12 Hour Nursing Shifts and Its Impact on Patient Safety
Penelope Baker Walden University EDUC 6125 Foundations of Research
Dr. Sunil Hazari December 12, 2012
Slide 3
Context Hospital nurses worked 8 hour shifts until the late
1970s Now, most nurses work 12 hour shifts (Bae, 2012; Geiger-Brown
& Trinkoff, 2010a)
Slide 4
Background Registered Nurse (RN) demographics 2.5 million
actively employed 62% work in hospitals 70% work full time Average
age 45.5 years (U.S. Department of Health and Human Services,
2010)
Slide 5
Problem Nurses find 12 hour shifts and shorter work weeks
satisfying Despite satisfaction, there is growing evidence 12 hour
shifts Have a negative impact on nurses physical health Jeopardize
patient safety Prompt older nurses to seek 8 hour jobs elsewhere
(Geiger-Brown & Trinkoff, 2010a; Geiger-Brown & Trinkoff,
2010b; Georgia Nurses Association, 2012; Stone, Du, Cowell,
Amsterdam, Helfrich, Linn, Gladstein, Walsh, & Mojica,
2006)
Slide 6
Controversy Initial research on effects of 12 hour shifts
focused on nurse satisfaction Later research examined effects of
longer shifts on quality of patient care Some researchers and
professional organizations recommend Returning to 8 hour shifts
Based on studies showing a relationship between the number of hours
worked and nursing errors (Geiger-Brown & Trinkoff, 2010a;
Geiger-Brown & Trinkoff, 2010b; Georgia Nurses Association,
2012; Vik & MacKay, 1982)
Slide 7
Review of Literature The risk of making an error was 3 times
higher when nurses worked 12.5 or more hours (Rogers, Hwang, Scott,
Aiken, & Dinges, 2004b; Scott, Rogers, Hwang, & Zhang,
2006).
Slide 8
Review of Literature More than half of nursing errors involved
medication administration (Rogers, Hwang, Scott, Aiken, &
Dinges, 2004b; Scott, Rogers, Hwang, & Zhang, 2006).
Slide 9
Review of Literature For nurses working 12 hour shifts, 75% of
the time they worked more hours than scheduled Increased reports of
fatigue and difficulty staying alert when working 12 hour shifts
Older workers were more sensitive to internal body clock
disruptions Older nurses working 12 hour shifts experienced other
physical problems (Fragar & Depczynski, 2011; Reid &
Dawson, 2001; Rogers et al., 2004b; Scott et al.,2006)
Slide 10
Review of Literature 16 U.S. states have laws regulating
mandatory nurse overtime though this does not mean they work less
mandatory overtime or fewer hours In 2006, researchers refuted
other studies by reporting no differences in quality or patient
outcomes when comparing 8 hour and 12 hour shifts (Bae, 2012; Stone
et al., 2006)
Slide 11
Controversy Revisited Returning to 8 hour shifts may be ideal,
but not practical If 12 hour shifts are eliminated, nurses may
become dissatisfied Unless research provides overwhelming evidence
12 hour shifts are detrimental to nurses and patients, hospitals
will continue offering 12 hour shifts and nurses will continue
working those shifts. (Geiger-Brown & Trinkoff, 2010a;
Geiger-Brown & Trinkoff, 2010b; Georgia Nurses Association,
2012; Montgomery & Geiger-Brown, 2010; Rogers et al.,
2004b)
Slide 12
Proposed Solution 1.Minimize 12 hour shifts 2.Limit work hours
to 12 hours in a 24-hour period 3.Schedule sufficient recovery time
between 12 hour shifts 4.Leave work at end of shift, 100% of time
5.Create a mixture of 4 hour, 8 hour, and 12 hour shifts
6.Eliminate overtime 7.Reduce medication administration errors with
use of bedside medication verification systems (Fragar &
Depczynski, 2011; Geiger-Brown & Trinkoff, 2010b; Rogers et
al., 2004b; Scott et al., 2006)
Slide 13
Proposed Solution 8.Use fatigue risk-management software to
identify schedules promoting fatigue 9.Respect nurses days off no
extra work days or training classes 10.Avoid scheduling night shift
staff meetings for 7:30 a.m. 11.Implement 12 hour shift nursing
policies based on guidelines from the Joint Commission and the
American Nurses Association (Geiger-Brown & Trinkoff, 2010b;
Rogers et al., 2004b; Scott et al., 2006; The Joint Commission,
2012; The American Nurses Association, 2012)
Slide 14
Proposed Solution 12.Design and implement e-learning modules
Minimizing fatigue and promoting alertness Improving sleep and
internal body clock functioning (Berger & Hobbs, 2006)
Slide 15
Next Steps Present key findings and proposal to nursing
stakeholders Vice President & Chief Nursing Officer Clinical
Directors Clinical Managers Clinical Educators Develop effective
solutions by working with members of these direct-care nursing
councils Nursing Research and Evidenced-Based Practice Council
Nursing Quality Council
Slide 16
Discussion Most significant finding, the risk of making an
error was three times higher when nurses worked more than 12.5
hours in a shift Nurses on 12 hour shifts worked more hours than
scheduled 75% of the time These studies did not explore level of
harm to patients when errors made Patient safety was compromised
(Rogers et al., 2004b; Scott et al.,2006)
Slide 17
Conclusion Evidenced-based strategies for 12 hour shifts need
to be implemented in every hospital and accepted by every nurse
Nurses get what they want, 12 hour shifts Patients get what they
want, patient care without errors
Slide 18
Acknowledgements Images used in this presentation obtained from
three sources Microsoft Corporation: www.Office.comwww.Office.com
iStockphoto:
http://www.istockphoto.com/index.phphttp://www.istockphoto.com/index.php
Meritus Medical Center, 11116 Medical Campus Road, Hagerstown,
Maryland, 21742 Images comprised of actual employees functioning in
dual roles of nurses and patients
Slide 19
References Bae, S. (2012). Nurse overtime, working conditions,
and the presence of mandatory nurse overtime regulations. Workplace
Health & Safety, 60(5), 205-214. Retrieved from DOI:
0.3928/21650799-20120426-01 Berger, A. M., & Hobbs, B. B.
