Extended Nursing Hours: Efficient or Inefficient?
While nurses are being asked to work longer shifts in the United States, a recent study confirmed that the same is also true for nurses in 12 different European countries. This demonstrates that the situation seems to be at least partially global and spreading.
What is the reason behind these extended hours? The researchers in this study note that some hospital managers believe the longer shifts reduce the number of patient handovers, thus increasing efficiency. Although this may seem logical, over time, these long hours actually start to decrease efficiency.
12-hour shifts are becoming increasingly common for hospital nurses but there is concern that long shifts adversely affect nurses’ well-being, job satisfaction and intention to leave their job.
— BMJ Open, 8/23/2015
The High Demand for Nurses Creates Burnout
Working in preventive medicine and health research, I have found that our local state university medical center employs hundreds of nurses at varying levels of certification, from LPN and VPN to RN and NP—even including some PhD-holding nursing professors.
Medical centers around the state are looking for additional nurses to fill in the hours. Some of the job ads even want nurse practitioners to work as physician assistants. However, with limited success in hiring new nurses, the current staff are being asked to fill in those hours with overtime. Private university hospitals and privately owned hospitals are experiencing similar nursing shortages.
Time-Saving Changes Can Become Stressors
In the late 1970s and early 1980s, we first heard about a time-saving schedule change that would provide nurses with four days off every week. This was wonderful for the first several years it was used.
In Cincinnati, a nurse I knew jumped at the change to work three 12-hour shifts weekly on Friday, Saturday, and Sunday so that she could care for her three children the rest of the week. In addition, she was paid for 40 hours of work, an entire week.
Soon, this scheduling option was also available to nurses in Central Ohio in both state-funded and private hospitals. Many people took advantage of that three-day schedule to attend classes at the Ohio State University during the week, especially since many classes did not meet on Fridays, and increasing numbers of four-day classes began to replace five-day classes.
By the 1990s, nurses were working four 12-hour shifts throughout the week instead of just three shifts, with requests for them to accept additional hours of two or four more hours after a shift. By the late 2000s, we saw nurses working five 12-hour shifts a week, and their four days off simply vanished.
Signs of a Burnout
The symptoms of burnout most reported by European nurses working 12-hour shifts were the same as those reported by American nurses:
- Emotional and mental exhaustion
- A sense of low personal accomplishment
- Feelings of depersonalization
Symptoms of Shift Work Disorder Mirror Nurse Burnout
Symptoms associated with working consistently long and/or changing shifts include:
- Excessive sleepiness on the job. For nurses, this can lead to life-threatening mistakes in patient medication treatment as well as physical accidents such as falls and dropping pediatric patients.
- Insomnia, as in failing to fall asleep at night and wanting to sleep during a daytime work shift or early awakening.
- One's sleep is not refreshing. Improper sleep may even lead to weight gain.
- Difficulty concentrating and ease in making mistakes, some of which go unremembered.
- Fatigue and lack of energy.
- Irritability, agitation, and even depression. In my experience, hallucinations even result.
- Problems in work and personal relationships.
Read More From Healthproadvice
Long Hours Can Create Health Problems
The latest in nursing news I have heard around Ohio is that some university medical center floor nurses often work 60 hours per week and are asked to work an extra two, four, or more hours after some of their regular shifts. They receive overtime pay after 40 hours and a higher wage rate on second and third shifts, but the higher pay is not relieving their work fatigue and exhaustion.
Some of these nurses are suffering the same types of health problems as workers who work variable shifts or hold more than one job (shift work disorder). Many nurses are retiring, and the remaining nurses are tempted to quit and find other occupations or to accept nursing positions in less demanding circumstances. In fact, up to 40% of RN nurses active in 2011 and 2012 will be retired in 2020.
The study mentioned in the beginning showed that Poland was the country where the most nurses (99%) reported working 12-hour shifts. In Ireland, the percentage was 79%. England came in third, with a much lower 36%.
