Running head: HELP NURSES HELP YOU 1

Help Nurses Help You

Destinie Emily Woodard

Arizona State University

HELP NURSES HELP YOU 2

Abstract

Twelve-hour nursing shifts escalate the possibility of harmfully affecting nurse care, safety and

increase the risk for medical mistakes among patients. To be able to provide safe effective health

care, the issue of sleep deprivation, injuries among the nurse and patient, and fatigue must be

addressed. An innumerable amount nurses today work twelve-hour shifts and favor it among

other options despite the possible consequences. There is increasing evidence that twelve hour

shifts negatively impact performance and safety for both the patient and the nurse. Studies have

indicated a greater increase in patient care errors and mistakes during a twelve-hour shift

compared to other alternatives. Nurses amass the most injuries out of all healthcare professions

and have been proven to take part in drowsy driving. Nurses are often labeled as sleep-deprived

workers. Working long hours, exceeding an eight-hour limit, can result in careless mistakes such

as needlestick injuries. Although fatigue is the main cause of patient errors, sleep deprivation is

what ultimately the source of fatigue that leads to careless mistakes. Not enough sleep is very

common among nurses, who have lives outside of work and demanding jobs that both require

undivided attention. Findings proven a decrease in medical mistakes and injuries in patients and

nurses in eight-hour shifts compared to the standard twelve-hour shifts.

Keywords: nurses, patients, medical mistakes, twelve-hour shifts, injuries

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Help Nurses Help You

Countless nurses today work only twelve-hour shifts, with very little health care facilities

offering other options. There is expanding indication that twelve hour shifts negatively influence

performance and many question the safety of twelve hour shifts for the patients and the nurse.

New studies expose growth in patient care errors when nurses work twelve-hour shifts compared

to other alternatives. Nurses acquire the most injuries out of all healthcare professions and have

been proven to take part in drowsy driving and are labeled as sleep- deprived workers. Twelve-

hour shifts escalate the possibility of negatively impacting nurse health and safety and increase

the risk for medical mistakes among patients. To provide the safest most effective heath care,

nurse shifts should be reduced and not exceed a twelve-hour limit.

Evidence has proven a dramatic health and safety difference in patient care errors

between twelve-hour shifts and eight-hour shifts. Patient care errors and unsafe conditions for the

nurse is likely to occur in twelve hour-shifts compared to eight-hour shifts because nurses are

sleep deprived from working straight twelve-hour shifts, fatigue, and do not have a consistent

sleep schedule. Patient care errors are 50% more likely to occur in a twelve-hour shift than an

eight-hour shift (Brown, 2010). Lorenz (2008) explains eight-hour shifts have been proven to be

healthier for the nurse and patients because with shorter shifts, nurses are able to gain amounts of

rest and decrease the possibility of sleep deprivation that can result in nurse burnout. Being

fatigue during a shift can lead to all levels of harm to a patient. If given the wrong prescription,

dosage of medication, or even the wrong type of care, a patient can suffer short term and long-

term damage or even death. If in the event a mistake like this were to happen, a nurse risks the

fact that they can lose their job and or be written up. Although twelve-hour shifts are more likely

to result in more patient care errors and mistakes, it very well can happen at any time in both
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shifts. Both shift lengths possess the same amount of chances for error because factors such as

number of shifts worked consistently, sleep schedule, and the individuals health can play a role

to how fatigue a person will get and respond to shift lengths (Pellico, 2009). Depending on each

individual nurse, their health, exercise routine, and sleep schedule can affect their performance

on both shift lengths. Every person takes different vitamins and medication that can affect their

productivity on the job. Eight-hour shifts can result in patient care errors if the nurse begins to

grow lazy and not caring of the patients around her. Twelve-hour shifts are still popular today

because it offers nurses a more flexible schedule and is a component most nurses look for in a

job. Nurses prefer and favor working twelve-hour shifts because it gives more days off and is

more of a convivence (Montgomery, 2010). Although it is popular among health care workers

today, it does not mean it is the safest approach to safe effective healthcare. In a recent study in

Roger’s Hospital, nurses have reported making three times the amount of errors in a twelve-hour

shift compared to an eight-hour shift (Brown, 2010). Patient care errors, occur and are more than

likely to happen during a twelve-hour shift than an eight-hour shift because of the physical,

mental, and emotional stress the job has to offer. It is proven that overall, with or without

individual circumstances, that errors do occur more in twelve-hour shifts than eight-hour shifts.

