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Lack of flexibility ‘consistent complaint’ in nine-hour shift trial


Nurses do not want to compromise the flexibility afforded to them by working 12-hour shifts despite burnout becoming a “growing concern”, a US researcher has warned.

She called on leaders to do more to find a solution to nurse fatigue by utilising the views of those on the frontline.

“The perception of burnout by the nurses during the nine-hour shift model was low”

Brandi McDonald

The study saw nurses on a 12-bed oncology unit at Midland Memorial Hospital in Midland, Texas, switching from 12-hour shifts to nine-hour shifts.

The new shift model idea was put forward by a hospital committee of frontline nurses and nurse leaders called the Nurse Staffing Advisory Council, which is responsible for responding to workforce concerns.

The reduction in shift length meant the nurses involved had to work four days a week instead of three.

While the results showed the nurses experienced low levels of burnout, they did not like that they could not do as much overtime.

“One consistent complaint during the project was the inability of nurses to pick up additional shifts to get overtime,” study author Brandi McDonald, director of clinical operations and critical care services at Midland Memorial Hospital, said in the study report. 

“Several discussed how this negatively impacted their financial situations,” she said.

The study – called Utilizing Nurse Staffing Committees to Engage Direct Care Nurses in Developing Alternative Shift Lengths and published in the journal Nurse Leader – found that nursing turnover on the unit during the trial was high at 46%.

Staff satisfaction surveys taken both before and after the switch from 12-hour to nine-hour shifts were evaluated looking at three key questions.

Improvement was seen in two of the questions – the degree to which nurses felt their day would never end and how much they had to force themselves to go into work. However, the results on the job enjoyment question got worse.

The study found that nurses working nine-hour shifts stayed on average one hour after their scheduled finish time but when they were doing 12-hour shifts they were stayed three hours extra.

Using a well-established survey, nurses involved in the trial reported low levels of burnout. 

They were questioned on their emotional exhaustion and depersonalisation – the higher the score, the higher the burnout – and personal accomplishment – the lower the score, the higher the burnout.

The emotional exhaustion score was 18 out of a possible 54; depersonalisation was four out of a possible 30; and personal accomplishment score was 40 out of a possible 48.

“Therefore, the perception of burnout by the nurses during the nine-hour shift model was low,” Ms McDonald said. 

But a survey was not carried before the trial to offer a comparison with when the nurses were working 12-hour shifts.

“Leaders need to develop processes to improve fatigue, burnout, and job dissatisfaction”

Brandi McDonald

Ms McDonald determined that nurses in this trial preferred working longer shifts due to the ability to work more overtime.

However, she said a solution was still needed to reduce burnout amongst nurses on 12-hour shifts.

“Nurses prefer 12-hour shifts due to the flexibility they provide,” Ms McDonald said.

“However, nurse fatigue is a growing concern, and leaders need to develop processes to improve fatigue, burnout, and job dissatisfaction among nursing staff,” she added.

Ms McDonald said consulting the views of frontline nurses would be key to finding a viable solution to the issue nurse burnout associated with long shifts.

“Utilising staffing committees where direct care nurses have opportunities to engage in staffing decisions is imperative to making impactful change,” she concluded.


Readers' comments (6)

  • The problem is that nurses want it all ways.

    We want to work less days for less travel and less childcare needs and so on.

    We want to work less days so as we're not so tired on our days off.

    We want to work less days so as we can overtime or agency.

    We want to work less hours in a day so as we don't get burned out.

    We want to work longer days for efficient (less handovers etc.)

    We can't have it all ways. Flexibility YES but patient care FIRST. And appropriate staffing and pay so that we don't need to consider stress, efficiency, burnout and making ends meet.

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  • If nurses were paid appropriately they wouldn’t have to worry about working over time or doing agency!!

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  • If nursesdis not have to work extra days to cover might not be burned out ,should not be allowed to work more than 1 extra days

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  • Interesting outcome consistent with some of the RN4cast information. It is worth considering but I am not a nurse who does shift-work so would be worth discussing with nurses who do .

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  • Sounds to me like nurses need to be paid better so they can do shorter shifts, less overtime and have a better work/life balance do avoid burnout and ensure a higher rate of staff retention.

    Funny, that.

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  • Agree totally with all of the above. As with any low paid occupation, lack of money must be made up for with burnout levels of overtime. It all comes down to money, always.

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