RORYs VALUES

Do 12-hour shifts put patients first?

2014 MA Healthcare Ltd

nterest in 12-hour nursing shifts has been come

about via two main routes; staff choice and 2 for
improved cost-effectiveness in the NHS, however,
the effects of this shift on the delivery of patient and
family-centred care are unclear. Todd et al (1993)
describe the results of a repeated-measures study of
10 wards, using activity analysis to describe patterns
of care under an 8-hour compared to a 12-hour
shift system. Significant reductions in the amount of
direct patient care were found under the 12-hour
shift, with corresponding increases in unofficial work
breaks. These findings, which were consistent over all
study wards and throughout the whole 12-hour day,
demonstrate a pacing effect by nurses who face 12
hours on duty.
It is unclear what the effects of 12-hour shifts are on
nursing education and the learning environment. Todd,
et al reported surveys of the attitudes of student nurses
and nurse educators towards 12-hour shifts. Learners
are reasonably positive about 12-hour shifts, but this
preference is based on social rather than professional
benefits. A reported effect of fatigue on home study is
evident.Very negative views about the 12-hour shift are
held by the group of educators. Their criticisms appear
to be primarily organisational, but they are unequivocal
that learning is detrimentally affected. Thus, even
if students appear to like this shift pattern, serious
concerns are raised by these findings about the impact
on nursing education.
It is generally agreed that some features of shift
systems can influence the extent of wellbeing and
health problems experienced by the workers involved.
Extended working days (9-12 hour shifts) have been
found to aggravate some problems associated with
shift work, especially when the work is mentally and
emotionally demanding. The aim of the study was
to compare measures of health, sleep, psychological
and social wellbeing, job satisfaction and burnout of
intensive care unit nurses on 12- and 8-hour shifts.
In a study that matched nurses for age, length of shift
work experience, marital status and number of hours
worked, the 12-hour shift nurses, when compared
to their 8-hour shift colleagues, experienced more
chronic fatigue, cognitive anxiety, sleep disturbance
and emotional exhaustion (Todd et al, 1991). Job
satisfaction seems to be independent of the shift
duration. The nurses on 12-hour shifts reported less
social and domestic disruption than those on 8-hour
shifts. The 12-hour shift nurses showed worse indices
of health, wellbeing and burnout than the 8-hour
shift nurses. This may be associated with their longer
daily exposure to the stress of work. The increased
number of rest days of 12-hour shift nurses seems
to be insufficient to dissipate the adverse health and
wellbeing effects that built up over their longer shifts.
In 2000 Wooten discussed the implementation

British Journal of Nursing, 2014, Vol 23, No 3

of 12-hour shifts using a locally devised nursing

development unit (NDU) framework. and the results
of a survey to evaluate the 12-hour shifts, the problems
encountered during the implementation of 12-hour
shifts, the solutions and the NDU framework as
described in the first part of the article. A qualitative
design to the postal survey was chosen with the
resulting data being subjected to a content analysis. Data
triangulation compared survey results with incident
reports and sickness records. The limitations of the
survey included having the change agent analysing
the data, the sampling method and being unable to
pilot the questionnaire. This piece of work concluded
that it is difficult to measure whether there was an
improvement in the quality of patient care as nursing
workload throughout a 12 hour shift is variable. Other
results centred on staff morale, social life, student
nurses experience and night shifts. The solutions to
identified problems included the employment of two
twilight nurses to help the night staff during the busy
early evening period. As a requirement of the NDU
framework, standards were produced from the survey
results, as this would allow subsequent audit of the
12-hour shift system.
NHS organisations will have systems to look at
clinical and non-clinical incidents and patient safety
issues, however, a lot of these systems do not have the
ability to pick up on whether the practitioners involved
were on an 8-hour or 12-hour shift and how long into
the shift the incident happened.
In March 2014 Grimsbys Hospital are aiming to
cut the length of nursing shifts from 12 hours to 7.5
expecting that it would bring immense benefits to the
quality and safety of patient care, according to Chief
Nurse Karen Dunderdale. Following a consultation
period with 400 nurses since October 2013, the
changes will bring the hospitals shift patterns in line
with others in the Northern Lincolnshire and Goole
Hospitals NHS Foundation Trust, as well as national
guidelines. As Karen Dunderdale said in October 2013:

Rory Farrelly
NHS Greater Glasgow
and Clyde
Director of Nursing
Acute Services Division

It is well evidenced that long shifts are

associated with clinical risk, particularly in
patient areas with high volume, acuity and
dependency. (Grimsby Telegraph, 2013)
Recommendations from some of the studies
mentioned included the dissemination of results both
locally and nationally to expand the body of nursing
knowledge and to promote practice based on the best
BJN
available evidence. 
Todd C, Reid N, Robinson G (1991) The impact of 12-hour
nursing shifts Nurs Times 87(31): 47-50
Todd C, Robinson G, Reid N (1993) 12-hour shifts; job satisfaction
of nurses. J Nurs Manag 1(5): 215-20
Grimsby Telegraph (2013) Shorter shifts for nurses will benefit
patients. http://tinyurl.com/o3p9k5m (accessed 3 Feb 2014)
Wooten N (2000) Evaluation of 12-hour shifts on a cardiology
nursing development unit. Br J Nurs 9(20): 2169-74

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