This is one reason why some nurses will quit a hospital and work with a travel nursing agency that offers variety, perks, and attractive incentives. Travel nurses receive higher hourly rates of pay, bonuses, reimbursement of travel expenses, and even payment of their rent or mortgage when they travel. These nurses spend anywhere from three to twelve months in one place and avoid feeling trapped in long-term situations.
Below is information regarding the metropolitan areas at highest risk for job burnout.
For registered nurses (RNs) with one to five years of experience:
- Houston, San Antonio, Dallas, and Austin, TX
- Los Angeles, CA
- Baltimore, MD
- New York City, NY
- Seattle, WA
- Washington, DC
- Atlanta, GA
For nurse practitioners (NPs) with zero to six years of experience:
- New York City, NY
- Houston and Dallas, TX
- Seattle, WA
- Chicago, IL
- Los Angeles, CA
- Tampa, FL
For licensed practical nurses (LPNs) with one to three years of experience:
- San Antonio, TX
- Puyallup, WA
- Columbus, OH
- Louisville, KY
- Phoenix, AZ
- Durham, NC
Most Important Things to Consider
- Effective, experienced nurses are in high demand and are often required to work 12-hour work shifts. This can lead to job burnout if the number of these shifts per week increases.
- Burnout may be lessened if nurses—particularly the floor nurses who are also RNs—are shown appreciation, consideration, and trust by doctors and administrators.
- Experienced RNs seem to avoid burnout more often when they feel that they have some authority at work. Nurses like to feel that they are an important part of their patients' treatment teams.
- Nurses should remember to take care of themselves. Eat healthy foods and regular meals, get enough rest and exercise, and find ways to de-stress between work shifts.
- Nurses working 12-hour shifts more than three times per week may need to learn how to say no to additional work hours. Some hospitals require mandatory overtime a few times per year, but beyond that requirement, frequent extended shifts can become unhealthy for the nurse and unsafe for the patient.
- Nurses in collective bargaining units may be able to bargain together with their employers for shorter work hours in their nursing contracts and may want to speak with their union representatives about this.
- Dall'Ora C, Griffiths P, Ball J, et al. (2015). Association of 12 h shifts and nurses’ job satisfaction, burnout and intention to leave: findings from a cross-sectional study of 12 European countries. BMJ Open, 5(9):e008331. doi: 10.1136/bmjopen-2015-008331
- National Sleep Foundation. Symptoms of Shift Work Disorder. https://sleepfoundation.org/shift-work/content/shift-work-disorder-%E2%80%93-symptoms Retrieved March 5, 2018.
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
Questions & Answers
Question: I am concerned that nurses who work too many hours for their pay level also miss the connection between poor compensation and burnout and lateral violence. I think that they also believe that being paid more than other careers should shield them from frustrations of not earning enough to support their families, pay off school loans, or own a home. Have you seen evidence of this?
Answer: Among nurses at all levels in our state university hospitals, I have not seen what you describe occur. In fact, I have not heard any complaints in my area about nurses' pay rates; and, travel nurses are paid even higher rates and several perks as well - like mortgage payments. I do hear from some nurses that they must work too much mandatory overtime, thereby wearing out physically and mentally with the effect that they cannot enjoy life. I know less about conditions in private hospitals in my state. However, nurses with an earned BSN have an average wage in Ohio of over $96,300.00.
© 2015 Patty Inglish MS
Patty Inglish MS (author) from USA and Asgardia, the First Space Nation on April 13, 2019:
@PoetikalyAnointed - I appreciate your response to this article!
Many of us probably understand the feeling of being overworked and underappreciated and I hope that working conditions - and even volunteer conditions (not to mention labor trafficking) - across our country improve day by day.
Too fast living and too young dying - that's right! High-paying but stressful jobs seem to be murder! Yes, people should be placed before monetary gain imo.
