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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. Context. Hospital nurses worked 8 hour shifts until the late 1970s Now, most nurses work 12 hour shifts.

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12 hour nursing shifts and its impact on patient safety

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

context
Context

Hospital nurses worked 8 hour shifts until the late 1970s

Now, most nurses work 12 hour shifts

(Bae, 2012; Geiger-Brown & Trinkoff, 2010a)

background
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)

problem
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)

controversy
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)

review of literature
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).
review of literature1
Review of Literature
  • More than half of nursing errors involved medication administration
  • (Rogers, Hwang, Scott, Aiken, & Dinges, 2004b; Scott, Rogers, Hwang, & Zhang, 2006).
review of literature2
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)
review of literature3
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)
controversy revisited
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)

proposed solution
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)
proposed solution1
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)
proposed solution2
Proposed Solution
  • Design and implement e-learning modules
    • Minimizing fatigue and promoting alertness
    • Improving sleep and internal body clock functioning
  • (Berger & Hobbs, 2006)
next steps
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
discussion
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)
conclusion
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
acknowledgements
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
references
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
references1
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
references2
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
references3
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
references4
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.