'What struck me was the powerlessness many nurses felt'

10 May, 2010 | By Jill Maben

Returning to short shifts would be like “turkeys voting for Christmas”, suggested one reader in response to my opinion piece, with another saying “hands off our long days”. I never imagined the storm it would create.

I argued that: “Twelve hour day shifts may have implications for staff wellbeing in terms of stress, burnout and physical injuries.” And wondered whether nurses could “give the same unwearied, dignified and compassionate care after 11.5 hours as they can after just one hour when fresh on duty”.

The piece generated 116 comments on nursingtimes.net. Nurses were divided. Many felt that with no rush to “hand over” their patients, they could plan care over the whole day, get to know their patients and had time to chat in the evenings. “The benefits [include] better staff morale on 12 hours; the nurse being able to spread out the nursing tasks; and better consistency with patients during the day and night.” Some suggested long days worked well in areas such as accident and emergency, theatres and intensive therapy units, and some noted the importance of time off for “child care or other caring responsibilities”. Many also felt it should be a matter of individual choice, and staff should be allowed to work flexibly - although some managers suggested this would “open a can of worms”.

‘What really struck me was the powerlessness many nurses felt in a system where they did not always feel valued or that their needs were uppermost’

Most felt working long shifts with more days off improved the work-life balance, as they “work to live, not live to work”. Many pointed out a 10 day “stretch” of early and late shifts was tiring and stressful and working a five day week, could result in travelling for a long time and high petrol costs.

Counter arguments included readers suggesting that ”four days off is actually an unhealthy myth” as it is time to catch up on sleep. This reader went on to say “I now work shorter shifts and, although I have to go into work for more days, my work-life balance has returned. I am now eating and sleeping at normal times and don’t feel constantly tired. I wouldn’t go back to long days ever”. Others agreed, also pointing out that long days resulted in more sickness absence that was harder to cover. Other difficulties highlighted included the limited teaching time available for students and “team nursing [being] in disarray after the staff have had three years of long days (11.5 hours). [An] ‘I am not here tomorrow’ mentality has set in with some staff, and the documentation is variable”.

What became evident when reading through all 116 posts was the passion people felt on the topic and the extent to which opinions were polarised and arguments could be made either way. What really struck me however, was the powerlessness many nurses felt in a system where they did not always feel valued. People did not feel they had choice or that their needs were uppermost.

Readers wrote of working long hours, unpaid overtime, the relentlessly busy work environments where anyone not meeting acute care needs would be moved to another area. This was written in reference to my comment about having “time to chat to patients, to undertake the ‘little things’ that matter so much to patients, like washing their hair, having a bath, taking them outside, or to the shop” - the last of which was described as “fairyland”. Others wrote of nurses working long days, sometimes up to 14 hours, with little or no break, inadequate food and dehydration: “The trust where I worked insisted we worked 14 hour days. Which is fine… if you have a break. We didn’t receive any breaks, so worked for 14 hours straight, eating/drinking when we got a spare minute.”

Some nurses highlighted what they saw as problems of tiredness and stress: “Nurses are tired and stressed because of workload, paperwork and nurse to patient ratios, not long shifts”. Inadequate staffing levels were also mentioned: “It is all very well to advocate for [better] patient care but for most nurses [the priority] is getting through the shift, providing the safest level of care you can when massively overstretched. In the past year over half our staff quota have left due to ill health, burnout, stress and so on - they have not been replaced creating a vicious cycle. So the question is not whether 12 hour shifts are detrimental to patient and staff health [but] whether the staffing levels are dangerous to staff and patient health.”

I never intended to be an evangelist about long days, I just wanted to share my observations. What I am an evangelist about is the importance of supportive and healthy work environments for nurses. I believe passionately that in the current NHS with more targets, more regulation and rapid throughput of patients, it is vital to take good care of nurses. There is growing evidence of a link between staff wellbeing and patient experiences and outcomes, not to mention that taking care of staff is the ethical approach to being a good employer.

In another opinion piece last year I asked: “Where is the duty of care to the carers?” Maybe this piece stated the obvious but it didn’t engage readers - not one reader posted a comment. But I urge us all to address the importance of caring for the carers - we all need to care about staff wellbeing. This must include giving staff time for proper breaks and drinks; and considering nurses’ levels of stress, burnout, and tiredness. By doing so we can help create supportive work environments, whether we work long or short days.

JILL MABEN is deputy director, National Nursing Research Unit, King’s College London

Readers' comments (35)

mike | 8-May-2010 7:05 am
One thing is clear about all this, our rota system NEEDS sorting out.

