Do 12 Hour Shifts Harm Patients? Nurses?

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Too much coffee?
Too much coffee?

I’m among those nurses still working 8 hour shifts. While I see the advantages of 12 hour shifts, it seems obvious to me that errors and oversights must increase late in long shifts, and work quality decline. I’ve worked and watched enough 16 hour ‘doubles’  over the years to form an informed opinion. Many and likely most nurses can’t possibly do optimal work for 12 hours straight. When the work suffers, patients suffer.

Worse, it sounds like 12 hour shifts might well increase the risk of short staffing and overtime under employer duress.

My guess? Nurses are getting sold one thing and given another. Patients suffer as nurses do, and management squeezes some more profits out of the bargain. We Americans lack a health care system: haven’t you figure that out yet? We have lots of great health care providers run around by a profit system, all to maximize profits for those who own it all. Health is quite secondary. Providers and patients are low priorities, both. Money rules all.

Do you disagree, really? Have you actually experienced the American system, awake, alert, yet you still drink the Koolaid?

Profiteers have long owned American health care. The rest of us, like mice in a fancy mansion, do our best for each other inside the walls, fight over the crumbs…

Am I wrong?

47 comments

  1. Over here in the UK, the Goverment moved care back into the community which we were very relieved about. Probably thou the reason was to save money and because an ageing population meant that some of the wards in the psychiatric hospitals were being used for care of the elderly.

    I agree that 12 hour shifts are a bad idea for reasons you have all mentioned but the thing is – the care in the community has not received the resources/funding it needs. This means that our son’s support has been cut from someone visiting for an hour twice a week to people visiting for about 40 minutes once every 2 to 3 weeks.

    This means i get a little tired but keep trying because i love my son. We think it is very short sighted.

    Even worse, the team in the community has for a year or two been short of a Clinical Psycologist which we think is a very important member of the team, again a funding issue because when people go on maternity leave they dont replace them and not surprisingly they dont always come back from maternity leave and then it takes time to rerecruit. Currently the role is filled by someone working part time. When we say anything we are reminded of the importance of their family. But our family is important to us too and to be honest we feel sidelined.

    Things like this create huge inconsistencys in the care of people and getting well is a postcode lottery.

    Think what we need around the World is to up the priority of mental health services on Government’s agendas. Perhaps a lot of problems that happen in the World today are a consequence of not doing this.

    Liked by 1 person

    1. I never meant to claim that shift length was anywhere near the most important factor determining health care quality. As you point out rather well, many other factors have a larger impact. Hopefully we can improve things, despite all the obstacles. Thanks for your thoughtful comment – Greg

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    2. I agree heartily with you: mental health remains a poor, neglected, & shunned ghetto within health care, ever a target for arbitrary budget cuts. Even parity laws have no teeth: how can one define parity between apples and oranges, knee operations (some shown to have no benefit but still pay extreme well) and (proven) psych treatments? Good luck, never give up, and thanks for your thoughtful comment – Greg

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  2. I have been in long term health care for 15 LONG years-and I see the harm that long shifts, understaffing, and profits do to the ones that I take care of. They suffer-the staff and the residents. There are no state mandates here on staffing to patient ratio, and that really breaks my heart and fuels my fire to change it. My residents shouldn’t have to suffer to less than mediocre quality care just so the company can have higher second quarter profits-charge the families THOUSANDS of dollars for a room that is three walls and a curtain, and i can’t be paid based on my experience. It’s an atrocity. Plain and simple.

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    1. My concern about them lies not so much in people choosing them: each of us can judge for ourselves. It’s that institutions seems to go all one way or the other. When I ask folks how sick calls and other stafing holes get handles with all 12s, it seems that often people get pushed into far more work than than is reasonable, or nurses have to work short for 12 hours, or both. I’m fortunate to work 8s in a place with a small pool of nurses who do nothing but fill holes or add an extra where needed. We occasionally work a 16, not allowed except to avoid running short, and we have per diems and part-time nurses willing to help out. There’s little hard selling on taking shifts, and there are small bonuses for getting force stayed of coming in short notice. It works rather well. If we had 12s, we’d be hard pressed to avoid working short rather often. The idea of flexibility is nice nice but seems rather complicated. And as you illustrate very well, short staffing and forced overtime can be planned to avoid hiring more nurses and save money. We have a duty to our patients. We have no such duty to help make companies more profitable, especially not when harm to nurses and patients are involved. In that case, our duty is to, however we can, to push back. The balance of power can make that rather risky and difficult. I’m very glad not to face such a challenge. Thanks for your great points – Greg

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    2. Health care as a business seems to heavily favor the business – profits must always increase – over the care. The customers are often far too vulnerable for the idea of a free market to have any meaning, except as propaganda to defend a model more akin to that of vampires, sucking the blood out if it’s “cattle” – human – victims. Thanks for your point – Greg

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  3. I’ve done my share of 12’s, the idea was if you work 3 twelves you will enjoy a better quality of life on your days off. That was never the case. I was always exhausted and trying to recover on my time off 😦 And I was a young ‘un!

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  4. The oncology night nurses would do 12s sometimes, and that was fine for slow nights and stable patients. I think they took naps. But when the nights were eventful, or the floor was full, it was obvious that they were a little off by the end. As a patient, you learn to be a little more alert in the mornings after crazy nights if possible.

