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Longer nursing shifts 'hit patient care', warns major study


Longer hours worked by nurses to help save hospitals money is hitting safety and patient care, according to a large international survey of nurses.

Results of the poll of more than 30,000 nurses across Europe show that nurses who work longer shifts and more overtime are more likely to rate the standard of care delivered on their ward as poor, give a negative rating of their hospital’s safety and omit necessary patient care.

Involving researchers at the University of Southampton and the National Nursing Research Unit at King’s College London, the RN4CAST survey of nurses in over 450 hospitals across 12 European countries is part of an international research programme looking at links between nursing workforce issues and patient outcomes.

“This is compelling evidence that policy makers in England need to take note of”

Peter Griffiths

Results showed that nearly a third of nurses in England are working shifts of more than 12 hours, something which is becoming more common in English hospitals.

Hospitals are adopting long shifts to reduce the number of handovers between nurses and to save costs. Some nurses seem to prefer them because they work fewer days in a week.

Nurses working these long shifts were 30% more likely to report poor quality of care compared with nurses working traditional eight hour shifts, according to the study published in the journal Medical Care.

They were also 41% more likely to report failing or poor standards of safety and reported leaving more necessary nursing care undone than nurses working shifts lasting eight hours.

“Rather than over-rely on hospital staff working lengthier shifts or overtime, the NHS must undertake the sensible long-term workforce planning and investment”

Peter Carter

Nurses working overtime in their last shift were also likely to report lower standards of care, safety and care left undone.

Professor Peter Griffiths, chair of health services research at the University of Southampton, led the study.

He said: “These findings raise questions for healthcare organisations, especially in the current economic climate, where employers in many countries including England are aiming to use the existing workforce more efficiently, either to reduce expenditure or because of nursing shortages.

Peter Griffiths

Peter Griffiths

“Moving from three shorter shifts per day to two longer ones has been claimed to save up to 14% of salary costs,” he said. “But at what cost to the patient? This strategy needs to be looked at in much more detail. If nurses perform less effectively and less safely, what’s the point?”

He added: “This is compelling evidence that policy makers in England need to take note of.

“Although eight hour shifts are still common, a lot of nurses are working these longer shifts, but this study shows that this could be counterproductive,” said Professor Griffiths.

“Additionally, the increased flexibility associated with working overtime may not deliver the desired goals for employers.”

Peter Carter, chief executive and general secretary of the Royal College of Nursing, said: “Patient care is being jeopardised by insufficient nurse staffing levels.

Peter Carter

“Nurses want to deliver the best possible quality of care but when there are too few nurses available then they have less time to spend with their patients and safety is undermined.

“The health service has limited resources to cope with rising numbers of patients, which is leading to massive pressures on the system and severely overstretched staff,” he said

“Rather than over-rely on hospital staff working lengthier shifts or overtime, the NHS must undertake the sensible long-term workforce planning and investment needed to make sure there are enough nurses to provide high quality patient care at all times,” he added.


Readers' comments (16)

  • I worked 14.5 hour shifts at the hospital I work at. I left as I couldn't stand working such ridiculous hours and all the time not having enough staff to undertake the nursing role as we were trained. It's ludicrous to expect you to be working at your best for this amount of time, and on your feet.

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  • could havetold you this result 15 years ago when our local hospital started to promote 12 hour shifts. What will managers think up next to save money

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  • it sounds like a combination of long hours and poor staffing numbers, not just long hours. I do 12.5 hour shifts and to be honest prefer them as I have done both shift patterns, and with the intensity of nursing care and ward environment, I find it less wearing overall than coming in 4-5 days a week.

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  • It's the long hours worked that affect patient care. I saw it years ago, when 12h shifts started. Everyone had to slow their pace and do less to get through the 13h. It is OK if they are feeling fit and energised, otherwise output is reduced. Also OK if they get enough breaks. Many people like it now because of days off, so can't see a change happening.

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  • Its not enough staff that affects patient care not long shifts. 12 hour shifts generally mean staff finish on time while 7.30 hour shifts generally mean overtime. long shifts mean days off and better worklife balance.and how come double shift are ok for nurse managers if it means cover for sickness etc. Yes staff need breaks preferably with decent facilities but dont throw the baby away with the bathwater, many staff prefer long shifts.

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  • absolute rubbish..I have been nursing over 40 years and know full well long days are the best, patients prefer the continuity of the same nurse for 12 hours rather than a change over half way through the day...nurses get more days off thus have a life outside a crumbling NHS plus I cannot afford the petrol and wear and tear on my car to travel to work 5 times a week.

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  • michael stone

    The divergence of opinion, is illuminating.

    This is something, which is probably capable of 'objective measurement' - which would provide the answer.

    But the question, presumably amounts to 'do 12 hour shifts result in nurses becoming 'tired' much more than shorter shifts' - because it is ruddy obvious, that tired people tend to make more mistakes.

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  • Yep. 12 hour shifts are too tiring. The day off results in you cramming everything into one day.
    Slow and steady wins the race.

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  • tinkerbell

    Tired. worn out nurses, working flat out for 12 + hours and recovering on days off to go back and repeat the same for 40 years + , what could possibly go wrong?

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  • stevengarbs

    Even machines do worn out if overused, what more can it do to us human? Time for a change!

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