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.
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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.
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.
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“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”
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.