12 hours, the long and the short of it, 2014.pdf

7/25/2019 12 hours, the long and the short of it, 2014.pdf

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20 april 23 :: vol 28 no 34 :: 2014 NURSING STANDARD

Many nurses prefer 12-hour shifts because it

suits them to work three days a week and have

four days off. However, concerns that such shifts

are too tiring for staff and increase the risk of

errors have prompted some trusts to try to

return to traditional, shorter shifts. The evidence

is still unclear and it may be that a mixedapproach, allowing some staff choice, is best.

AuthorAlison Moore is a freelance journalist

SU

MMARY

Evidence on the risks of longer shifts is building,

but some nurses love them. Alison Moore reports

12 hours: the long

and the short of itThere are few issues more likelyto upset at least some nursing

staff than changes to shiftlengths and patterns.

Over the past few years, manytrusts have moved towardsoperating just two shifts a dayon some wards, reducing thenumber of handovers when theyneed double staffing. Nurses willtypically do three long shifts aweek, with four days off.

Many nurses love 12-hourshifts: they can reduce the cost of

childcare and travel, and allowmore days free to do somethingelse whether that is bank shifts,looking after children or elderlyrelatives, or a hobby.

But others find 12-hour shiftsexhausting and would prefershorter ones that allow them tospend a part of each day withtheir family and to do otherthings on a working day.

At Worcestershire Acute Trust,

nurses on 12-hour shifts likehaving to travel in to work onlythree times a week, says patientsafety adviser Jane Brown. Butthey do find they are getting tired,

may not get their breaks and theyare worried about making errors,she adds. When I worked in theprivate hospital sector, I worked12-hour shifts and I found themreally tiring, but I liked theextra time off.

An RCN survey in 2009found that more than four out often NHS hospital nurses worked12-hour shifts, but they weremore common in care homes,where more than 60 per centof nurses reported workingthem. These numbers may haveincreased since then as morehospitals have moved staff tolonger shifts.

However, there are concernsthat the trend has gone toofar. Some board-level nurseshave raised concerns about theconsequences of 12-hour shifts,

a few hospitals are trying tomove away from them, and NHSEngland chief nursing officer

Jane Cummings announced lastyear that a report on them wouldbe commissioned. Initially itappeared that if this would becompleted quickly, but NHS

England now says the scope forthe study is still being decided.

Jill Maben, directorof the National NursingResearch Unit at KingsCollege London, returned topractice a few years ago andwas surprised at how manytrusts had adopted 12-hourshifts. It has almost becomethe norm now. I feel we havesleepwalked into this process

without any understanding ofthe implications for staff, forpatients and whether it is a goodor bad thing, she says. Staffget very tired. There is a dip inenergy around 5pm when peopleneed to sit down and take stock.

She is also concerned that12-hour shifts remove a shortperiod of double staffing in theearly afternoon, when staff fromtwo shifts traditionally overlap.

That was often when the littlethings important to staff couldbe done, she says. You handedover the essential stuff tothe staff coming in, but youcould do things like washingsomeones hair. This overlap isalso often time for mentoringand offers an opportunity forinformal education sessionswith nursing students.

Professor Maben adds thatmany of the moves to 12-hourshifts were justified by financialsavings rather than improvementsfor patients or staff. We have

The risks of working extended hours a briefing paperSeveral studies suggest the risks to patientsafety significantly increase once nurses workbeyond 12 hours.Nurses who work 12-hour shifts are atincreased risk of occupational hazard,compared with those on eight-hour shifts.

This includes physical exhaustion,musculoskeletal problems, sharps injuries, roadaccidents and near misses when driving home.

There is insufficient evidence to determine the

effect of shift length on the quality of patientcare and healthcare provider outcomes.

Source: www.kcl.ac.uk/nursing/research/nnru/policy/By-Issue-Number/Policy--Issue-38.pdf


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GARRY

PARSONS

to make sure that there are notunintended consequences. Sometrusts have not only moved totwo handovers rather than three,but have reduced the lengthof these. Across a large numberof wards in a hospital, thiscan save seven-figure sums

each year.Lead RCN steward for acute

care at NHS Lothian SusanLloyd says it can be difficultto find a solution that suitsnurses, employers and patients.She suggests there are someareas where 12-hour shifts arenecessary such as in theatre,where operations can take manyhours. However, she has concerns,particularly in high-activity and

demanding areas.Organisations see the cost

benefits, and staff like thembecause they can get their shiftsover in three long days, she says.But I am seeing an increasein nurses joining agenciesand bank nursing,and picking up shiftselsewhere on theirdays off.

Ms Lloyd

says that long

shifts are associated with moreerrors and she is seeing morestaff on these shifts with healthproblems. Switching from a longday to a long night shift can alsobe exhausting.

Flexible mix

She has also noticed more nursesapproaching her for support toreturn to eight-hour core shifts.Sometimes the only optionis for the nurse to move to anarea where shorter shifts canbe accommodated. A flexiblemix of 12 and eight-hour shiftswould probably be the best wayforward, says Ms Lloyd there is no one-size-fits-all

solution.

Professor Maben says theevidence on the impact of longshifts is not definitive, withmuch of it coming from otherhealth systems. Her departmenthas produced a briefing paperon the emerging issues (seebox, left).

