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Rise in potentially risky 12‐hour shifts among nursing staff


There has been an increase in the use of 12-hour nursing shifts that may potentially be influencing patient care, according a review commissioned by the chief nursing officer for England.

It appears to confirm anecdotal evidence of a rise in popularity of longer shifts and acknowledgement by staff that they leave them feeling more tired than eight-hour shifts.


The independent report, undertaken by some of the country’s leading nurse researchers, investigated the prevalence and impact of 12-hour shifts in nursing, looking at links between shift length and patient outcomes.

It concentrated predominantly on registered nurse but the researchers suggested there was no reason to suggest that their findings did not also apply to healthcare support workers.

The study reported that 12-hour shifts have become more prevalent in the NHS – 31% of staff nurses on wards reported working 12-hour shifts in 2005 compared with 52% in 2009.

For independent care homes, there was an increase from 41% to 69% over the same period.

The finding on prevalence chimes with previous findings from the Nursing Times annual survey.

But the new study also highlighted the risks of long hours in terms of performance, fatigue, stress and patient safety.

The research follows a gradual shift away from traditional shift work patterns based on three eight-hour shifts per day over the past 20 years.

Many hospitals have moved to 12-hour shifts because managers believe it is a more cost effective way of providing 24-hour care, with lower costs and greater continuity of staffing.

Meanwhile, some nurses also prefer to work longer daily hours with fewer shifts, which gives them greater flexibility and more days away from work.

The new report – titled 12-hour shifts: prevalence views and impact – was commissioned in 2013 by the CNO as part of work set out in the national nursing strategy Compassion in Practice.

Researchers – from the National Nursing Research Unit at King’s College London and Southampton University – reviewed 26 studies carried out from 1982 to 2014 in the UK, US and European Union.

Among the data sources were surveys conducted for the Royal College of Nursing and those done as part of last year’s seminal RN4Cast study on nurse staffing trends.

The researchers warned that the level of evidence they found on the impact of different shift lengths was “weak to moderate”.

However, in general, most of the studies appeared to show “some degree of negativity” linked with 12-hour shifts – either for nurses, patients or both.

For example, nurses working 12-hour shifts are found to be at increased risk of occupational hazards including needle stick injuries and musculoskeletal disorders.

“Many of the adverse outcomes studies relate to fatigue which can also jeopardise patient safety,” said the report. “Other factors can affect the quality and safety of nurses’ work, such as shift rotation, hours and the number of consecutive days worked, and unplanned or extended shift times.”

“These findings mirror those of our European wide study, which shows that longer shifts are associated with nurses reporting lower quality care… and higher levels of burnout”

Peter Griffiths

Professor Jill Maben, chair of nursing research King’s College, said: “Our work shows that in spite of limited evidence, 12-hour shifts have increased across the NHS without fully understanding the risks to patient safety and staff wellbeing.”

Lead study author Jane Ball, principal research fellow at the University of Southampton, added that the analysis found that working 12-hour or longer shifts was associated with care being rated as “poor quality” and an increased risk that necessary nursing care was left undone.

“It seems clear that there are risks associated with a move to longer shifts and they need to be managed very carefully,” she said.

Professor Peter Griffiths, chair of health services research at Southampton, noted that the findings “mirror” those of the European-wide RN4Cast study, which showed that longer shifts were linked with nurses reporting “lower quality care, more missed care and higher levels of nurse burnout”.

“Meanwhile, the overall job satisfaction reported is no better for those working 12-hour shifts than those working eight-hour shifts,” he said.

The research was commissioned under action area five – titled Ensuring we have the right staff, with the right skills, in the right place – of the Compassion in Practice strategy.

CNO Jane Cummings said: “This report is a welcome addition to the work we are undertaking as part of the Compassion in Practice Programme and its findings will be carefully considered.

“It is really important that we continue to develop a body of research to inform safe staffing to support senior local professional judgements,” she added.


Readers' comments (33)

  • I could have told them that!!

