer, P., & P. (2008). Shift Work in Nursing: Is it Really a Risk Factor for Nurses’ Health and Patients’ Safety? Nursing Economics, 26(4), 250-257. Retrieved November 2, 2017, from http://eds.a.ebscohost.com.proxy-hs.researchport.umd.edu/eds/pdfviewer/pdfviewer?vid=3&sid=3a951e92-ca89-4c07-8cf5-91550efc9e60%40sessionmgr4009

Berger, A. M., & Hobbs, B. B. (2006). Impact of Shift Work on the Health and Safety of Nurses and Patients. Clinical Journal of Oncology Nursing, 10(4), 465-471. doi:10.1188/06.cjon.465-471

Caruso, C. C. (2013). Negative Impacts of Shiftwork and Long Work Hours. Rehabilitation Nursing,39(1), 16-25. doi:10.1002/rnj.107

Ilhan, M. N., Durukan, E., Aras, E., Türkçüoğlu, S., & Aygün, R. (2006). Long working hours increase the risk of sharp and needlestick injury in nurses: the need for new policy implication. Journal of Advanced Nursing, 56(5), 563-568. doi:10.1111/j.1365-2648.2006.04041.x

Keller, S. M. (2009). Effects of Extended Work Shifts and Shift Work on Patient Safety, Productivity, and Employee Health. AAOHN Journal, 57(12), 503-504. doi:10.3928/08910162-20091124-05

Nelson, R. (2012). Long Work Hours for Nurses. AJN Reports, 112(5), 19-20. Retrieved November 1, 2017.

Rogers, A. E., Hwang, W., Scott, L. D., Aiken, L. H., & Dinges, D. F. (2004). The Working Hours Of Hospital Staff Nurses And Patient Safety. Health Affairs, 23(4), 202-212. doi:10.1377/hlthaff.23.4.202