Because they’re worth it? A discussion paper on the value of 12-h shifts for hospital nursing

Abstract

The organisation of the 24-h day for hospital nurses in two 12-h shifts has been introduced with value propositions of reduced staffing costs, better quality of care, more efficient work organisation, and increased nurse recruitment and retention. While existing reviews consider the impact of 12-h shifts on nurses’ wellbeing and performance, this discussion paper aims to specifically shed light on whether the current evidence supports the value propositions around 12-h shifts. We found little evidence of the value propositions being realised. Staffing costs are not reduced with 12-h shifts, and outcomes related to productivity and efficiency, including sickness absence and missed nursing care are negatively affected. Nurses working 12-h shifts do not perform more safely than their counterparts working shorter shifts, with evidence pointing to a likely negative effect on safe care due to increased fatigue and sleepiness. In addition, nurses working 12-h shifts may have access to fewer educational opportunities than nurses working shorter shifts. Despite some nurses preferring 12-h shifts, the literature does not indicate that this shift pattern leads to increased recruitment, with studies reporting that nurses working long shifts are more likely to express intention to leave their job. In conclusion, there is little if any support for the value propositions that were advanced when 12-h shifts were introduced. While 12-h shifts might be here to stay, it is important that the limitations, including reduced productivity and efficiency, are recognised and accepted by those in charge of implementing schedules for hospital nurses.

The important factors nurses consider when choosing shift patterns: A cross‐sectional study

“…time and low travel costs, and that short shifts offer good quality of patient care and a healthy diet/exercise pattern-echoing previous research(Dall'Ora et al, 2022;Nicholls et al, 2017;Richardson et al, 2007). Rotating shifts did not offer clear advantages for any of the domains addressed-this was also reflected in nurses' qualitative responses, where the poor arrangement of shift start/end time and rest time when working rotating shifts were mentioned as difficult in many contexts.…”

“…Certain configurations of shift patterns and working time, including long weekly working hours, unpredictable shifts and shifts worked during social hours and nights, have been identified as potential stressors on work‐life balance (Albertsen et al., 2008; Arlinghaus et al., 2019; Arlinghaus & Nachreiner, 2016; Grzywacz, 2016). Some shift configurations may be actively chosen by nurses to enable work‐life balance, like long shifts or compressed working weeks (Dall'Ora et al., 2022). However, consequences can appear in the long term, such as increased fatigue and longer time needed for recovery, which nurses identified in this study as disruptive to their priorities in and outside of work.…”

“…shifts lasting 8 h or less; Ball et al., 2015). Nonetheless, research has also shown that working long shifts can lead to harmful outcomes for patients as well as increased burnout and job dissatisfaction for nurses (Dall'Ora et al., 2022). The conflict between these viewpoints stresses a need for closer examination of the relationships between different shift configurations and nurses' choices over working time.…”

The impact of COVID‐19 on nurse alcohol consumption: A qualitative exploration

“…Although there is evidence that longer shift lengths and shorter roster pattern rotations reduce SARS‐CoV‐2 infections among healthcare workers (Kluger et al, 2020 ), studies support our finding that longer shift length is attributed to poor well‐being and mental health during the pandemic (Shaukat et al, 2020 ). Research exploring 12‐hour nursing shifts prior to the onset of the pandemic found that fatigue had an impact on patient safety and an increased intention to leave their profession (Dall'Ora et al, 2022 ), further highlighting that enforced overtime to cover staffing shortages may actually endanger both the nursing workforce and patients they care for.…”

“…Longer shift lengths have been studied in nursing, finding that fatigue leads to negative effects on safe, quality care (Dall'Ora et al, 2022 ). Although not specifically researched in the context of the COVID‐19 pandemic, where nurses often remained ‘on shift’ due to staff furloughing and shortages, research has highlighted extended working hours as detrimental to quality care and nurse well‐being (Nymark et al, 2022 ; Yayla & Eskici İlgin, 2021 ).…”