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  • I could have too .. the "so called " desire for 12hr shifts leading to more time off is a myth in the private nursing home sector and just means that employers encourage their work force to sign to say they will work over the prescibed 37and a half hours .. the pay deferential means that in a lot of carehomes to gain a living wage the nurses /care team will do in excess of 44 hrs per week.. yes we are tired .. 8 hrs or 6 hour contracted hours are not the preferred option as listed above for both the NHS and the private sector .. job satisfaction can be had but the general public have higher expectation and are better informed than before and we are duty bound to provide a safe environment and prevent harm to our patients/clients.. David Sheard a dementia specialist highlighted this factor a while ago . Profits drive the current trend I believe

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  • When I began my ED job when I qualified I had to do 8 hour shifts. It was the worst period of my employed life. To be at work for 5-10 days straight would be enough to drive me utterly insane. As soon as I could I switched to long days. The time away from work and the flexibility is what keeps people coming back. Having read the comments above it seems as though (obviously!) different approaches work not only for different departments but different people. My department is very flexible and offer people the choice. It is unsurprising that a huge majority opt for long days. I think it is important that a blanket approach to shift templates is avoided.

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  • Number of Nurses who are having to have a few hours nap at a near to the hospitals friends place due to not being able to drive home due to being so tired is staggering. I've heard tales of Nurses nodding off on the drive home one even ended up in a ditch on the other side of the road.

    Of course it's effecting patient care... but you know what else is? Nurses worrying about how much overtime they'll have to put in that month to pay the bills.

    Start paying Nurses a living wage (Could scrape off that 10% MP pay rise along with other 'heads' to pay for it) And reduce number of shifts a week.

    Or at least bring a return of Nurses housing next door to the hospitals. Someone should be kicking themselves for selling all that off.

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  • I can support this, I have relatives working in these conditions

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  • Personally i do not find the 12 hour shift a problem.

    They should look at the practice of working double shifts as I use to do in the NHS where you could do 15 hours in one stretch ie 07.00 to 10.00 or 14 hours 07.30 to 21.30.

    I used to find these shifts tough, especially if I was doing an early the next day. Also I found the types of shifts varied too much between earlies, lates, twilights and mids as well as nights. At least you know where you are with 12 hour shifts.

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  • 12 hour shifts are preferred by many nurses and on some wards their really is not option for anything else. However with the changes in retirement age how will those same nurses cope with 12 hour shifts when they are 60 or older. Firemen and policemen are still able to retire at an earlier age so why is there not a special exemption for nurses. It is a very stressful and responsible job and it can also be physically demanding too. Not only do nurses work 12 hour shifts they often work day and night shifts in the same week. How many older members of staff could manage that and stay healthy?

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  • I would pick 3 long days per week over 5 short days anytime. When travel time is factored in, i genuinely feel less tired on long days. As a result i feel more able to provide a good service.

    Short days are all well and good, but who is actually resting on this "time off?" Whether at work or at home, there are still things to do and can be equally tiring as being at work.

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  • I came out of hands on nursing in 2006. At the time I enjoyed my job working in a neurorehab centre, but management brought in 13 hour shifts. This suited some staff, which was fine, but definitely had a detrimental effect on me, working on a demanding unit, dealing with challenging behaviour. Unfortunately there were no other options available, it was either put up or shut up. After 10 years of working there, I had no option but to resign, as it was having an effect on my health. I now work with the same client group within the community, Monday to Friday, and could never conceive going back to long days. Also as I am now 61, I can sympathise with older nurses who would really struggle with the physical effects of long shifts.

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  • I retired at 60 from a full time HCA post in the NHS ,I returned as a bank worker for the same trust I was immediately put down a pay band and Although I earn less I am able too choose which shifts to work if I feel up to a 12 hour shift I can do one if not there's no pressure to work a long day I don't see why we can't choose everyone has a different level of energy some can do some can't surely we could be allowed to make our own choice

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