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    1. I imagine 12s work fine for some nurses some of the time. My concern lies in that nurses often have little choice in the matter, and facilities can use 12s to generate “unforeseen” staffing shortages. In a pinch two 8s are doable and likely better for all than running short. You can’t do 24s. People in healthcare, ironically, can be the least receptive to the idea that we’re human and have limits, that usually getting by does not equal safe practice. I’m no expert, clearly, but I hear form lots of folks with experience. I hear from folks who see clear risk and harm, and from those doing 12s, angry I threaten their routine. Thanks for your helpful comment – Greg

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    1. I’ve worked many 16 hours shifts, and watched others do the same. You can see people slowing down, holding back, getting irrtiable, losing patience and concentration. You can manage it and usually get by. Over time, that kind of success adds up to quite a lot of impact. Thanks for your comment – Greg

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  5. Not sure, but guessing there’s statistics somewhere to answer this question but then again, statistics can be found on almost anything. I know someone well, who does 12 hour shifts and aside from getting stuck in horrible traffic or any other aspect that would delay sleeping before the next shift, it hasn’t negatively impacted anyone at the time of this writing!

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    1. Stats are gathered and studied and accepted. Otherwise they’re quite invisible. You don’t need statistics to show the obvious. Tired people make more mistakes, and mistakes in health care kill people. A very strong, clear series of effects.

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      1. Of course mistakes in health care kill someone. I was responding, in a way I thought of as positive, to your blog post by saying in order to prove or disprove something, find statistics to back up or discredit something (i.e do 12 hr shifts hurt more people). I disagree that you don’t need stats to prove the “obvious”, as you state because that’s a subjective, not scientific statement. Also, the so-called invisible stats may matter in some arenas because not only are accepted and well known stats used, the smaller and sometimes unknown stats are shared as gospel in some ways as well…

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      2. Thanks, and yes, I seek discussion too. Just didn’t want to be offensive. Ah, such is writing and context at times, isn’t it? Your question is a good one because without proof, maybe the priority is placed on efficiencies, etc. Instead of well-being and safety and like you pointed out, in the healthcare industry, that’s dangerous!

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      3. I guessed it would be a controversial point and attract heat. Nursing is not a culture to accept disagreement very gracefully, more apt to make everything personal. It holds us back, seriously so. Thanks, Natasha, for your thoughtful and intelligent comment – Greg

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      4. Thank you for the insightful question and openness to discussion, Greg. Opinions are good, even when mine is different. That’s interesting, I didn’t realize that nursing could be a field in which disagreements aren’t accepted gracefully. However, since it is such an important and critical profession, maybe being in agreement on things like treatments, meds, PITAs, etc. are good, thus saving the annoyance for doctors who aren’t helpful. 🙂 Have a great day!

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    2. It’s hard to see how errors tracking is complete enough or detailed enough or consistent enough to show anything clear. Many things we could do wouldn’t hurt anyone most of the time. We often have layers of protections against rarities because with millions of actions, those rarities add up to lots of harm. Research on error deaths in American hospitals make them one of the largest public health risks, far worse than cars and guns combined. My concern with 12s also lies in that I guess they can be abused to save money more easily than 8s. I often hear of such from nurses. Thanks for commenting! – Greg

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      1. We do all we can to do our best, of course. Do such efforts have limits? Of course. Fatigue and discomfort make for errors and poorer quality care, despite our best efforts otherwise. It’s like ignoring gravity to assume otherwise, as far as I can tell.

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    1. I dropped out of medical school when the sleep deprivation made me start to hate patients for waking me up with their problems. There is no rational, evidence-based rational for it. It’s tradition, and the old guard insisting they weren’t hapless victims of obsolete training, and insisting the young suffer as they did. How many patients has this tradition killed to date? MANY. Do you doubt it, really? Stay awake a few days in a row…

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    2. Because they have no choice, and it’s tradition. I did it a while. It takes no research to see the results. Stay up all night a few times a week, take no naps, and tell me you’re functioning 100%. Research does clearly show that hospital errors kill far more Americans each year than guns and cars combined. The status quo makes hospitals a rather dangerous place.

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  6. Agreed! As a former RN and an employee of the Government, meaning they hold the purse strings, over the years with cut back over cut back it is very scary how pressured nurses are. My day was led with the terror of making a mistake simply because we were all over stretched on any length of shift.

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      1. When there’s not enough RNs short is short no matter how long the shift is. However when I worked call for 12 hour shifts people were less likely to come in for overtime opposed to 8 hours. The length of shift isn’t the answer. Finding a way to pay for the number of RNs working that creates a safe environment for both the RN and the patient is a challenge and should be a priority.

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      2. Would an employer switch to 12s in order to achieve fewer people coming in? Could save big $ and pretend it was unplanned. You’re absolutely right, of course. Shift length is one piece of the puzzle. The underlying problem is a health care system that long ago became a profit system pretending otherwise. We waste – profits! – more than any other nation’s spends on health care, total. Hard to address when no one accepts giving up their cash cow, whether useful, useless or corrupt. Thanks for your comment, Shannon! – Greg

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