12‐hour shifts: Prevalence, views and impact

The provision of 24-hour nursing care inevitably involves shift work and flexible working, including “long days” or 12-hour shifts (Newey and Hood 2004, Lorenz 2008). However, these shift patterns have become increasingly controversial, with concerns raised over performance, fatigue, stress and patient safety. Historically, traditional shift work patterns were based on three eight-hour shifts per day (Ferguson and Dawson 2011, Estabrooks et al. 2009), but over the past 20 years there has been a tendency to move away from this pattern of working in preference for the 12-hour shift (Todd et al. 1989, McGettrick and O’Neill 2006). In the UK, many hospitals utilise 12-hour shifts primarily because managers believe it is a more cost effective way of providing 24-hour care, with lower costs and greater continuity of staffing (Estabrooks et al. 2009). Some nurses also prefer to work longer daily hours with fewer shifts, which gives them greater flexibility and more days away from work (Josten et al. 2003). As the majority of the nursing workforce is female, this may also make it easier to balance work and personal responsibilities (Messing 1997, Josten et al. 2003). However, there are increasing concerns over potential threats to patient safety and quality of care (Stimpfel and Aiken 2013), and some employers now question the benefits of such extended hours and are choosing to revert to eight-hour shifts (Geiger-Brown and Trinkoff 2010). Although the handover period has been criticised for being unproductive, with no formal ‘overlap’ 12-hour shifts can have a negative impact on opportunities for ward meetings, teaching, mentorship, teambuilding and research (Sprinks 2012). A study in the US by Stimpfel and colleagues published in 2013 found that nurses who worked shifts of 12-hours or longer were significantly more likely to report poor quality care and poor patient safety when compared to those working eight-hour shifts. Patients also reported lowersatisfaction with care in hospitals where staff worked longer shifts (Stimpfel et al. 2012). Shift work is a common feature across many industries. Fatigue associated with long shifts has been linked with disasters such as the Chernobyl nuclear accident, Three Mile Island incident and the grounding of the Exxon Valdez (Miller 2011). However, research to date is equivocal and some studies have found little differences in terms of cost or productivity (Williamson et al. 1994) or levels of fatigue (Duchon et al. 1994) by shift length. A systematic review by Smith et al. (1998) compared eight and 12-hour shifts across a broad range of industries and concluded that longer shifts increased fatigue but also led to an increase in job performance. Tucker et al. (1998) examined the effect of shift length on alertness. Their findings showed that more rest days between shifts were associated with slightly higher levels of alertness and lower levels of fatigue. In nursing, Geiger-Brown and Trinkoff (2010) reviewed studies up until 2008. In five of the seven studies reviewed, those working 12-hour shifts were significantly more fatigued. Estabrooks et al. (2009) reviewed 12 studies comparing the effect of eight and 12-hour shifts on quality of care and health care provider outcomes. They found insufficient evidence to conclude that shift length had an effect on patient or healthcare outcomes. A common question asked by health care employers and employees around shift work is “is it OK to work 12-hour shifts?” (Ferguson and Dawson 2011, p. 519). Our current study brings together findings from previously published studies and from new analysis of previously collected data, to address this question. Aim The aim of this study is to review existing data sources to identify what we know about the prevalence of 12-hour shifts in nursing and the impact on both staff and patients. Specifically, this study aims to address the following questions: What is the prevalence of 12-hour shifts in nursing? How much internal variation in shift length is there in NHS hospitals? What impact does shift length have on quality of patient care and staff experience?