Long shifts lead to nurse burnout and dissatisfied patients

In the first study to examine the relationship between nurse shift length and patients' assessment of care, researchers from the University of Pennsylvania School of Nursing report that nurses working shifts of ten hours or longer were up to two and a half times more likely than nurses working shorter shifts to experience burnout and job dissatisfaction. Furthermore, seven out of ten patient outcomes were significantly and adversely affected by the longest shifts.

"Traditional eight-hour shifts for hospital nurses are becoming a thing of the past. Bedside nurses increasingly work twelve-hour shifts. This schedule gives nurses a three-day work week, potentially providing better work-life balance and flexibility," said Amy Witkoski Stimpfel, PhD, RN, a post-doctoral 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 took place in California, New Jersey, Pennsylvania and Florida, which represents approximately 25 percent of the United States population and 20 percent of annual US hospitalizations. Nearly 23,000 registered nurses took part in the study over a three-year period.

Sixty-five percent of nurses worked shifts of 12-13 hours, the percentages of nurses reporting burnout and intention to leave their job increased incrementally as shift length increased, wrote Dr. Witkoski Stimpfel and Penn Nursing co-authors Linda Aiken, PhD, RN, FAAN and Douglas Sloane, PhD, in the November issue of the policy journal Health Affairs.

In hospitals which had higher proportions of nurses working longer shifts, higher percentages 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.

Dr. Witkoski Stimpfel and co-authors recommend restricting the number of consecutive hours worked, that state boards of nursing consider whether restrictions on nurse shift length and voluntary overtime are advisable, and nurse management should 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 Dr. 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."