I always thought that work should not be punishment. A few of my acquaintances sometimes remind me that in the Book of Genesis, Adam was given a sentence of sorts to be required to work for a living, so some individuals feel work should indeed by very hard. I don't see where any verse in Genesis requires humankind to be worked into the ground and killed by work.
Yes, let's put people above money!
PoetikalyAnointed on April 12, 2019:
I believe the problem is all the above but mostly: working long hours and not being appreciated overall.
People these days just don't seem happy. Most work at dead-end jobs, making pennies. If they are making a good salary, the stress on the job overshadows the former. Proof that $$$$$ can't buy happiness!
We living too fast and dying too young. Let's start putting people first, again!
Patty Inglish MS (author) from USA and Asgardia, the First Space Nation on March 08, 2017:
Hi Jean - I feel bad for your friend and it sounds like she only feels pretty good two days a week, Thursday and Friday. I hope she can find some health-issue answers before she takes on a week-long assignment.
This work is very hard on the employees and I feel they should be paid more. IF minimum wage is lowered bu this presidential administration, or eliminated altogether, then this work will kills those older folks who will have to work seven days a week. It's not fair and I will keep your friend in my thoughts.
Jean Bakula from New Jersey on March 07, 2017:
This could have been written for a friend of mine. She does 3 12 hr. shifts on Sat., Sun. and Mon., so she's up all night. She's in her early 60's and needs the money, but it takes her 2 days to get her body and mind back in shape after the hard shift. Now the Mom of the patient wants her all week, and she doesn't feel she can do it, but has no other job offers that pay so well. But she has chronic health issues herself, not ones a patient can get, but I worry it's hurting her.
Patty Inglish MS (author) from USA and Asgardia, the First Space Nation on October 04, 2015:
That's right, FlourishAnyway - The system is burning out healthcare workers and needs an overhaul, more nursing instructors, and better work conditions.
FlourishAnyway from USA on October 04, 2015:
You can't take care of others adequately (family, patients, etc.) if you're running on empty. Burnout is not quick to recover from. Prevention is key.
drbj and sherry from south Florida on September 19, 2015:
A shortage of nurses here in the U.S. as well as elsewhere has been on the horizon for some time. Overlong shifts certainly do not aid in recruitment.
Bronwen Scott-Branagan from Victoria, Australia on September 16, 2015:
Nurses are often between a rock and a hard place. They need a life of their own as well as work, but if they don't accept long shifts, they may lose their jobs.
SALVAONEGIANNAOLCOM from south and west of canada,north of ohio on September 16, 2015:
Worked A 12 hour shift for about 6 months straight. From 8 pm to 8 am.
It, isn't something I would recommend to anyone. The time displacement threw off my bodies need for regularity in eating as well as sleeping.Sleep deprivation is especially concerning for professions like nursing, doctors, firefighters ,police and any other job that demands a high level of skill and may be affected by such a change.Some may be able to adapt to it well. I don't know. I never really could. I would find myself dosing off very often in the early am hours about 1 am - 3 am.
mckbirdbks from Emerald Wells, Just off the crossroads,Texas on September 16, 2015:
Hello Patty. I happen to know a few nurses who write (or had written) here at Hubpages. They talked about the hours, the hazards and the overwhelming demands of the job. I even have been led to understand that nurses are now being required to get a four year degree, up from specialty classes with a two year program. So the profession is being squeezed. (Not unlike so many others.)
I think part of this may be the demographics of the Baby Boomers plus the impractical healthcare system operated here.
Patty Inglish MS (author) from USA and Asgardia, the First Space Nation on September 15, 2015:
@RevRobinHarris - So great to hear from you about this subject. Nurses certainly work hard and are dedicated. Any creative ideas I see put into use, I will add them to the material. Thanks for the work your family does!
Robin Harris from Georgia on September 15, 2015:
Hi Patty, I come from a family of nurses and your article is spot on. It is very important that nurses and other's in demanding professions find ways to invest in self-care. It would be nice if the industry found creative ways to help with this. I am sure there are things that can be done if we just think outside the box.