Nursing Notes

October 8, 2010

Linking Medical Errors, Nurses’ 12-Hour Shifts

As a 12 hour shift worker myself, I read this with concern.  I love working three days and being off 4 days.  It may be the only way I can stay working as a nurse until I retire.  However, that said, I have to agree that those last 4 hours of the shift are usually a nightmare and occur at a time when I am exhausted.  So, there is something to be said for the reduction of shift hours.  I like the idea of 4 hour shifts, but don’t see how they could work.

Please read this article and let me know what you think, won’t you?  This article is from HealthLeadersMedia and I hope you read the entire article which include many interesting comments on the original site.


Rebecca Hendren, for HealthLeaders Media, October 5, 2010

It’s well known that caregiver fatigue is a huge cause of medical errors, whether the caregiver involved is a new resident coming off a marathon week or an overworked nurse pulling back-to-back shifts.

A few months ago, the Accreditation Council for Graduate Medical Education placed new restrictions on the hours residents can work and the supervision they receive. This follows years of research into new physicians’ training and the effect long hours and tiredness play in performance and contribute to poor quality care. A 2004 study found that first-year residents working all night were responsible for more than half of preventable adverse events.

Nurses don’t have the same extraordinarily-long work requirements as residents—and they clearly perform very different tasks—but like residents, they work long shifts and suffer from fatigue. Studies have linked nurse fatigue with medical errors, poor quality care, stress, and burnout.There are many reasons for nurse fatigue, but one stands out as pretty easy to fix: shift length. It’s no wonder that nurses are fatigued when 12-hour shifts are the norm. Despite the fact the Institute of Medicine has recommended limiting use of 12-hour shifts, it’s standard practice throughout the profession. Nurses routinely work back-to-back-to-back 12-hour shifts.

At the recent Nursing Management Congress in Grapevine, TX, held September 23-25, I attended a presentation by Cole Edmonson, CNO/vice president of patient care services at Texas Health Presbyterian Hospital in Dallas. Edmonson noted that research is helping us understand the dangers nurse fatigue presents to patients and to nurses themselves. He called 12-hours shifts a dead idea whose time has passed and suggested they may cause more problems than they solve. He asked attendees whether it is time to declare the end of 12-hour shifts.

I can’t imagine working a 12-hour day as a nurse. Nursing is a professional job, requiring college education and high-level thinking. But it’s also manual labor. Nurses are on their feet all day, running everywhere, lifting patients, changing dressings, inserting IVs, and all the other direct patient care responsibilities.

It’s no wonder that nurses are fatigued. Shifts include mountains of paperwork, difficult patients and families, and hundreds of tasks. Somewhere in all this nurses make time to connect with their patients, expressing compassion and empathy. Let’s not forget that 12-hour shifts also frequently run into overtime, when the nightmare shift means they have to stay late to complete their charting.

Over the next few years, more studies will be published that show the danger of nurse fatigue. What if hospitals preempted the public outcry and started reducing 12-hour shifts now? Let’s focus on shifts that are best for patients, nurses, and hospitals alike. This means ending rigidity and allowing greater flexibility.

Senior leadership can embrace creative staffing and scheduling options that increase satisfaction for nurses and improve efficiency. For example: <…click here to continue…>

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  1. I also work 3 twelve hour shifts/week. I work at night. So everyone talks about how great it is to have 4 days off. (I work EVERY Friday, Saturday, and Sunday night) Consider that my Fridays are messed up because of worrying I won’t be rested enough to stay up all night. Then I get off on Monday morning, and have to sleep. Pure exhausted by this time. If I sleep until I am rested, then I am up half the night on Monday night. This sets Tuesday up for a mess. Well, to put it frankly, I don’t feel normal again until Thursday. Then it’s time to start over. I have been an nurse over 20 years, and it really wasn’t like this in the beginning. I did work 8 hour shifts, and had 6 patients on day shift with no problem. Acuity was lower, and paperwork was much easier. You go down the list, check, and only write if there was an exception to the norm. Boom, you’re done. Then med pass took an hour, and you could get it done on time. Now, everything is electronic. The med times, well, I could have a pill scheduled for 8:00 PM, 9:00 Pm, 9:30 Pm, 10:00 PM all on the same patient. Duh, they get it all at the same time. AND because computer charting is so detailed and so much duplication, well, most of me meds are never on time, or they are early, which ever I happen to fall in the rounds of things. 12 hour shift are hard. But then, there is so much to do, I don’t know if I could get it all done in 8 hours. I can have things done, and be cruising about 4 o clock in the morning. But, then, labs are due. If any of our patients have ports, we draw the blood. Then 6:00 meds are due. Then the critical calls for the labs start pouring in. You have to chart on those and call MD if needed. Monday mornings are the worst. EVERYONE gets labs it seems. AND THEY ALL have criticals. I cringe when I hear the phone ring. THEN, the people who have stayed all night in the emergency room, are conveniently needing to be admitted right at 6:00 AM. Hurry hurry, have to get them out of the E.R. Change of shift admissions is just the pits. Then day shift comes in all bright and bushy tailed, after their weekends off, and you just end up looking like you can’t get it together. Well, that just about summarizes my thoughts at this time. I probably veered way off the topic. Honestly Shirley, health care isn’t what it used to be. We just can’t be nurses anymore, and give the caring support nursing is all about. It has become all about making sure we dot all our I’s and cross all our T’s for medicare, and Joint commission, and is less and less about patient care. AND to top it off all the patient satisfaction survey companies now, the “scripting” to be added into our conversations have made our care less about being genuine, and more about making sure we say the right thing to get the patient and family to say they received “very good care”.
    Funny thing is, I am the nurse that has a website I am building dedicated to bringing back the art of caring in nursing. We need to bring back the art of caring. Do what nurses are called to do. Somehow we need a real overhaul in the system…Enough said…

