12 Hour Nursing Shifts and Its Impact on Patient Safety

1. 12 Hour Nursing Shifts and Its Impact on Patient Safety Penelope Baker Walden University EDUC 6125 – Foundations of Research Dr. Sunil Hazari December 12, 2012

2. Context Hospital nurses worked 8 hour shifts until the late 1970s Now, most nurses work 12 hour shifts (Bae, 2012; Geiger-Brown & Trinkoff, 2010a)

3. Background • Registered Nurse (RN) demographics • 2.5 million actively employed • 62% work in hospitals • 70% work full time • Average age 45.5 years (U.S. Department of Health and Human Services, 2010)

4. Problem • Nurses find 12 hour shifts and shorter work weeks satisfying • Despite satisfaction, there is growing evidence 12 hour shifts… • Have a negative impact on nurses’ physical health • Jeopardize patient safety • Prompt older nurses to seek 8 hour jobs elsewhere (Geiger-Brown & Trinkoff, 2010a; Geiger-Brown & Trinkoff, 2010b; Georgia Nurses Association, 2012; Stone, Du, Cowell, Amsterdam, Helfrich, Linn, Gladstein, Walsh, & Mojica, 2006)

5. Controversy • Initial research on effects of 12 hour shifts focused on nurse satisfaction • Later research examined effects of longer shifts on quality of patient care • Some researchers and professional organizations recommend • Returning to 8 hour shifts • Based on studies showing a relationship between the number of hours worked and nursing errors (Geiger-Brown & Trinkoff, 2010a; Geiger-Brown & Trinkoff, 2010b; Georgia Nurses Association, 2012; Vik & MacKay, 1982)

6. Review of Literature • The risk of making an error was 3 times higher when nurses worked 12.5 or more hours • (Rogers, Hwang, Scott, Aiken, & Dinges, 2004b; Scott, Rogers, Hwang, & Zhang, 2006).

7. Review of Literature • More than half of nursing errors involved medication administration • (Rogers, Hwang, Scott, Aiken, & Dinges, 2004b; Scott, Rogers, Hwang, & Zhang, 2006).

8. Review of Literature • For nurses working 12 hour shifts, 75% of the time they worked more hours than scheduled • Increased reports of fatigue and difficulty staying alert when working 12 hour shifts • Older workers were more sensitive to internal body clock disruptions • Older nurses working 12 hour shifts experienced other physical problems • (Fragar & Depczynski, 2011; Reid & Dawson, 2001; Rogers et al., 2004b; Scott et al.,2006)

9. Review of Literature • 16 U.S. states have laws regulating mandatory nurse overtime though this does not mean they work less mandatory overtime or fewer hours • In 2006, researchers refuted other studies by reporting no differences in quality or patient outcomes when comparing 8 hour and 12 hour shifts • (Bae, 2012; Stone et al., 2006)

10. Controversy Revisited • Returning to 8 hour shifts may be ideal, but not practical • If 12 hour shifts are eliminated, nurses may become dissatisfied • Unless research provides overwhelming evidence 12 hour shifts are detrimental to nurses and patients, hospitals will continue offering 12 hour shifts and nurses will continue working those shifts. (Geiger-Brown & Trinkoff, 2010a; Geiger-Brown & Trinkoff, 2010b; Georgia Nurses Association, 2012; Montgomery & Geiger-Brown, 2010; Rogers et al., 2004b)

11. Proposed Solution • Minimize 12 hour shifts • Limit work hours to 12 hours in a 24-hour period • Schedule sufficient recovery time between 12 hour shifts • Leave work at end of shift, 100% of time • Create a mixture of 4 hour, 8 hour, and 12 hour shifts • Eliminate overtime • Reduce medication administration errors with use of bedside medication verification systems • (Fragar & Depczynski, 2011; Geiger-Brown & Trinkoff, 2010b; Rogers et al., 2004b; Scott et al., 2006)

12. Proposed Solution • Use fatigue risk-management software to identify schedules promoting fatigue • Respect nurses’ days off – no extra work days or training classes • Avoid scheduling night shift staff meetings for 7:30 a.m. • Implement 12 hour shift nursing policies based on guidelines from the Joint Commission and the American Nurses Association • (Geiger-Brown & Trinkoff, 2010b; Rogers et al., 2004b; Scott et al., 2006; The Joint Commission, 2012; The American Nurses Association, 2012)

13. Proposed Solution • Design and implement e-learning modules • Minimizing fatigue and promoting alertness • Improving sleep and internal body clock functioning • (Berger & Hobbs, 2006)

14. Next Steps • Present key findings and proposal to nursing stakeholders… • Vice President & Chief Nursing Officer • Clinical Directors • Clinical Managers • Clinical Educators • Develop effective solutions by working with members of these direct-care nursing councils… • Nursing Research and Evidenced-Based Practice Council • Nursing Quality Council

15. Discussion • Most significant finding, the risk of making an error was three times higher when nurses worked more than 12.5 hours in a shift • Nurses on 12 hour shifts worked more hours than scheduled 75% of the time • These studies did not explore level of harm to patients when errors made • Patient safety was compromised • (Rogers et al., 2004b; Scott et al.,2006)