It should be illegal to make us work the kind of shift patterns that we do.

A mixture of Early, Late and Day shifts in one week, with night shifts thrown in at random, do nothing for our health and wellbeing, never mind the work life balance. There is to little time to turn over between shifts when you are on a late shift then an early. It is as if we are expected to practically live in the hospital and deliver care 24/7!!
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Anonymous | 8-May-2010 10:08 am
I am a nurse for 35 years and still working. Initially I requested with my manager that I would do only Late,Early and occasional nights because of internal rotation. I find this easier to do and I can think and concentrate better and do my job properly. At the end of the day I go home with job satisfaction and a good conscience. I have seen quite a lot of my colleagues looking very tired , exhausted and come by the end of the day looking uninterested and make mistakes due to long stressful working days. unfortunately some nurses like doing long days to fit in their family life BUT not realiazing that if a serious mistake is done then they might NOT even have a job.
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Anonymous | 8-May-2010 5:15 pm
Maz
Sleep days should be re-introduced, it is sole distroying to finish nights on Monday morning and have that as your day off.
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Anonymous | 9-May-2010 9:47 am
Its great that some nurses can request from their managers what shifts they want no matter what reason. What about the rest of us who work full time and have to put up with all the other shifts that nobody else wants to the detriment of classes and social life. On our ward part timer and Mum's with children always had priority and we were told we should join classes and involve ourselves in more social activities. The request for a couple of hours off regularly worked for a short while until someone else said they were unavailable to work during that time leaving no option but to miss a class on several occasions making it difficult to catch up, taking any pleasure and motivation away and many classes and some social activities are etremely expensive if one has to miss half of them.
Why isnt everybody treated the same and fairly whether they work full or part time and why are some favourites of the manager and not others? Of course, patients come first and their is a lot of pressure and manipulation which goes on to make one feel guilty if one refuses to cover the shift - like there is nobody else available!
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katherine mccarthy | 10-May-2010 5:04 pm
What about the nursing students?? I have spent when ever possible 70-80hrs per week on wards as i bank on adults as well as doing my child nursing training. I have to work weekends for money as my bursery does not pay my mortgage and increasing household bills and child care..I know other students who have to do the same so yes working long 12 half hour shifts is so tiring but also means you can squeeze in those bank shifts as they arise. Ill be a burnt out student nurse before i even qualify which is in 6 months. So please before putting students down as to "posh to wash" there are those who by sheer determination are working like dogs to acheive better in life!!
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Anonymous | 11-May-2010 10:04 am
If nurses and students are working like dogs are they able to provide the highest quality of care to their patients?
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Anonymous | 11-May-2010 10:11 am
Not after working long shifts no. You'd have to have eaten and drank well throughout the shift and prepared yourself physically and emotionally the day before.
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susan | 11-May-2010 12:14 pm
Fairly recent research has indicated that nurses doing 12 hour shifts have an impact on patient care. ie 'three times more likely to make errors than nurses working short shifts'.
(Source:The American Nurses Association, Journal Of Health Affairs: Online,2004). Does anyone know of more recent research to verify American nurses findings?.
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Anonymous | 11-May-2010 1:02 pm
I am very happy with my long shifts. I eat well and keep well hydrated. My days off are well spent. Long days means I have less traveling. I am not stuck in traffic. I save money on petrol. I would not want to return to short shifts as it would have a negative impact on my quality of life.
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susan | 11-May-2010 2:18 pm
That's fine if you are content to work 12 hour shifts (Anonymous,1:02pm)
However, if American research indicates that 12 hour shifts impact on patient care through increased errors, then surely this is about the patients quality of life in large measure as well and nurses should always be working in the interest of the patient.
As nursing is a researched based profession the evidence shouldn't be ignored.

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Anonymous | 11-May-2010 4:03 pm
Is nursing for the convenience of the nurses and their quality of life and travel budget or for the benefit of the patients?
Split shifts with more concentrated and shorter working hours with time off in the middle of day means that nurses return refreshed and more highly motivated for the evening shift and handover to the night nurse. It is far more motivating when you know that after a few hours hard work you can get a break and enjoy some sort of normal life during the day with more daylight hours in winter and the opportunity to participate in sports, meet friends, go shopping or have a siesta or take a class. This is far more healthy than 12 hour shifts which makes for zombies, diminishing motivation through fatigue, even thought this may not be apparent to the individual, and leading to a greater likelihood of errors and less tolerance of others - patients, colleagues, managers, doctors, visitors, and the like. It is far more beneficial to patients to be looked after by nurses who are refreshed by longer breaks and shorter shifts even with a working week of 42 hours, except for those working part time. It has to be far more economical as well. In Europe this is how it is and is unconditionally accepted or else you are out of a job and this avoids so many of the wingeing nurses apparent from all the NT comments! If nurses can get it right in the rest of Europe why all the difficulties in the UK where nurses seem to be so self obsessed?
It is largely up to every indiviudal to make something of the job they are on and not constantly blame others or their employers.
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Anonymous | 11-May-2010 4:05 pm
It seems that nurses are often entirely self absorbed instead of considering the needs of their patients, colleagues, etc.!
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jjjez@hotmail.com | 11-May-2010 6:17 pm
Who says it's better to be looked after by nurses working short shifts.

