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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)

  • we work 12 hour shifts which I don't mind. The main problem is we now work nights and days on a 4 week rota so often within the same week a wednesday night and long day friday is not uncommon for example. This is absolutely knackering as you finish work thursday and either sleep part of the day and force yourself out of bed midday so you can hopefully sleep that night or you try to stay awake all day so you will sleep and be like a zombie. Either way it exhausting and you can barely function half way through the day shift

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  • The Working Time Directive will pose an obstacle to returning to the late/early shift pattern - unless people don't mix the shifts in a week. There is a requirement for an eleven hour break between shifts, if that does not occur the worker then accrues 11 hours of time owing. It doesn't take a genius to work out that two late/early quick changes with a break of 7.5hrs in a week equals 22hrs of TOIL which is three further (paid) days off. Twelve hour shifts came in for a reason......

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  • Working nights and days in a week is much more unsafe than doing long days.
    We are forced to do rotation to night even though there are adequate nurses willing to do nights only.
    I feel quite ill after a night shift and cannot cope with it well, but we have no choice but to do it.
    The body finds it difficult to cope with this mixing up of night and day.

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  • Anonymous | 16-Apr-2013 9:03 pm

    "It is absolutely incredulous that priority is no longer given to patient outcomes and their experience of care but to staff convenience and saving money."

    So never heard of work-life balance then?If you are half as experienced as you claim to be, then you surely would have learned by now that NOTHING in the NHS is done for staff convenience?! The lack of focus on staff wellbeing (regardless of what side of this "shift" debate you stand), within healthcare is a major factor in patient outcomes.

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  • It's important to consider staff as well as patients because if the workforce are made to do a shift pattern they hate, they are going to get tired and demoralised.

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  • Anonymous | 16-Apr-2013 10:11 pm

    They try to knock everything but short staffing. If the wards are well staffed then 12 hours does not present a problem as long as there are rest days between them.
    I favor 12 hours as I have more days off for myself. I value a good balance in my life.
    Working shorter shifts means you are at work more days.
    What about pilots they do long shifts, they have rest days between. What about surgeons they do long shifts, I can go on naming lots of jobs where long hours are necessary. We need MORE STAFF, that is the problem.
    I will like to see more senior staff on the shop floor instead of them walking around the hospital with a clip board in their hand.
    Too much money is spent on grade 7s who got a lot of clinical training and doing absolutely nothing with it.
    I will also like to see a national tool in use for measuring how much staff a ward should actually have to ensure safe care.

    Everything you have written here is EXACTLY right. Will it be taken on board? NO

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  • I agree with the above in that far too many people in highly graded jobs wander around with a clipboard trying to look important and busy. I could easily keep them busy!

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  • Anonymous | 17-Apr-2013 2:13 pm

    Absolutely agree. 24 hour rotational work has the worst impact on the health of workers. Get rid of it.

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  • Expecting nursing staff to work 12hr shifts is a recipe for disaster, and would be best avoided at all costs.
    Years ago, when I did my general nursing, we worked 'split shifts' i.e., 7am - noon, then, have a few hours break, and recommence our shift until mid evening. (Can't recall exact times, but you get the picture).
    Years later, my colleague ward sister and I used to cover 7am until 9pm at times of staff shortages, on a psychiatric ward. We deemed ourselves as competent, and responsible nurses, but, even then we were working to the limit.
    Nursing is not a sedentary job, it is both physical and mentally taxing, and to try and work with all the demands made on us by patients, and nursing managers, it can and will be the precursors leading to 'Burn Out'.
    This will undoubtedly result in clinical mistakes and errors in judgement being made, and worst still causing suffering to the patients.

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  • When I was younger I loved 12 hour shifts as I had bags of energy and this fitted with my interests outside of work. Now I'm not sure I would be able to do a 12 hour shift in a physically demanding role and am not sure what element of choice there is for or staff before taking on 12 hour shifts.
    On reflection I'm not sure the care I gave at the latter part of my shift was as thoughtful and intuitive as at the beginning of my shift.

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