Running head: EFFECTS OF 12 HOUR SHIFTS

Effects of 12 Hour Shifts on Nurses and Patient Safety

Shamila Hashimi
Western Washington University

EFFECTS OF 12 HOUR SHIFTS

Effects of 12 Hour Shifts on Nurses and Patient Safety

As a fresh, newly graduated registered nurse working at a public hospital in Mt. Vernon, WA,
getting accustomed to a work schedule is a habit that is just starting to kick in. After two years
of nursing school and working 8-16 hours a week while attending school, becoming adapted to
working 12-hour shifts, three times a week or more is not an easy alteration. After a month of
working, I began to feel fatigued and exhausted. Driving home late at night, receiving less than 8
hours of sleep, and then dragging myself out of bed to get back to work on time formulated my
curiosity. I was curious if the other nurses were feeling half as worn-out as I was feeling. Based
on what I experienced within these past couple of months and research articles I found online, it
became almost obvious that the effects of 12-hour shifts are in fact valid which led to my
decision to explore this topic in detail.
Library and Keyword Search
During the beginning of my research I was assigned to the staffing group. The keyword
search that yielded the most important research was nurse* AND fatigue* 12-hour shifts*; using
this I managed to find the Chen, Davis, Daraiseh, Pan, and Davis (2014) article on fatigue and
recovery in the 12-hour dayshift amongst hospital nurses. I was also led to an article by Stimpfel,
Sloane, and Aiken (2012) on how nurse fatigue led to patient dissatisfaction. After keyword
searching nurse* AND 12-hour shifts* patient safety*, the article by Peate (2014) appeared
which led to the finding of the subsequent article by Rollins (2015) on 12-hour shifts and the
general safety of them as opposed to 8-hour shifts. These keywords also assisted in finding the
article by Ball, DallOra, and Griffiths (2015) which looked at a study of many registered nurses
and their opinions on 12-hour shifts in relation to their level of burnout. After looking through
the articles, I began to formulate my pointed question; are 12-hour shifts increasing nurse

EFFECTS OF 12 HOUR SHIFTS

burnout and fatigue leading to negative patient outcomes? I used this question while critically
reading my research to formulate a more substantial claim.

With an increase in nurse shortages across the country, extended work shifts of 12 hours
and longer are becoming more common and popular amongst hospital staff nurses. As the
amount of hospital nurses working prolonged hours increases, patients dissatisfaction with care
also increases. Additionally, nurses working shifts of ten hours or longer were up to two and a
half times more likely than nurses working shorter shifts to experience burnout and job
dissatisfaction and to intend to leave the job (Stimpfel, Sloane, and Aiken, 2012). With an
increase in nurse fatigue and burnout, do 12-hour shifts also compromise patient care? 12-hour
shifts are detrimental to the health and safety of both nurses and patients in the hospital setting.
Increased nurse burnout and fatigue leads to an increase in medication and assessment errors
which ultimately cause poorer patient outcomes (Peate, 2014). The conclusion of various articles
in which research was conducted to prove 12-hour shifts were not beneficial to the health of the
nurses proved that increased nurse burnout and fatigue led to a decrease in the safety of the
patient.
Nurse Burnout and Fatigue
Fatigue; weariness from bodily or mental exertion. Many people experience fatigue and a
lack of energy every day. Most of the time, fatigue develops after activity that is acute and
temporary and, in most cases, can be relieved by regular rest (Chen, Davis, Daraiseh, Pan, and
Davis, 2014). However, without appropriate periods of rest, chronic fatigue sets in. Chronic
fatigue is characterized by unrelieved physical and mental exhaustion (Chen et al., 2014).

