Returning to short shifts would be like “turkeys voting for Christmas”, suggested one reader in response to my opinion piece, with another saying “hands off our long days”. I never imagined the storm it would create.
I argued that: “Twelve hour day shifts may have implications for staff wellbeing in terms of stress, burnout and physical injuries.” And wondered whether nurses could “give the same unwearied, dignified and compassionate care after 11.5 hours as they can after just one hour when fresh on duty”.
The piece generated 116 comments on nursingtimes.net. Nurses were divided. Many felt that with no rush to “hand over” their patients, they could plan care over the whole day, get to know their patients and had time to chat in the evenings. “The benefits [include] better staff morale on 12 hours; the nurse being able to spread out the nursing tasks; and better consistency with patients during the day and night.” Some suggested long days worked well in areas such as accident and emergency, theatres and intensive therapy units, and some noted the importance of time off for “child care or other caring responsibilities”. Many also felt it should be a matter of individual choice, and staff should be allowed to work flexibly - although some managers suggested this would “open a can of worms”.
‘What really struck me was the powerlessness many nurses felt in a system where they did not always feel valued or that their needs were uppermost’
Most felt working long shifts with more days off improved the work-life balance, as they “work to live, not live to work”. Many pointed out a 10 day “stretch” of early and late shifts was tiring and stressful and working a five day week, could result in travelling for a long time and high petrol costs.
Counter arguments included readers suggesting that ”four days off is actually an unhealthy myth” as it is time to catch up on sleep. This reader went on to say “I now work shorter shifts and, although I have to go into work for more days, my work-life balance has returned. I am now eating and sleeping at normal times and don’t feel constantly tired. I wouldn’t go back to long days ever”. Others agreed, also pointing out that long days resulted in more sickness absence that was harder to cover. Other difficulties highlighted included the limited teaching time available for students and “team nursing [being] in disarray after the staff have had three years of long days (11.5 hours). [An] ‘I am not here tomorrow’ mentality has set in with some staff, and the documentation is variable”.
What became evident when reading through all 116 posts was the passion people felt on the topic and the extent to which opinions were polarised and arguments could be made either way. What really struck me however, was the powerlessness many nurses felt in a system where they did not always feel valued. People did not feel they had choice or that their needs were uppermost.
Readers wrote of working long hours, unpaid overtime, the relentlessly busy work environments where anyone not meeting acute care needs would be moved to another area. This was written in reference to my comment about having “time to chat to patients, to undertake the ‘little things’ that matter so much to patients, like washing their hair, having a bath, taking them outside, or to the shop” - the last of which was described as “fairyland”. Others wrote of nurses working long days, sometimes up to 14 hours, with little or no break, inadequate food and dehydration: “The trust where I worked insisted we worked 14 hour days. Which is fine… if you have a break. We didn’t receive any breaks, so worked for 14 hours straight, eating/drinking when we got a spare minute.”
Some nurses highlighted what they saw as problems of tiredness and stress: “Nurses are tired and stressed because of workload, paperwork and nurse to patient ratios, not long shifts”. Inadequate staffing levels were also mentioned: “It is all very well to advocate for [better] patient care but for most nurses [the priority] is getting through the shift, providing the safest level of care you can when massively overstretched. In the past year over half our staff quota have left due to ill health, burnout, stress and so on - they have not been replaced creating a vicious cycle. So the question is not whether 12 hour shifts are detrimental to patient and staff health [but] whether the staffing levels are dangerous to staff and patient health.”
I never intended to be an evangelist about long days, I just wanted to share my observations. What I am an evangelist about is the importance of supportive and healthy work environments for nurses. I believe passionately that in the current NHS with more targets, more regulation and rapid throughput of patients, it is vital to take good care of nurses. There is growing evidence of a link between staff wellbeing and patient experiences and outcomes, not to mention that taking care of staff is the ethical approach to being a good employer.
In another opinion piece last year I asked: “Where is the duty of care to the carers?” Maybe this piece stated the obvious but it didn’t engage readers - not one reader posted a comment. But I urge us all to address the importance of caring for the carers - we all need to care about staff wellbeing. This must include giving staff time for proper breaks and drinks; and considering nurses’ levels of stress, burnout, and tiredness. By doing so we can help create supportive work environments, whether we work long or short days.
JILL MABEN is deputy director, National Nursing Research Unit, King’s College London