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Longer shifts increase risk of sick days for nurses and HCAs


Researchers have called for the routine implementation of 12-hour shifts to be avoided after they found long shift patterns lead to a higher risk of sickness absence for hospital nurses and healthcare assistants. 

Led by researchers at the University of Southampton, the study concluded that higher sickness absence rates associated with long shifts could result in additional costs or loss of productivity for hospitals.

“This study shows objectively what happens after nurses have worked more long shifts”

Chiara Dall’Ora

They analysed data from over 600,000 shifts worked by 1,944 staff members across 32 general inpatient wards at an acute hospital in England from April 2012 to May 2015.

Funded by the National Institute for Health Research, the study found 38,051 shifts were lost due to sickness absence, corresponding to 8,090 distinct episodes.

The three-year study also revealed that 1,689 staff (86%) experienced at least one sickness episode. In this, the most common length of sickness episode lasted two days.

Last year, Nursing Times reported on findings from the study, but they have now been published in full in the Journal of Nursing Management.

Lead author Dr Chiara Dall’Ora, a research fellow in nursing workforce at Southampton, said: “The aim of this study was to examine the extent to which shift patterns are associated with sickness absence within a sample of nursing staff working on hospital wards.”

Though surveys in the past have suggested negative impacts from nurses working 12-hour shifts for both nurses and patients, he noted that his research was the first longitudinal study to look at the issue and further demonstrate the impact on nurses’ sickness rates.

“Research into this issue in the past relied mostly on surveys of nurses to report their opinions of job satisfaction and quality but this study shows objectively what happens after nurses have worked more long shifts” said Dr Dall’Ora.

“As well as being bad for employees, such increases in sickness rates are likely to be costly”

Peter Griffiths

This new study also established that when scheduled to work a shift of 12 hours or more, staff were 24% more likely to miss the shift due to sickness compared to those who were supposed to work shifts of eight hours or less, he said.

He added: “While occasional shifts of 12 hours or more in the past 7 days were not significantly associated with more sickness absence, when staff worked a higher proportion of shifts of 12 hours or more, sickness rates increased, with the highest odds for those working more than three quarters of their shifts as 12 hours or more shifts.”

The study also found that when more than 75% of shifts worked across a seven-day period were 12 hours long, the odds of both a short-term and long-term sickness episode were increased compared to working none.

Professor Peter Griffiths, a co-author of the paper and chair of Health Services Research at the University of Southampton, reiterated how both long and short-term sickness was associated with staff working more long shifts.

“As well as being bad for employees, such increases in sickness rates are likely to be costly and may undermine a key motivation for introducing the 12-hour shift pattern – organisational efficiency,” he said.

peter griffiths

peter griffiths

Peter Griffiths

Dr Dall’Ora added: “In the current context and in light of previous findings from our work and that of others, our research suggests that, while occasional 12-hour shift work may not have adverse consequences, working higher proportions may lead to higher sickness absence.

“Therefore, nurse managers should question routine implementation of long shift patterns, especially if this is based on assumed cost savings,” he said.

The study also included researchers from the University of Portsmouth, Portsmouth Hospitals NHS Trust, and Italy’s Libera Università Maria Ss Assunta. Their findings have been published in the Journal of Nursing Management. 


Readers' comments (7)

  • I don't think long shifts lead to sickness. In my opinion, badly created rotas lead to sickness. I very often see staff having day shifts coming right after night shifts, so people don't have enough time to rest. Or murses have to do too many shifts in a row.

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  • This is a sound, careful piece of research which adds furhter weight to previous findings. Its results need to be taken seriously. They cannot be dismisssed because they do not fit our own experience. Having planned nursing establishments and rotas I find it difficult to believe anyone is routinely workig a day shift after a night shift. If so it needs to be reported.

    We now need a cost-benefit analysis to identify costs against the presumed benefits from reductions in numbers of staff needed and therefore their salary costs.

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  • I agree with anonymous, also another problem I find with Rotas in various places I worked are ‘favourites’ getting better shifts than others

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  • Jennifer Hunt thank you for your in put but I agree with Anonymous and Sheenorama, I just had a conversation with my friend and former colleague. she has just finished 4 nights this morning and then she is back to work on a long day tomorrow. There are a few issues that needs to be explore yes you might argue that 12 hour shifts may be one of key contributors but not in its entirety. Other contributing factors are 1. who you work with if you're on duty with a lazy member of staff you are done for. 2 successive shifts without adequate breaks as mentioned about is the salt to a wound. 3. low staff morale 4. non-supportive senior staff etc etc,

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  • I've just turned down a job that involved 12 hour shifts, because I know that long shifts make me ill long term, and I can't provide the same level of care at the end of a 12+ hour shift as I could at the end of an 8 or 10 hour shift. That's one less experienced nurse on that ward.

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  • Lisa Inglis

    I agree, but this is something that is not new knowledge. The evidence of how these long hours as well as poor management of adequate time of to rest, of course is going to affect nurses health. Patient care is suffering as well as nurses families. Staff are overwhelmed by pressures put on them on a daily basis by the increasingly high demands of the use of our hospitals. Charge nurses are being told by line managers to call own staff members first to cover shifts for sickness rather than using bank or agency. This is not the solution, bank staff are an asset, they come in to the ward with a positive attitude and work hard with delegation.

    Full time nurses are run down, home sick and feel unappreciated for the work they do.

    The family friendly policy exists but is rarely used due to the lack of staff on the wards, nurses are struggling financially due to child care prices increasing four times faster than nurses wages. The combination of all of this stress of this undoubtedly a huge Concern for nurses, hospitals and future care.

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  • In my experience over 40 years of nursing, the latter 20 as a nursing manager, this research rings true. It has been evidenced several times in the past as well. However it goes deeper than this - nurses like working 12 hour shifts for practical reasons - not because they would actually choose to be on duty for 12 hours + .... it is the costs of parking at the workplace, travel, child care - further influenced by lack of resourcing hours required to cover the off duty, work force planning, and cost control (is it cheaper having a nurse on duty for 12 hours than running a dual/triple shift system with handover time? Probably - as long as they stay fit ........ I wonder if anyone has actually done a comparator study taking into consideration the increased costs?) .... and I have not even mentioned the weary nurse trying to maintain the quality of his or her care to patients having been on their feet for 12 hours ....... so I agree with the comments that the challenge is deeper than this. If Mr Hancock really means what he says about staff wellbeing, we need action rather than words as a result of all this evidential research ......

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