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CNO to review safety of 12-hour shifts


The impact of 12 hour shifts on patients and staff is to be reviewed by NHS England as part of its plan to implement the chief nursing officer for England’s national nursing strategy.

The review is one of a raft of initiatives planned over the next few years with the aim of making the Compassion in Practice strategy a reality.

Professor Juliet Beal, NHS England’s director of nursing for quality and improvement, told Nursing Times the review would focus on which shift patterns were most appropriate for different settings.

“There is a concern that for some nurses in some areas working 12 hour might be a very long shift to work – 12 hours is a very long time to do something that requires a lot of emotional labour.

“In some areas it might be perfectly acceptable, but we don’t have the evidence base. We need to look at it to make sure we are really giving patients the best care.”

She said although 12-hour shifts could provide continuity during the shift, it was not always the case for patients who had longer stays in hospitals.

Compassion in Practice was published last December. But the senior nurses leading it waited for the publication in February of the Mid Staffordshire Foundation Trust Public Inquiry report before setting out detailed implementation plans for the strategy.

Due to be launched yesterday, they include initiatives at national, local and individual level and across areas including workforce planning, education, leadership and staff experience.

Alongside new staffing tools for community, mental health and learning disability nursing, it is hoped the shift pattern review will contribute to establishing “adequate, and appropriate, staffing levels for all care settings”.

Jill Maben, director of the National Nursing Research Unit in London, said a review of shift patterns was “long overdue”.

“Twelve hour shifts have crept into the NHS with very little evaluation of their impact on staff or quality and safety. It seems to be either down to staff preference or costs savings,” she told Nursing Times.

Last week cash-strapped Bolton Foundation Trust announced it was piloting a move to 13-hour shifts in a bid to save £1.5m.

Royal College of Nursing director of policy Howard Catton said it was important nursing took ownership of the issues around shift patterns. “There could be very significant temptations for others to look at shift systems to reduce head count,” he said.

The review is due to complete by September. However, whatever its conclusions Professor Beal said NHS England did not have the power to make certain shift patterns compulsory.

“It’s a new world. NHS England cannot mandate anything… What we want to do in the new world is do things because people think it’s the right thing to do and it will work locally,” she said.

Sally Brearley, chair of the Prime Minister’s Nursing and Care Quality Form, also welcomed the review but predicted more research would be needed as there was little existing evidence on staffing levels.

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Readers' comments (54)

  • I do not know how nurses keep going on a 12 hour day shift on general ward areas. My observations are that Nurses often work without proper breaks, there has been a total elimination of the 'overlap' so no opportunity for ward based teaching and learning, physically it must be exhausting - nurses rarely get the chance to sit down. I am aware that some nurses also supplement their income by doing extra 12 hour shifts for agencies and nurse banks
    I can understand that it can be easier for child care purposes but I would welcome some research to assess whether sickness levels, especially due to stress, have risen since the introduction of 12 hour shifts. I worked 11 hour night shifts for many years and was able to take at least one break and had the opportunity to sit and write up patient documentation most of the time. I always had a full day off before commencing these shifts and at least 2 days off to recover - those were the days!

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  • Matilda McCrrimmon

    I work 12.5 hour shifts and would hate to return to 22:00 finish with 07:30 next day. i don't think 12 hour shifts are intrinsically the problem ,as stated by Joanne it is the removal of any lap over in the afternoon which is the problem and the fact that we have 6 staff in the morning dropping to 4 from 13:30 most days. The lap over allowed time for talking to patients ,cleaning , teaching ect. Would a return to eight hours increase staff numbers ?Also I understand EU working times make old finish times unworkable as need 11 hours between shifts.

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  • I'm a labour ward midwife who works 12 hour shifts. The positive side of the 12 hour shifts is the continuity of care it gives to the women which is both rewarding for the midwife and beneficial to the patient. Another positive for myself is that i have to travel 50miles to work, so with 3 shifts per week my petrol consumption is much less. The negative side is that we frequently don't get time to have our ,unpaid, half hour break, thus the trust is gaining a lot of unpaid time from their staff (we are not allowed to claim back time owing for this, we are basically told that we have to make time for breaks). The 12 hour shifts are definately exhausting and i would definately question the level of concentration of staff by the the 10th hour, particularly with shifts that are incredibly busy. It is becoming increasingly apparent that trusts are so eager to find ways to save money they are forgetting that the staff providing the care to patients are only human, and are constantly being set up in environments that can only fail.

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  • The article mentions 12 hour shifts involves a lot of 'emotional labour' but nothing about the level of concentration needed to sustain a good standard of care and safety. The last comment states it is convenient for them and cheaper but exhausting and questions concentration; and the first comment mentions taking 2 days to recover from long shifts which then encroaches on family time. 13 hour shifts may save Bolton Foundation Trust £1.5m but at what cost to life? Perhaps false economy in the long run. Slogging your way through a never ending shift willing it to end is in no-one's best interests.

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  • In my hospital, we work 14 hour shifts with an hour's break. If we work short shifts, you end up having to work 8 in a row at times to get a weekend off.

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  • I don't think it is the 12 hour shifts that is the problem, but the implementation of shift patterns. Split days off, not enough time to recover, long days mixed in with lates then earlies, I have even seen nights rotad in on the same week as days! I know nursing is 24/7, but that doesn't mean nurses can work 24/7!

    If long days are done, then 4 days off together or at least 2 days off together either side of the 3 long days MUST be implemented.

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  • 8 lates, an early and then a single day off was better?

    It's jack all to do with 12 hour shifts more lack of ability to manage rotas, sufficient breaks, and lack of staff.

    Funny at Bolton they took them off 12 hour shifts because they told them E-Rostering couldn't cope with it...

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  • 12 hour shifts may benefit the hospitals staffing budget. However that saving is probably ofset by the investigations that need to be carried out when things go wrong.
    How many of us are going to be able to work these shifts when we get closer to our state retirement age? Perhaps the service will have killed us by then, so no worries!

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  • I would hate to return to 8 hour shifts and 10 day stretches. The long shifts suit me much better, and I have more days to use for non work activities.

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  • I remember when 12 (really 13) hour shifts came in for maternity services. Everyone had to slow down and reduce activities to a minimum in order to keep going for the whole day. Of course, this is not always possibleand the shifts are a long physical slog. The idea was to save money, and that still applies. There may be continuity of care with individual patients, but there is no continuity within the department or section - most staff have 3 or 4 days off each week.

    Good idea to review it in terms of safety, also review the physical safety of those who have to do it

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