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Study indicates that 12-hour nursing shifts are linked to lower quality patient care


Nurses report significantly lower quality of care if they work a 12-hour shift compared to a stint of eight hours or less, according to new analysis, which also found longer shifts were associated with higher job dissatisfaction.

The researchers, from the University of Southampton and King’s College London, also found nurses were more likely to leave a larger amount of care uncompleted if they worked for 12 or more hours.

“[This] raises a significant challenge to the assumption that 12-hour shifts can reduce costs without any deleterious effects”

Study authors

The finding come from new analysis of data from the 31 acute NHS trusts in England that were included in a major European study from 2010, called the RN4Cast study.

Academics behind the latest analysis said their results showed that 12-hour shifts may not be cost effective or efficient – as some have previously argued.

“The analysis of data presented here raises a significant challenge to the assumption that 12-hour shifts can reduce costs without any deleterious effects,” they stated.

“In the absence of a more complete picture of both the effects and the costs of 12-hour shifts, managers should proceed with caution,” they said in their report, published in the journal BMC Nursing.

The results, based on a survey of 2,568 nurses, showed most trusts have a mix of eight-hour, 12-hour and other variety of length shifts, with few using just one type across wards.

“Working 12 hour shifts or longer are associated with poor ratings of quality of care and higher rates of care left undone”

Study authors

Poor quality care was 1.64 times more likely among nurses working 12 hours or more, compared to those working eight hours or less.

Meanwhile, the amount of care left undone was 1.13 times higher for nurses working these longer shifts.

Nurses were also 1.51 times more likely to be dissatisfied with their jobs if they worked 12-hour shifts, compared to those working eight hours or less.

“Our findings add to the international body of evidence reporting that working 12 hour shifts or longer are associated with poor ratings of quality of care and higher rates of care left undone,” said the study authors, who were led by Southampton University principal research fellow Jane Ball.

They noted that, while anecdotal evidence suggested some nurses preferred 12-hour stints because it meant they worked fewer days and had more time off, others described them as exhausting and having a negative effect on their performance.

“When nurses are working 12-hour shifts, they were less likely to express satisfaction with their jobs”

Study authors

“In our study, nurses working 12-hour shifts were…no more or less satisfied with their work schedule flexibility than those working shorter shifts,” said the study authors.

“However, our results highlight that when nurses are working 12-hour shifts, they were less likely to express satisfaction with their jobs when compared to those working less than 12 hours,” said the report.

The authors suggested that, even if nurses found working fewer days appealing for their work-life balance, this longer shift pattern may lead to stress and fatigue on the job.

“Individual nurses may hold a range of views on 12-hour shifts including personal efficiency benefits in working longer shifts whilst nonetheless finding them very tiring and being concerned about the effects of fatigue on their ability to deliver good patient care,” they said.


Readers' comments (13)

  • 12 hour shift can at times be very stressful. It also involve the whole day if one staff call sick for the shift.

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  • Carol C. Burns

    I work x3 long shifts a week i find them much better than doing late shifts followed by an early shift a run of 10 of these types of shifts left me feeling far more tired. I am more likely to get work done in 12 hrs than I am in 7.5 which means I have less jobs to handover. There is NO work family life balance with short shifts! Think id look for a new career if I was unable to do my 3 long days a week.

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  • I don't feel working shifts of this length or longer bring any greater benefit to the patient. I have heard many nurses say that they think it is better because of continuity of care, but how much of a benefit is that when that same nurse is absolutely shattered from having to work such a long shift with few, if any breaks? Often working long days means less than 12 hours before the next shift, leaving little time for an adequate rest in between each shift. It might well mean less time at work for some, but others work more than the 3 long days a week to cover staff shortages. Having spent 20 years with the police prior to re-training as a nurse, I have always found the lack of a pattern in nursing shifts to be quite difficult to understand and leads to far more fatigue and stress than if wards organised staff into teams to cover shifts, thereby leading to more regularity and giving staff more a rest between each duty.

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  • I prefer 3 x long days. It gives me 'me' time during the week. And i find that if i eat properly within that shift i feel awake throughout. Maybe this isnt the same for everyone, so there should be options for nurses to do short or long shifts as there are in some trusts. Nurses would then have the opportunity to have a work-life balance that suits them.

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  • I know a lot of nurses prefer long shift because it gives them more family / relax time so they are unlikely to go away, however there should be a choice for those who do not like them, sadly often there is not. Will those same nurses still feel the same in their fifties, or their sixties - I think not! Many hospitals require nurses to work a mixture of days and nights within the same week! In the end boxes are ticked for number of staff on shift, but ultimately the patient suffers because no-one can be that alert after twelve hours on their feet with few (if any ) breaks. How many senior managers work long shifts I wonder, very few I expect.

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  • In reply to "anonymous" 19 June 2017 6:52PM
    I have often wondered this too - so many other public services and private industry have set shift patterns which see to work (yes, I my hubby works one of these rotas) - I suspect nursing has traditionally be seen as a female profession and as such there may be more emphasis on flexible working for childcare, etc???

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  • I don't think is about the length of the shift, I think is all about who does the off duty. 4 long days in a row, finish night duty Monday morning and then back on a long day Tuesday morning this is ludicrous. All to cover the shifts but in the long run makes nurses tired and go off sick. Shift patterns on the off duty is more important than long days itself. As previous comments I prefer long days short shifts lead to incomplete work sometimes.

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  • It is the shift pattern that is the issue. Working nights and day the same week is enough to make you go off sick. The perfect rota would be doing you three nights in one week and then days the following week. It does work because I have done the rota before.

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  • This is quite a personal choice. I prefer short days since long days are quite tolling on me physically and mentally. I also find doing three shifts in a row too exhausting so the time off is mostly spent relaxing or trying to recover from being ill. Short days allows more social time since you'll be finishing work at a decent time and not having to rush home to get enough sleep for your next shift. I don't mind not having more days off in a week. I prefer to be well rested each day so I can deliver better quality care and enjoy my job as well.

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  • I have been doing shifts as long as 14.5hr, so these new 12hr shifts are not anything new. The thing I find has made the shifts harder and staff giving less care, as your figures state, is that instead of having 3x half hrs breaks, we are now only given 2x half hr breaks. Having been on a 33 bed Stroke Unit, we never have full template of staff , but on the only occasion we do, members are staff are taken to cover other wards, which are less manually demanding. What we need is more staff to help those wards which have a higher dependency level, to those that don't, which will allow us to provide a better level of care. It's not the 12hrs shifts that aren't providing the better care, it's the shattered staff with shortened breaks, too much work and not enough staff!
    The system can work, but they need some serious staffing levels addressed as soon as possible before we loose many more nursing staff.

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