(2006). Impact of shift work on the health and safety of nurses and
patients. Clinical Journal of Oncology Nursing, 10(4), 465-471.
Retrieved from DOI: 10.1188/06.CJON.465-471 Fragar, L. J., &
Depczynski, J. C. (2011). Beyond 50. Challenges at work for older
nurses and allied health workers in rural Australia: a thematic
analysis of focus group discussions. BMC Health Services Research,
11(1), 1-13. Retrieved from DOI: 10.1186/1472-6963-11-42
Geiger-Brown, J., & Trinkoff, A. M. (2010a). Is it time to pull
the plug on 12-hour shifts? Part 1. The evidence. Journal of
Nursing Administration, 40(3), 100-102. Retrieved from DOI:
10.1097/NNA.0b013e3181d0414e
Slide 20
References Geiger-Brown, J., & Trinkoff, A. M. (2010b). Is
it time to pull the plug on 12-hour shifts? Part 3. Harm reduction
strategies if keeping 12-hour shifts. Journal of Nursing
Administration, 40(9), 357-359. Retrieved from DOI:
10.1097/NNA.0b013e3181ee4295 Georgia Nurses Association (2012). GNA
Reference Reports: Adopted 2011 Georgia Nurses Association Action
Report, 12 hour shifts and fatigue. Georgia Nursing, 72(1), 7-8.
Retrieved from
http://ezp.waldenulibrary.org/login?url=http://search.ebscohost.com/login.aspx?
direct=true&db=rzh&AN=2011446899&site=ehost-live&scope=site
Montgomery, K. L., & Geiger-Brown, J. (2010). Is it time to
pull the plug on 12-hour shifts? Part 2. Barriers to change and
executive leadership strategies. Journal of Nursing Administration,
40(4), 147-149. Retrieved from DOI: 10.1097/NNA.0b013e3181d40e63
Reid, K., & Dawson, D. (2001). Comparing performance on a
simulated 12 hour shift rotation in young and older subjects.
Occupational & Environmental Medicine, 58(1), 58-62. Retrieved
from http://oem.bmj.com
Slide 21
References Rogers, A. E., Hwang, W., & Scott, L. D.
(2004a). The effects of work breaks on staff nurse performance.
Journal of Nursing Administration, 34(11), 512-519. Retrieved from
Accession Number: 00005110-200411000-00007 Rogers, A. E., Hwang,
W., Scott, L. D., Aiken, L. H., & Dinges, D. F. (2004b). The
working hours of hospital staff nurses and patient safety: both
errors and near errors are more likely to occur when hospital staff
nurses work twelve or more hours at a stretch. Health Affairs,
23(4), 202-212. Retrieved from DOI: 10.1377/hlthaff.23.4.202 Scott,
L.D., Rogers, A. E., Hwang, W., & Zhang, Y. (2006). Effects of
critical care nurses work hours on vigilance and patients safety.
American Journal of Critical Care, 15(1), p. 30-37. Retrieved from
http://ezp.waldenulibrary.org/login?url=http://search.ebscohost.com/login.
aspx?direct=
true&db=rzh&AN=2009096375&site=ehost-live&scope=site
Slide 22
References Stone, P. W., Du, Y., Cowell, R., Amsterdam, N.,
Helfrich, T. A., Linn, R. W., Gladstein, A., Walsh, M., &
Mojica, L.A. (2006). Comparison of nurse, system and quality
patient care outcomes in 8-hour and 12-hour shifts. Medical Care
(MED CARE), 44(12), 1099-1060. Retrieved from Western Maryland
AHEC, Interlibrary Loan with Medical Library, Perry Point VA
Medical Center, Perry Point, Maryland, 21902. The American Nurses
Association (2012). Position statements: opposition to mandatory
overtime, Registered nurses responsibility in all roles and setting
to guard against working when fatigued. Retrieved from
http://www.nursingworld.org/ The Joint Commission (2012). Hospital
national patient safety goals for 2012. Retrieved from
http://www.jointcommission.org/assets/1/6/2012_NPSG_HAP.pdf U.S.
Department of Health and Human Services (2010). The registered
nurse population: Findings from the 2008 national sample survey of
registered nurses. Retrieved from
http://bhpr.srsa.gov.healthworkforce/rnsurvey/initialfindings2008.pdf
Slide 23
References Vik, A. G., & MacKay, R. C. (1982). How does the
12-hour shift affect patient care? Journal of Nursing
Administration, 12(1), 11-14. Retrieved from Western Maryland AHEC,
Interlibrary Loan, Source Unknown.