Working long hours exceeding an eight-hour limit can result in careless mistakes among

nurses and result in a needlestick injury. Stimpfel (2014) states nurses who work the twelve-hour

shifts are more likely to not be aware of their surroundings and be blindsided by a dirty needle

that wasn’t properly disposed and accidently puncture their skin. After giving a shot or putting

more fluid into an I.V., nurses are to dispose of the needles with care and in the proper container

for contaminated needles. If an individual was punctured or pokes with one of the dirty needles

than they are at big risks of getting sick and in worst cases, facing death. Having long shift hours
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can lead nurses to get lazy with their jobs and leave a used dirty needle exposed and out in the

open. When working long hours, nurses tend to not pay much attention to the little things that

can cause injuries, such as needlestick injuries. In long hours, nurses focus on the patient

themselves and the bigger issue rather than an issue that should already have been discussed.

Nurses working twelve-hour shifts have the highest rate of needlestick injuries than eight-hour

shift nurses (Patricelli, 2016). Nurses are often pushed to work long hours that can result in

injuries making it unsafe to work in such conditions. Nurses are not given enough time and space

to clear their minds to think straight to prevent injuries among themselves. Eight-hour shift

nurses are well rested individuals and have a less chance of making mistakes that can harm

themselves and their coworkers. Eight-hour shift employees tend to make little to no mistakes

because of the amount of sleep they gain at night without having to have the feeling of

drowsiness. Ball (2014) goes on to explain that because they have increased rest, they will gain

self-awareness of their surroundings and not be lazy when it comes to performing the right task

all the way through. Despite the shift length, needlestick injuries occur in both shift lengths and

have other reasons for occurring than just work and shift length alone (Brown, 2010).

Needlestick injuries can occur in both shifts. Healthcare facilities are the top place that

needlestick injuries happen because of the number of needles around as well as sick individuals.

Laziness can occur in both shifts because an individual can choose upon themselves to not

perform their designated task properly and accidently leave a dirty needle in harm’s way. Nurses

working twelve-hour shifts regularly have a 95% higher chance of getting a needlestick injury

than those who work eight-hour shifts (Brown, 2010,). Nurses working long shift hours are more

likely to become drowsy and feel the need to make their job easier for themselves and do things

with half effort. The percentage is extremely high because needles are used for a lot for
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medication and is used to give it quickly. By doing that, they are causing harm to themselves and

individuals around them. Eight-hour shifts do not deal with as much needlestick injuries because

a nurse working that shift would likely be more energetic knowing that they get off work and

have a good night’s rest unlike nurses working twelve-hour shifts.

Healthcare employees have the highest reported musculoskeletal injuries, more

commonly in the back, than any other industry. Connie (2008) states that back injuries among

nurses is very common in the modern society because the amount of lifting, bending, and

physical movements nurses make throughout the day. Nurses are constantly on their feel meeting

the needs of their patients. Health care employees, specifically nurses, are not using the proper

body mechanics that can save them from even gaining musculoskeletal problems in the first

place. Farrelly and Trinkoff (2014) both found that when nurses work longer hours than eight-

hour shifts, they are more exposed to the physical demands to be a nurse and have a greater

chance of getting an injury in the musculoskeletal area. Twelve-hour shifts are approximately

four more hours than an eight-hour shift would be. That is four more hours of meeting the

physical demands of their patients. Nurses often life people their size or even more on their own

and even if they use a gate belt, there is still room for backs to get hurt. Axelsson (1998) states

that pain in the lower back can result in surgery or enough injury to hinder a nurse in their work