You'll be tired no matter what you work.
People doing 8 hour ddays still harp on about how tired they are yadda yadda.

I think this artcile misses thepoint about 12 hour days in that they don't have to be exhausting if you look after yourself.

Nobody asks these women (and they are usually) to be martyrs or to work like dogs. that's their choice.

But the article itself just sounds too mumsy and 'i'm only looking out for you' blah blah blah.

It's not really an issue for anyone and not a serious one.

I am astonished that people remark that they are tired after work

EUREKA!!!
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Anonymous | 12-May-2010 10:00 am
some of these comments are pathetic and so badly written as to be incomprehensible. This reflects on the image of the entire nursing profession and many of those working in it.
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Anonymous | 12-May-2010 11:19 am
I have known someone who did 19hr shifts for 3 days,she was doing late shifts combined with nights,is this legal? What surprised me was that management had let her do it.
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Anonymous | 12-May-2010 11:26 am
Katherine Mccarthy stated..."katherine mccarthy | 10-May-2010 5:04 pm

What about the nursing students?? I have spent when ever possible 70-80hrs per week on wards as i bank on adults as well as doing my child nursing training. I have to work weekends for money as my bursery does not pay my mortgage and increasing household bills and child care....! "

I am a second year adult nursing student and in our trust the bank will not allow us to do more than 11 hours a week whilst at uni (whether on placement or at university) due to the fact they count that as a 37.5 hour week. This doesn't touch the sides in terms of covering my mortgage or paying the bills and if i didn't have such a supportive partner I dont know how I would be able to continue on this course - but the fact of the matter is... that is the law. You are only allowed to work a 48 hour week for a reason. If you are breaking the law and working for 70-80 hour weeks then you only have yourself to blame for 'burning out'.
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Anonymous | 12-May-2010 12:17 pm
Day shifts whether long or short are not as tiring as nights. As the article highlights having breaks during shifts and having enough staff to deal with patients is the key. Those who enjoy working 10 days in a row should carry on. Those who prefer the comfort of three long days should be given that choice. if we were paid enough we would not need to do overtime to feed our families and keep roofs over our heads.
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Anonymous | 12-May-2010 12:49 pm
anon 11/5/10 4.03 pm.

It's called a work life balance! Of course we are here for the patients but good God we have our own lives to live!

But i pretty much agree with everything you are saying...long shifts are a nightmare and should be banned.
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maria gough | 12-May-2010 3:42 pm
I have observed that a couple of hours prior to the end of their long shift, the staff member is generally more tired and their concentration is greatly diminished.

I see the same thing in those who do short days, finishing work at 22.30 and back on at 07.45 next day when only the goal of finishing at 15.45 keeps them going with the promise of a late shift the following day, usually followed by another early in the 'traditional' way our rotas continue to be conceived - only nursing seems to take this 'ELEL' approach to shift work.

Previously, when we all lived a stone's throw from our wards and had no life anyway - didn't matter so much. But now we have lives and can afford to live them further away from our wards.

However, the most interesting thing I have observed in those that work 'long days' is that when that person goes off sick - we are down a staff member from both early and late shifts with no one willing or able to fill in for both shifts.

The question now is: do those on long days have more sick leave than those on short days? This does not mean of couse that working long days 'makes' you sick but it certainly does not help filling the gap when you do.
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Victoria Turner | 12-May-2010 8:08 pm
I currently work with the police as a custody nurse and do 2 x 12 hour shifts per week. Not so long ago I was working on a ward part-time doing 4 x 6 hour shifts. I prefer to do two longer days and have time to go to uni and have a life on my days off. The cost of travelling is also enormous these days. However, I do think the police have it right with set rotas then at least staff can plan ahead what they are going to do and rest days are built into their shift pattern. We have a 4 week rota and I know my shifts for the next 12 months or more which is worth its weight in gold for planning childcare etc.
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