    Comment by Joyce Harrell,RN, OCN — October 8, 2010 @ 8:43 am | Reply

    • Joyce, I could not have said it any better. Although I work Friday, Saturday, Sunday day shifts, the exasperation is the same. You can’t get out of morning report before the admissions department is calling with one, two, or three admissions that HAVE to get to the floor NOW–never mind that they have kept them in admissions all night long. I also don’t know how nurses get the work done in an 8 hour shift, because I would still be charting for the next 3 hours after I got off, so where would be the difference? I agree that this is not why I became a nurse and wish things could go backward to when I first started and I actually had time to sit and talk with my patients and their families–actually get to know them and they get to know me. Back then, I loved nursing. Today, not so much most of the time. I hope the new nurses today find something to love about what they do. If not, they won’t be doing nursing for long.
      Thanks again for the wonderful comment and for sharing you thoughts with me. I always enjoy hearing from you.


      Comment by Shirley — October 8, 2010 @ 12:28 pm | Reply

  2. Funny Shirley, this was the last week I had a contract nursing job where I worked on Mon, Tues and Wed night as well. I am totally exhausted, and didn’t realize how much. I had slept until 3:30 PM yestday, then went to bed at 1:00 AM this morning. Woke up at 4:00AM because my sleep is all messed up. I saw this, and answered. I laid back down for a little, and just go up thinking, Wow, I bet everyone that reads my post thinks this is that crazy nurse on crack. LOL. I started to regret my ranting a little, and then saw I wasn’t the only one that felt this way. I am honestly doing things to change my situation. I emailed you a brief letter last week, and due to still working this week, just didn’t get back with you. But, there are options, and there are lot’s of things we can do to get the nursing back in nursing. We do have choices, and yes, I feel sorry for the new grads. My daughter is one of them. I am so sorry they weren’t able to be nurses when we could actually just be nurses. The stress is so different these days. I LOVE being a nurse. I LOVE helping people. That’s it. Helping people. That’s my mission, my purpose, and my passion. The mission on my nursing page (not published yet) is to change the nursing industry…one nurse at a time…

    Comment by Joyce Harrell — October 8, 2010 @ 12:48 pm | Reply

    • Joyce, I have to tell you that your comment was not off the mark. Too many nurses I work with would echo your sentiments. I am looking forward to a conversation with you about health coaching and making nursing work again. I’d love to see your nursing page when you get it published. I am excited to see another nurse who has had it and plans to make a difference. I finally got to the place that I either had to do something about the problems in nursing, or get out of the profession. I, too, love nursing. I love taking care of my patients. I love getting to know them and their families. I just don’t love what nursing has become.

      I try to keep nursing issues in the forefront of people’s minds with this blog. I feel that by being aware of all the different issues nurses face today, we stand a better chance of change. I hear from others who feel the same way. Maybe we can all stand firm and make a difference.

      Thanks for the comment, again. I love to hear your thoughts.

      Comment by Shirley — October 8, 2010 @ 2:53 pm | Reply

  3. I don’t think I’d even be able to finish everything in 8 hours anyway. For me, it’s as much effort to drag myself in for 12 hours

    Comment by Edwin — October 20, 2010 @ 8:59 am | Reply

  4. I discovered your blog site on google and check a few of your early posts. Continue to keep up the very good operate. I just additional up your RSS feed to my MSN News Reader. Seeking forward to reading more from you later on!?

    Comment by branchenbuch — October 21, 2010 @ 9:50 pm | Reply

  5. […] Linking Medical Errors, Nurses’ 12-Hour Shifts « Nursing Notes […]

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