and limit them in their physical availability. Nurses often lift without using their knees which

causes all the pressure to build up in their back and cause it pain. Nurses are seen working out

more and going to the gym to gain weight and get muscle because of the amount of lifting they

must go through at work. When lifting a patient or object, if nurses do not have or use the proper

body alignment they can injure themselves. Depending on the individual nurse and their body as

well as physical activity, their bodies can respond differently to the physical demands making
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shift length only a small factor in this argument (Lothschuetz, 2010). Different people take care

of their body differently. Each person has their special way of keeping fit and healthy. Some like

to work out more than others but most of the time nurses primarily do it to gain muscle.

Improper body alignment can occur in both shifts depending on the individual. Nurses who were

not taught proper body mechanics can take their wrong-doings into an eight-hour and twelve-

hour shift. Each body on each nurse is created differently and some work out more than others

which can result in differences and tolerances to certain movements that occur at work such as

bending and lifting. Nurses who keep up with a healthy lifestyle and lift weights may have a high

tolerance to lifting so much weight and have it not bother them so much. There is a 12% increase

in nurses working twelve-hour shifts reporting back injuries than those working shorter shifts

(Trinkoff, 2010). Nurses working twelve-hour shifts have more exposure to the physical

demands of the job consistently than eight-hour shift employees. Back injuries are common

among nurses because they will lift anybody no matter the size and sometimes even must do so

on their own. Four hours in a physically demanded health care facility can increase the chances

of a nurse getting a musculoskeletal injury.

Long hours working can affect the safety of driving for the nurse and society around

them. Twelve-hour shifts have been proven to be associated with drowsy driving because of how

fatigue nurses leave work. Being as sleep deprived as they are, nurses look forward to coming

home to sleep so they tend to be wild drivers on the road to quickly get home to sleep as much as

they can until their next twelve-hour shift. Nurses who exceed a twelve-hour limit are proven to

take part in drowsy driving and have an increased chance at falling asleep at the wheel than those

working eight-hour shifts (Brown, 2010). Eight-hour shift workers get to have more time to sleep

and refresh their minds before coming to work and after work still have enough self-awareness to
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drive home safely on their part. Twelve-hour shifts are long and are a way to throw fuel to the

fire because driving is dangerous because people drive crazy. Nurses working the eight-hour

shifts do not have to deal with their extra four hours of more physical and mental demands that

twelve-hour shift nurses deal with. Falling asleep at the wheel can not only injure the nurse’s life

but also the community in which the nurse was driving. Harm can be caused to themselves and

other cars involved if they were to get into a car accident. At the worst, death can occur because

of the long working hours affecting a nurse’s reaction time to avoid harm. According to Peate

(2014), nurses often work three consecutive twelve-hour shifts but then are expected to drive

home “safely” putting themselves and others in danger. Health care managers and owners know

the risks of driving while exhausted. Barker (2011) explains that managers and health care

workers understand the risks of a nurse driving home with such hours but still manage to let

nurses work almost any shift they want if they work. Driving while exhausted and driving under

the influence of drugs and alcohol cause the same amount of potential danger to an individual

and the community they are driving in around them. Nurses who take part in drowsy driving

have risk of falling asleep at the wheel and getting into a serious car accident. Drowsy driving is

not limited to only nurses exceeding a twelve-hour shift but is most common in sleep deprived

workers and can be seen in eight-hour shifts too (Brown, 2010). Drowsy driving can happen to

almost everyone. It all depends on how sleep deprived an individual is, their sleeping schedule,

and how much physical and mental stress they were put on that day. Situations change daily, and

some days are worse than others which can also affect the amount of exhaustion one possesses

and in turn cause drowsy driving. At least in eight-hour shifts nurses are not exposed to as much

physical demands and can get to go home earlier to gain more sleep. Although that is true, nurses

working twelve-hour shifts are exposed to a high demand of physical barriers. A study has
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proven that sixty-seven percent more nurses reported taking part of drowsy driving in a twelve-

hour shift rather than an eight-hour shift (Trinkoff, 2010). A study was conducted to have the

nurses themselves admit to their drowsy driving and vote how they felt. Hoffman (2008) goes on

to state a study showing over half reported themselves to have taken part in drowsy driving

during their twelve-hour shift rather than their eight-hour shift. Nurses are given twelve-hour

shifts continually even though evidence proves they can cause hard to themselves and others.

