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British Journal of Nursing, 2014, Vol 23, No 3 189

2014MAHealthcareLtd

Do 12-hour shifts put patients first?

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 nursesand 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 exper ienced 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 12- and 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 asdescribed 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 toidentified 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 Grimsbys Hospital are aiming to

cut the length of nursing shifts from 12 hours to 7.5expecting 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 hospitals 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:

It is well evidenced that long shifts are

associated with clinical risk, particularly in

patient areas with high volume, acuity and

dependency. (Grimsby Telegraph, 2013)

Recommendations from some of the studies

mentioned included the dissemination of results both

locally and nationally to expand the body of nursing

knowledge and to promote practice based on the best

available evidence. BJN

Todd C, Reid N, Robinson G (1991) The impact of 12-hournursing shifts Nurs Times 87(31): 47-50

Todd C, Robinson G, Reid N (1993) 12-hour shifts; job satis factionof nurses.J Nurs Manag 1(5):215-20

Grimsby Telegraph (2013) Shorter shifts for nurses will benefitpatients. http://tinyurl.com/o3p9k5m (accessed 3 Feb 2014)

Wooten N (2000) Evaluation of 12-hour shifts on a cardiologynursing development unit. Br J Nurs 9(20): 2169-74

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