How Are 12-Hour Shifts Working?

• How do you handle 12-hour shifts? That seems so long.
• I wouldn’t want someone taking care of me after they’d been working 11 hours.
• Don’t 12-hour shifts make you tired?
• I don’t like it when my nurse obviously just wants to get off shift.

These are all questions and comments I have heard. In general, anecdotally, patients are concerned that long shifts for nurses will make their care unsafe. Do they? It seems that the answer is yes, and working long hours is actually unsafe for nurses too.

Problems for patients

Fatigue in nurses is a problem. The ANA wrote a position statement[1] in 2006 specifically addressing this issue. In the statement it reminds nurses that they are ethically bound to consider their fatigue level and capacity to safely work when accepting additional hours or shifts. It acknowledges “the health care system has lagged behind in recognizing that fatigued health care providers endanger not only themselves, but also the patients for whom they care.” (The ANA also issued a position statement[2] for employers reminding them of their responsibilities in this area.)

A study in Health Affairs with a relatively large sample size found that more hours equaled more errors, and the risk increased after consecutive work longer than 12.5 hours (a not-unusual shift length for an RN).[3] This study found that “the likelihood of making an error increased with longer work hours and was three times higher when nurses worked shifts lasting 12.5 hours or more.” Three times higher is a lot higher. A different study found that the risk of making an error only doubled after 12.5 hours,[4] but still. Concerned patients seem to have a point.

Problems for nurses

Long shifts are not a problem only for patients; they also may hurt nurses. The 3-day work week is an advantage to the 12-hour shift, but not all nurses are happy with their schedules. Twelve hours is a long time to work hard, which nurses do, and “there are already hints that the fatigue associated with working twelve-hour shifts is contributing to absenteeism and job dissatisfaction among RNs.”[3] We are apparently also more likely to hurt ourselves between our 8th and 12th hours of work by means of needlesticks and musculoskeletal injuries.[5] Medical residents have had their weekly work hours capped for some time because they were making egregious errors and/or driving off the road on the way home from the hospital, but the same kinds of restrictions are only now beginning for nurses (my hospital just recently began requiring a certain number of hours between successive shifts).

What to do

According to the ANA, we should refuse assignments that would push us over the edge. Whether that will fly in the workplace remains to be seen. We can, however, be aware toward the ends of our shifts that both we and our patients are at a higher risk of getting hurt and can exert increased diligence. We can also cooperate with institutional efforts to help us out by limiting our overtime, number of hours worked per week, and number of hours worked per shift, and we can object as a profession to mandatory overtime.

About Megen

Megen Duffy, RN, BA, BSN, CEN, works in an ED at a community hospital in the Midwest. She serves as a local board member of the Kansas State Nurses Association and is a contributing editor to the American Journal of Nursing. Before her nursing career, she was a freelance medical editor and writer.

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