Twelve-hour shifts leave nurses restless.

Although fatigue is the main cause of patient care errors, sleep deprivation is what

ultimately causes fatigue to occur in the first place. Nurses are sleep deprived individuals who

live to work more condensed days to get the maximum amount of days off. Not having enough

sleep is common among nurses because they live lives outside of their work environment and

tend to have other responsibilities aside from work. Writers (2015) explains that nurses are not a

group of individuals who always have a fixed sleep schedule because of how busy they are as

people. A fixated sleep schedule is highly uncommon for nurses because of the physical and

mental demands of their job as well as the other responsibilities they may have at home. Sleep

deprivation leading to fatigue and patient care errors is increased in twelve-hour shifts because

long working hours leave less time for sleep and body function renewal (Trinkoff, 2010). Sleep

is a very important factor to gaining as much rest and control the amount of patient care errors

made in a hospital. Twelve-hour shifts that are worked back to back to maximize the amount of

days off, have that benefit but can result in high risks for other people involved. Many nurses

choose to become a nurse in the first place because of the amount of flexibility this job offers.

Having to be fulltime and work three days in a row and having four days off is good for many

people. Nurses acquire the most injuries out of all health care workers because of their long shift
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hours. Nurses are not as careful when they are exhausted, to make sure they are self-aware and

able to drive and work properly, Nurses often just assume this is what they signed up for and do

it without speaking up. Nurses become lazy and do things that they would not normally in high

pressure situations. To be able to make smart logical decisions, a nurse must and should well-

rounded and well rested. Sleep deprivation can happen between both shifts because sleep

schedules can be altered depending on the next shift and other factors than just one shift length

(Writers, 2015). Deprivation of sleep can happen for both eight-hour shifts and twelve-hour

shifts because sleep solely depends on the individual person and their needs as an individual.

Someone working an eight-hour shift can be just as fatigue as a nurse working a twelve-hour

shift because of the amount of sleep they get at night. Eight-hour shift employees tend to have an

abundant amount of time between their shifts and shift days, making it more suitable to get some

rest than in a twelve-hour shift. Nurses have been reported that when working three twelve hour

shifts instead of five eight-hour shifts, they work harder and show less signs of fatigue (Stone,

2006). According to studies, they are expanding the idea that working only three twelve-hour

shifts and having four days off is a positive among many nurses. Nurses having to work five

eight-hour shifts are proving to end up more fatigue because of the longer hours they work.

Twelve-hour shifts associate with the positive idea of more days off which explains how one

might say nurses work harder and have a better work life during twelve-hour shifts. Twelve-hour

shifts lead to only about 5.5 hours of sleep, especially when working three consecutive twelve-

hour shifts, leaving the nurse feeling overworked, fatigue, and drowsy (Trinkoff, 2010). Many

nurses do not see the harm in working twelve-hour shifts even though they are fatigue. Nurses

just tend to want to believe it is a healthy way of living although it isn’t.

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Twelve-hour shifts should be eliminated or reduced because of the harm it causes nurses,

patients, and society around them. Patient care errors occur more frequently in long shift hours

than short shift hours. Evidence suggests a correlation between working past twelve-hour shifts

and injury in the musculoskeletal area of the nurse because of the physical demands of their job.

Nurses are often participants of drowsy driving because of how sleep deprived they are, which

can lead to not only injuring themselves, but others as well. Being sleep deprived increases the

nurses risk to making an error that can harm the life of a patient. Nurses prefer the glory of

having more days off working consistent twelve-hour shifts even though there are risks attached

that prove otherwise for safety. To make healthcare safe for everyone involved, nurse shifts

twelve hours or more should be reduced or eliminated.

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