16. Conclusion • Evidenced-based strategies for 12 hour shifts need to be implemented in every hospital and accepted by every nurse • Nurses get what they want, 12 hour shifts • Patients get what they want, patient care without errors

17. Acknowledgements • Images used in this presentation obtained from three sources • Microsoft Corporation: www.Office.com • iStockphoto: http://www.istockphoto.com/index.php • Meritus Medical Center, 11116 Medical Campus Road, Hagerstown, Maryland, 21742 • Images comprised of actual employees functioning in dual roles of nurses and patients

18. References • Bae, S. (2012). Nurse overtime, working conditions, and the presence of mandatory nurse overtime regulations. Workplace Health & Safety, 60(5), 205-214. Retrieved from DOI: 0.3928/21650799-20120426-01 • Berger, A. M., & Hobbs, B. B. (2006). Impact of shift work on the health and safety of nurses and patients. Clinical Journal of Oncology Nursing, 10(4), 465-471. Retrieved from DOI: 10.1188/06.CJON.465-471 • Fragar, L. J., & Depczynski, J. C. (2011). Beyond 50. Challenges at work for older nurses and allied health workers in rural Australia: a thematic analysis of focus group discussions. BMC Health Services Research, 11(1), 1-13. Retrieved from DOI: 10.1186/1472-6963-11-42 • Geiger-Brown, J., & Trinkoff, A. M. (2010a). Is it time to pull the plug on 12-hour shifts? Part 1. The evidence. Journal of Nursing Administration, 40(3), 100-102. Retrieved from DOI: 10.1097/NNA.0b013e3181d0414e

19. References • Geiger-Brown, J., & Trinkoff, A. M. (2010b). Is it time to pull the plug on 12-hour shifts? Part 3. Harm reduction strategies if keeping 12-hour shifts. Journal of Nursing Administration, 40(9), 357-359. Retrieved from DOI: 10.1097/NNA.0b013e3181ee4295 • Georgia Nurses Association (2012). GNA Reference Reports: Adopted 2011 Georgia Nurses Association Action Report, 12 hour shifts and fatigue. Georgia Nursing, 72(1), 7-8. Retrieved from http://ezp.waldenulibrary.org/login?url=http://search.ebscohost.com/login.aspx? direct=true&db=rzh&AN=2011446899&site=ehost-live&scope=site • Montgomery, K. L., & Geiger-Brown, J. (2010). Is it time to pull the plug on 12-hour shifts? Part 2. Barriers to change and executive leadership strategies. Journal of Nursing Administration, 40(4), 147-149. Retrieved from DOI: 10.1097/NNA.0b013e3181d40e63 • Reid, K., & Dawson, D. (2001). Comparing performance on a simulated 12 hour shift rotation in young and older subjects. Occupational & Environmental Medicine, 58(1), 58-62. Retrieved from http://oem.bmj.com

20. References • Rogers, A. E., Hwang, W., & Scott, L. D. (2004a). The effects of work breaks on staff nurse performance. Journal of Nursing Administration, 34(11), 512-519. Retrieved from Accession Number: 00005110-200411000-00007 • Rogers, A. E., Hwang, W., Scott, L. D., Aiken, L. H., & Dinges, D. F. (2004b). The working hours of hospital staff nurses and patient safety: both errors and near errors are more likely to occur when hospital staff nurses work twelve or more hours at a stretch. Health Affairs, 23(4), 202-212. Retrieved from DOI: 10.1377/hlthaff.23.4.202 • Scott, L.D., Rogers, A. E., Hwang, W., & Zhang, Y. (2006). Effects of critical care nurses’ work hours on vigilance and patients’ safety. American Journal of Critical Care, 15(1), p. 30-37. Retrieved from http://ezp.waldenulibrary.org/login?url=http://search.ebscohost.com/login. aspx?direct= true&db=rzh&AN=2009096375&site=ehost-live&scope=site

21. References • Stone, P. W., Du, Y., Cowell, R., Amsterdam, N., Helfrich, T. A., Linn, R. W., Gladstein, A., Walsh, M., & Mojica, L.A. (2006). Comparison of nurse, system and quality patient care outcomes in 8-hour and 12-hour shifts. Medical Care (MED CARE), 44(12), 1099-1060. Retrieved from Western Maryland AHEC, Interlibrary Loan with Medical Library, Perry Point VA Medical Center, Perry Point, Maryland, 21902. • The American Nurses Association (2012). Position statements: opposition to mandatory overtime, Registered nurses’ responsibility in all roles and setting to guard against working when fatigued. Retrieved from http://www.nursingworld.org/ • The Joint Commission (2012). Hospital national patient safety goals for 2012. Retrieved from http://www.jointcommission.org/assets/1/6/2012_NPSG_HAP.pdf • U.S. Department of Health and Human Services (2010). The registered nurse population: Findings from the 2008 national sample survey of registered nurses. Retrieved from http://bhpr.srsa.gov.healthworkforce/rnsurvey/initialfindings2008.pdf

22. References • Vik, A. G., & MacKay, R. C. (1982). How does the 12-hour shift affect patient care? Journal of Nursing Administration, 12(1), 11-14. Retrieved from Western Maryland AHEC, Interlibrary Loan, Source Unknown.