Are Extended Nursing Shifts Good for Nurses and Patients?

Hospitals have widely accepted 12-hour nursing shifts as a way to enhance service continuity and cost-effectiveness. Nurses prefer them, too. As a result, the three-day workweek is often touted in hospital recruiting and retention efforts.

A considerable amount of research isn’t as fond of the idea, however. Some studies indicate that traditional eight-hour shifts are preferable to the 12-hour shifts that many hospitals have adopted. Debate about shift length has taken place during the past several years, and it’s showing no signs of slowing down.

There’s no clear answer as to whether eight- or 12-hour shifts are better. But by examining the key issues involved, healthcare leaders can be more aware of how shift length can impact outcomes for nurses and patients alike.

How 12-hour Nursing Shifts Impact Burnout and Job Satisfaction

A large European study linked hospital nurses who work 12-hour shifts to adverse outcomes like burnout and job dissatisfaction. The survey published in BMJ Open involved more than 31,000 nurses in 488 hospitals across 12 countries.

One of the major results was that nurses working 12 hours or more in a shift experienced high burnout. Most notably, nursing shifts of at least 12 hours increased the odds of high emotional exhaustion by 26%, compared with nurses working shifts of eight hours or less. Nurses who worked longer shifts were also more likely to experience high depersonalization (a dreamlike or detached state of mind) and low personal accomplishment.

Another important finding was the connection with job dissatisfaction. Nurses who worked shifts of 12 hours or more were 40% more likely to report being dissatisfied with their job — and 31% were more likely to plan to leave their job — compared with nurses working shifts of eight hours or less.

The researchers noted a paradox. Nurses prefer longer shifts because of the perception that they improve job satisfaction, but longer shifts may have the opposite effect. “Nurses may be choosing to sacrifice work satisfaction for benefits in other spheres of life,” they said. “However, this type of choice is likely to compromise nurses’ recovery sleep, physical and psychological well-being: the stress of those long workdays and the recovery time needed may counterbalance any perceived benefit.”

Similar findings were seen in an American study of more than 22,000 nurses in four states. According to researchers in Health Affairs, longer nursing shifts “were associated with significant increases in the odds of burnout, job dissatisfaction, and intention to leave the job.” In particular, the odds of burnout and job dissatisfaction were up to two and a half times higher than nurses working eight- to nine-hour shifts.

Perhaps most striking was the study’s conclusion that the longer the shift for hospital nurses, the higher the levels of patient dissatisfaction. In fact, both studies warned how nurse burnout and job dissatisfaction could adversely affect patient safety.

Evaluating Job Performance for Nurses Working Longer Shifts

If longer nursing shifts contribute to burnout and job dissatisfaction, the consequences fall across two general spheres. One is the impact that issues like turnover and absenteeism can have on an organization’s culture and finances. The other area encompasses issues, according to BMJ Open, like higher risks of medical error, lower quality of care, and reduced well-being (for nurses and patients).

While there’s no consensus that 12-hour shifts are a health risk, it’s not hard to find sources that support the affirmative. That’s the case for the two major studies mentioned so far, and researchers in Health Affairs were much bolder with their results. “Our findings contribute to a growing body of research associating nurses’ shift length with patient safety issues,” they said while noting four additional studies. “The results also highlight an area of health care ripe for policy development at both national and institutional levels.”

The other side of the debate is well-represented. A separate study in BMJ Open was the first to bring in an objective measure of missed care, in the form of missed or delayed vital signs observations, to gauge any impact on the quality of care. Healthcare assistants who worked long shifts at the large hospital in England had a significant increase in delayed vital signs observations, but the same wasn’t true for RNs. According to those nurses, time constraints result in less interpersonal care (such as comforting patients and planning their care) instead of clinical care.

Another study published in the Journal of Intensive Care Society compared eight- and 12-hour shifts during a two-year period at a large intensive care unit in Wales. The first year everyone worked the traditional shift, and the second year, the longer shift was introduced for those who opted in. The results showed no significant differences between the two groups across multiple outcomes, including clinical incidents, sickness rates, personal injuries, and staff training. An improvement was found in emotional exhaustion and depersonalization for those working 12-hour shifts.

Perspective on the Debate Over Nursing Shift Length

It’s important to remember the complexity surrounding research on extended nursing shifts.

“It is difficult to control extraneous variables, including shift sequence, overtime and break patterns,” according to authors in the Journal of Intensive Care Society, when discussing their perception about the research varying in quality. “Age, grade, and experience of the nurse may also influence study findings.”

Another thing to keep in mind is whether shift length is the most critical issue in the broader discussion. “This is a topic in nursing that has been debated for many years,” said Leeann Denning, assistant professor and chair of the nursing department at Shawnee State University. “I know nurses who prefer and do well with 8-hour shifts and those who prefer and perform well with 12-hour shifts. Research is clear on the effects of fatigue, but I think the conversation needs to move from the hours worked to what level of care is required of that nurse during the shift.”

From shift length to the level of care, research on those types of topics can help raise more awareness and ultimately improve the quality of care. Engage in these conversations while you earn your online RN to BSN — a designation that research has linked to improved patient care. You’ll gain the knowledge and skills to prepare for leadership or specialized roles to make a positive impact in your career.

Achieve your goals with the fully online RN to BSN from Shawnee State University.