Rejigging rotas can, to someextent, minimise the drawbacksof 12-hour shifts. Consecutivelong shifts can be particularlytiring, as nurses will often gohome, eat and sleep, and thenget up and come


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22 april 23 :: vol 28 no 34 :: 2014 NURSING STANDARD

to work again, so rotas thatavoid those may work better.However, this can have an effecton continuity of care, especiallywith shorter stays.

Rotations between nightand day shifts also need carefulplanning so as not to add to

fatigue, which Professor Mabenidentifies as an importantproblem with 12-hour shifts.

Another issue is that, in largehospitals, half an hour is oftennot long enough to get to thecanteen and eat a meal, so nursestend not to leave the ward. It isvery important for staff to come

together to have breaks, saysProfessor Maben. There is littleopportunity to have downtimewith colleagues to talk aboutwork. She suggests longer breaksmay be needed in some cases.One of the challenges of this isthat staff are meant to have at

least an 11-hour break betweenshifts and more or longerbreaks during the shift canmake it harder to rota nursesfor two 12-hour shifts onconsecutive days.

The National NursingResearch Unit also suggestsmanagers need to be aware

of the risks associated with longshifts. Safeguards include limitingovertime and meetings at the endof shifts, encouraging nurses tounderstand the risks of fatigue,and making improvements inphysical layouts, communicationand handovers.

RCN head of policy HowardCatton says the college hasnot come out in favour of anyparticular shift pattern, butemployers should be aware ofrisks such as fatigue and reducedconcentration. These factorshave the potential to impact carequality and there is also evidenceto suggest they increase healthrisks to individuals.

He adds that if saving money

is the driver for shift patterns,it is important to identify andmonitor risks through qualityand safety indicators.

Childcare mattersChanging the shifts of existingstaff is always going to be achallenge. North Lincolnshireand Goole Foundation Trustconsulted staff about a movefrom 12 to 7.5-hour shifts at its

hospital in Grimsby last year.Chief nurse Karen Dunderdaletold the local media it wouldbe better for patients andwould allow staff to improveknowledge and experience.

However, some nurses fearedtheir childcare arrangementswould be disrupted and therewere warnings that staff wouldleave. The trust already hasstaffing problems and has

recently recruited nurses fromSpain. The trust says it is stillpulling together responses fromthe consultation and, like manythat have made or contemplatedchange, is reluctant to discuss it.

Ultimately, it is the state of thenursing labour market that mayprevent trusts changing shiftpatterns against nurses wishes.A big issue is childcare, saysMr Catton. So when the labourmarket becomes tight, employersstart to say, We need to get staffin and we will offer you the shiftsthat you want. NS

Trusts experiences o moving to 12-hour shifsThe experience of trusts moving either

to or away from 12-hour shifts suggests

that change of any kind is likely to upset

at least some of the workforce and may

not yield all the benefits hoped for.

The Queen Elizabeth Hospital, Kings

Lynn, moved several hundred ward staff

to standardised shorter shifts last year,

arguing it would improve patient care.

Previously, many staff had been on

12-hour shifts.

However, a review of the trust carriedout soon afterwards by NHS England

raised concerns about the effect on

morale and retention. The trust

was struggling with low

staffing and the changes

resulted in more than 20

qualified staff leaving,

NHS England said. The

new shift pattern had

also meant that bank staff

were less available. A staff

survey found strong supportfor either a return to the old shift

pattern or a mix of long and short shifts.

The trust moved back to offering

longer shifts at the end of last year,

allowing staff to choose what worked

best for them. Karen McGuire, associate

chief nurse, says fatigue can be an issue

with longer shifts. Whatever shift you

do can be tiring, she explains. You work

differently with a longer day than a short

one you pace yourself. For us it was less

about the finance and much more aboutthe workforce. But the trust found it

struggled to get staff to work bank

shifts when they were working more

days. If you have three to four days off in

a week, it has less effect on you to do an

extra shift, Ms McGuire says.

Two years ago, Ipswich Hospital

decided to move towards 12-hour shifts

for many of its nurses. The impetus came

from both staff members and patients,

who valued receiving care from the same

person throughout the day. The decision

was not financially driven, and the trust

was actually expanding its nursing

provision at the time.This was piloted in some areas and

then, just over a year ago, more nurses

were moved to 12-hour shifts.

Although the trust strongly

encourages nurses to work

these, they do have the option

of shorter shifts and some

nurses have remained on

them. We have not had any

negative feedback and we

monitored it carefully, says

a spokesperson.But it is not always easy to separate out

the effects of a change in shift patterns

from other developments. At Bolton

NHS Foundation Trust, for example,

many ward-based staff have moved to

a 12-hour shift pattern. The trust says

this was about balancing quality of care

and cost-effectiveness: it allowed the

reduction of lengthy handover times.

A pilot scheme had won the support

of around 70 per cent of staff. However,

a review of staffing levels has meantthe trust has also invested in additional

nurses, which has wiped out the financial

savings from the change.


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C o p y r i g h t o f N u r s i n g S t a n d a r d i s t h e p r o p e r t y o f R C N P u b l i s h i n g C o m p a n y a n d i t s c o n t e n t

m a y n o t b e c o p i e d o r e m a i l e d t o m u l t i p l e s i t e s o r p o s t e d t o a l i s t s e r v w i t h o u t t h e c o p y r i g h t

h o l d e r ' s e x p r e s s w r i t t e n p e r m i s s i o n . H o w e v e r , u s e r s m a y p r i n t , d o w n l o a d , o r e m a i l a r t i c l e s f o r

i n d i v i d u a l u s e .

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