Extended shifts for nurses adversely affected 70% of patient outcomes
A new study states that nursing shifts totaling 10 hours or greater were more likely to cause nurse burnout, nurse job dissatisfaction, and discontent in care among patients.
Researchers from the University of Pennsylvania School of Nursing conducted the first study to examine the relationship between nurse shift length and patients’ assessment of care. Study results showed that nurses working shifts of 10 hours or longer were up to 2.5 times more likely than nurses working shorter shifts to experience burnout and job dissatisfaction. Furthermore, 70% of patient outcomes were significantly and adversely affected by the longest shifts.
“Traditional 8-hour shifts for hospital nurses are becoming a thing of the past,” said Amy Witkoski Stimpfel, PhD, RN, a postdoctoral fellow at the Center for Health Outcomes and Policy Research at Penn Nursing. “When long shifts are combined with overtime, shifts that rotate between day and night duty, and consecutive shifts, nurses are at risk for fatigue and burnout, which may compromise patient care.”
This study, conducted over a 3-year period, included nearly 23,000 registered nurses from California, New Jersey, Pennsylvania, and Florida. These states represent approximately 25% of the population of the United States and 20% of annual US hospitalizations.
According to Witkoski Stimpfel and Penn Nursing coauthors Linda Aiken, PhD, RN, FAAN, and Douglas Sloane, PhD, 65% of nurses worked shifts of 12-13 hours, and the percentages of nurses reporting burnout and intention to leave their job increased incrementally as shift length increased.
In hospitals that had higher ratios of nurses working longer shifts, a larger percentage of patients reported that nurses sometimes or never communicated well, pain was sometimes or never well controlled, and they sometimes or never received help as soon as they wanted.
Witkoski Stimpfel and coauthors advocate limiting the number of consecutive hours worked and advise nurse management to monitor nurses’ hours worked, including second jobs.
“Nursing leadership should also encourage a workplace culture that respects nurses’ days off and vacation time, promotes nurse’s prompt departure at the end of a scheduled shift, and allows nurses to refuse to work overtime without retribution,” noted Witkoski Stimpfel. “These types of policies that facilitate manageable work hours can contribute to the development of a healthier nursing workforce, prepared to manage the complex care needs of patients and their families.”
The study is published in the November issue of Health Affairs.