EFFECTS OF 12 HOUR SHIFTS

According to Chen et al. (2014), after a study of 150 nurses working 8 and 12-hour shifts, it turns
out that the fatigue for nurses working a 12-hour shift was higher than that found in a study of 8hour shifts. In turn, these fatigued nurses may be compromising positive patient outcomes in the
hospital setting.
The introduction of 12-hour shifts initially started to reduce overlap between shifts.
Without a surprise, a study done by Stimpfel, Sloane, and Aiken (2012) showed that nurses
reporting burnout and an intention to leave the job increased incrementally as the hours of their
shift increased. The study also found that nurses shift length was significantly associated with
patient satisfaction. Exploring the meaning of fatigue and relating the definition to nurses who
experience it makes one wonder the impact it has on the delivery of care. The dissatisfaction
amongst these nurses are being projected onto their patients. In turn, dissatisfied and drained out
nurses are unintentionally contributing to poorer patient outcomes.
Patient Dissatisfaction
The greater likelihood of adverse nurse outcomes directly affect patient care in a negative
way. Hospitals that staffed nurses working longer hours tended to have lower ratings from
patients. In addition, these patients would not recommend the hospital to friends and family
(Stimpfel, Sloane, and Aiken, 2012). Among the reasons behind why patients were giving lower
ratings of hospitals containing nurses working longer shifts, little to no communication, poor
pain control, and not receiving help as soon as patients needed it were amid the top. Hospitals
need to realize that patient dissatisfaction may be controlled in addition to the nurses displeased
by their jobs. If one truly ponders, nurses have control over patients moods and in turn, patients

EFFECTS OF 12 HOUR SHIFTS

have great control over how they make their nurses feel. If a nurse despises coming to work, this
greatly affects patients and patient outcomes.
Occupational Hazards
Nurses working less hours and days have the potential to having an improved work/life
balance. In a hospital setting, the longer shifts mean less overtime and use of traveling nurses.
Developing schedules are easier as well with only two shifts to cover each day and two daily
handoffs (Rollins, 2015). Rollins also states that fatigue and insufficient/poor-quality sleep for
nurses are troublesome factors in 12-hour shifts for nurses of all ages.
Ball, DallOra, and Griffiths (2015) articulated a questionnaire survey of nurses working
in five different hospitals. The survey was done to explore the relationship between shift work
and job satisfaction in relation to 12-hour shifts. Although the majority of nurses are in favor of
12-hour shifts due to personal reasons such as having more time to spend with family, these
longer hours can have other adverse outcomes in the long-run. Due to the increase fatigue, nurses
working are found to be at an increased risk of occupational hazards such as needlestick injuries
and musculoskeletal disorders (Ball et al., 2015). Based on this evidence, it becomes quite
evident that because of the increased fatigue these nurses experience, poorer patient outcomes
increase as well.
Patient Safety
Another study aimed to address questions about the possible effects of 12-hour shifts on
patient safety and quality. Nurses working overtime most likely reported poorer quality of care.
Both longer shifts and working overtime were significantly associated with lower quality of
care, worse patient safety reports, and more care left undone (Ball et all., 2015).

EFFECTS OF 12 HOUR SHIFTS

Nurses working overtime on their most recent shift were 32% more likely to report
poorer quality of care, 67% more likely to report poorer patient safety, and reported a
29% higher rate of care left undone than was reported by those nurses who were working
shorter shifts. (Ball et all., 2015)
Based on this data, its suggested that the policy of moving to longer shifts have accidental
consequences that are more essential to consider than the benefit of a reduced workforce.
Increased hours greatly effect nurses performance level which reduces the efficiency and
effectiveness of the workforce in being able to deliver care that is both safe and of high quality.
There may be benefits to these shifts when scheduling is considered, however, the risks
must also be understood. Nurses performing less efficiently and less safely due to the extended
hours greatly impact patient outcomes. Peate (2014) studied the impact of caregivers working in
various hospitals on their adherence to hand-hygiene standards from the beginning to the end of
a typical 12-hour shift. The study identified a decline in compliance over the course of the shift.
Hand-hygiene is one of the most important standard precautions caregivers need to follow to
prevent the spread of hospital-acquired ailments. Seeing a decline in nurses adherence to this
vital habit may significantly have an impact on patient and employee safety.
Synthesis
12-hour shifts ultimately cause nurses to become chronically fatigued overtime and
without proper recovery, both the nurse and patient may become greatly affected by the adverse
outcomes of prolonged hours. According to Chen, Davis, Daraiseh, Pan, and Davis (2014),
chronic fatigue becomes more prominent amongst nurses working 12-hour shifts than nurses
working 8-hour shifts. Fatigue subsequently has a major impact on nurses attitude towards their

EFFECTS OF 12 HOUR SHIFTS

chosen career. Its not a surprising fact to consider that being worn-out causes a negative attitude.
In the hospital setting, nurses may project their negativity towards their patients. Stimpfel,
Sloane, and Aiken (2012) clearly state that nurses are more dissatisfied and are inclined to leave
their jobs as the hours of their shift extended. Since increase fatigue causes increase burnout and
dissatisfaction, nurses are more prone to accidents that are harmful to themselves. Ball, DallOra,
and Griffiths (2015) mention the likelihood of occupational hazards rising amongst nurses
working 12-hour shifts.
Dissatisfied nurses lead to dissatisfied patients. Nurses who are fatigued tend to care less
and deliver poorer quality of care to their patients. The performance level of nurses considerably
decrease as hours go by. Although the workforce may benefit from lengthy shifts by the
reduction of employees, patients are not getting a higher quality of care as they should. All
caregivers are at an increased risk of fatigue, burnout, and dissatisfaction when working 12-hour
shifts. It is crucial to eliminate the risk factor of prolonged work hours in order to sustain the
goal of providing highly efficient and excellent care to patients.
Conclusion
Caregiver fatigue is a huge safety concern for not only the caregiver but for the patients
being taken care of by the weary caregiver. Hospitals and other organizations need to be fully
aware of the effects that 12-hour shifts can have on staff and, consequently, on the patients.
Studies after studies prove that the cons significantly outweigh the pros when considering 12hour shifts. Increased adverse implications to patient safety, leading to poorer patient outcomes is
something hospitals need to recognize, after all, positive patient outcomes should be the
fundamental goal of hospitals.

EFFECTS OF 12 HOUR SHIFTS

Gaps in the research articles I found failed to look at the pros of shorter shifts. Although
theres proven evidence that 12-hour shifts are harmful to nurses and patients, I would research
how 8-hour shifts and having more hand-off reports over the course of the day may impact
patient safety. Having two handoff reports and one nurse who knows a patient quite well over the
course of 12-hours sounds safer for the patient. I would recommend more research on the impact
of shorter shifts and if being familiar with a patient for a shorter amount of time does in fact
impact positive patient outcomes in a negative way.
Before starting my first draft, I did not have a clue on how to write a source analysis
paper. Throughout nursing school and English 101/102, I had only written APA research papers
analytically and persuasively. What I learned from this type of research paper is that it involves a
more critical mind. Formulating a question and finding a thesis was the most important aspect of
this paper so you could start conducting your research. After researching various articles, it was
essential to connect what you obtained from those articles to your thesis. This was crucial in
papers I had written before, however, I learned the importance of this strategy with this specific
type of paper because we are not only to read and understand articles but to also analyze them.
Analysis of various articles in relation to your thesis defines source analysis. With supporting
evidence and analyzation, source analysis papers seem more persuading than any other paper I
have written.

EFFECTS OF 12 HOUR SHIFTS

9
References

Ball, J., Dall'Ora, C., & Griffiths, P. (2015). The 12-hour shift: friend or foe?. Nursing Times,
111(6), 12-14 3p.
Chen, J., Davis, K. G., Daraiseh, N. M., Pan, W., & Davis, L. S. (2014). Fatigue and recovery in
12-hour dayshift hospital nurses. Journal Of Nursing Management, 22(5), 593-603 11p.
doi:10.1111/jonm.12062
Peate, I. (2014). Twelve-hour nursing shifts are unsafelets end them. British Journal Of
Nursing, 23(22), 1171-1171 1p.
Rollins, J. A. (2015). From the Editor. The 12-Hour Shift. Pediatric Nursing, 41(4), 162-164 3p.
Witkoski Stimpfel, A., Sloane, D. M., & Aiken, L. H. (2012). The Longer The Shifts For
Hospital Nurses, The Higher The Levels Of Burnout And Patient Dissatisfaction. Health
Affairs, 31(11), 2501-2509 9p. doi:10.1377/hlthaff.2011.1377