Do 12-hour shifts put patients first?

Abstract

Interest in 12-hour nursing shifts has been come about via two main routes; staff choice and 2 for improved cost-effectiveness in the NHS, however, the effects of this shift on the delivery of patient and family-centred care are unclear. Todd et al (1993) describe the results of a repeated-measures study of 10 wards, using activity analysis to describe patterns of care under an 8-hour compared to a 12-hour shift system. Significant reductions in the amount of direct patient care were found under the 12-hour shift, with corresponding increases in unofficial work breaks. These findings, which were consistent over all study wards and throughout the whole 12-hour day, demonstrate a ‘pacing’ effect by nurses who face 12 hours on duty. It is unclear what the effects of 12-hour shifts are on nursing education and the learning environment. Todd, et al reported surveys of the attitudes of student nurses and nurse educators towards 12-hour shifts. Learners are reasonably positive about 12-hour shifts, but this preference is based on social rather than professional benefits. A reported effect of fatigue on home study is evident. Very negative views about the 12-hour shift are held by the group of educators. Their criticisms appear to be primarily organisational, but they are unequivocal that learning is detrimentally affected. Thus, even if students appear to like this shift pattern, serious concerns are raised by these findings about the impact on nursing education. It is generally agreed that some features of shift systems can influence the extent of wellbeing and health problems experienced by the workers involved. Extended working days (9-12 hour shifts) have been found to aggravate some problems associated with shift work, especially when the work is mentally and emotionally demanding. The aim of the study was to compare measures of health, sleep, psychological and social wellbeing, job satisfaction and burnout of intensive care unit nurses on 12and 8-hour shifts. In a study that matched nurses for age, length of shift work experience, marital status and number of hours worked, the 12-hour shift nurses, when compared to their 8-hour shift colleagues, experienced more chronic fatigue, cognitive anxiety, sleep disturbance and emotional exhaustion (Todd et al, 1991). Job satisfaction seems to be independent of the shift duration. The nurses on 12-hour shifts reported less social and domestic disruption than those on 8-hour shifts. The 12-hour shift nurses showed worse indices of health, wellbeing and burnout than the 8-hour shift nurses. This may be associated with their longer daily exposure to the stress of work. The increased number of rest days of 12-hour shift nurses seems to be insufficient to dissipate the adverse health and wellbeing effects that built up over their longer shifts. In 2000 Wooten discussed the implementation Rory Farrelly NHS Greater Glasgow and Clyde Director of Nursing Acute Services Division of 12-hour shifts using a locally devised nursing development unit (NDU) framework. and the results of a survey to evaluate the 12-hour shifts, the problems encountered during the implementation of 12-hour shifts, the solutions and the NDU framework as described in the first part of the article. A qualitative design to the postal survey was chosen with the resulting data being subjected to a content analysis. Data triangulation compared survey results with incident reports and sickness records. The limitations of the survey included having the change agent analysing the data, the sampling method and being unable to pilot the questionnaire. This piece of work concluded that it is difficult to measure whether there was an improvement in the quality of patient care as nursing workload throughout a 12 hour shift is variable. Other results centred on staff morale, social life, student nurses’ experience and night shifts. The solutions to identified problems included the employment of two twilight nurses to help the night staff during the busy early evening period. As a requirement of the NDU framework, standards were produced from the survey results, as this would allow subsequent audit of the 12-hour shift system. NHS organisations will have systems to look at clinical and non-clinical incidents and patient safety issues, however, a lot of these systems do not have the ability to pick up on whether the practitioners involved were on an 8-hour or 12-hour shift and how long into the shift the incident happened. In March 2014 Grimsby’s Hospital are aiming to cut the length of nursing shifts from 12 hours to 7.5 expecting that it would bring ‘immense benefits to the quality and safety of patient care’, according to Chief Nurse Karen Dunderdale. Following a consultation period with 400 nurses since October 2013, the changes will bring the hospital’s shift patterns in line with others in the Northern Lincolnshire and Goole Hospitals NHS Foundation Trust, as well as national guidelines. As Karen Dunderdale said in October 2013: