12-Hour Shifts: Love 'Em or Leave 'Em

As a group, my nurse practitioner coworkers and I in the emergency department, enjoy some freedom in the way we structure staffing. Shift length has traditionally been determined largely based on input from members of the group. And, it seems, we have a difficult time reaching a consensus. 

Working fewer, longer shifts gives the advantage of showing up to the hospital far fewer days each month. Working a greater number of shorter shifts allows for more daily balance in one's schedule and for many better accommodates logistics such as childcare. Personally, my opinion on the shift length debate has bounced around based on personal circumstances. As a new graduate motivated to build an initial nest egg, I favored 12-hour shifts which gave me the ability to cram as much work into each week as possible. Once my financial situation became more stable, not to mention, I began to feel burnt out, 8-hour shifts seemed the more favorable model for the department's staffing structure. 

Interestingly, the physicians in our group have always worked 8-hour shifts. Whether as a result of burnout from residency, or the fact that more of our group's docs than NPs have families, whenever the schedule is evaluated, MDs vote that 12-hours shifts are hands-down too long given their job description. As nurse practitioners, we serve a similar function as physicians in the emergency department. Are we missing an important perspective when it comes to shift length?

Cons: Ditch the 12-Hour Shift

While there are not studies specifically addressing nurse practitioners and shift length, we can look at research relating to shift length and medical residents as well as shift length and nurses. Many studies highlight the fact that working longer shifts leads to fatigue and therefore a greater number of medical errors. Here are a few thoughts on the matter: 

  • Even nurse practitioners who don't work the night shift suffer from sleep deprivation. Factor in time getting ready for work as well as a commute, and a 12-hour shift easily necessitates 16+ hours of awake time.
  • One study found that moderate sleep deprivation, of less than 20 hours without sleep, produced impairments equivalent to level levels of alcohol intoxication. 
  • Studies show that injuries to employees increase exponentially after the 9th hour of work. One study showed that needle stick injuries increased significantly among nurses working 12-hour shifts compared to those working 8-hour shifts. 

Not only is safety a consideration with lengthier shifts, job dissatisfaction and burnout are more common among RNs working shifts of 10 hours or more. 

Pros: Embrace the 12-Hour Shift

The case for shorter shifts, at least based on safety considerations, seems clear, right? Not so fast. While longer shifts are linked to fatigue, and therefore injuries, errors, and accidents, there are some benefits to the 12-hour model. Proponents note that for night shifters, working shorter shifts means working more nights, arguably leading to a greater degree of fatigue. Medical errors are also known to occur when transitioning patients from one provider to another in the hospital setting. Longer shifts means fewer patient hand-offs. 

Having worked the night shift, the day shift, long shifts, and short shifts, and having nearly fallen asleep at the wheel after any given number of these combinations, for me, the bottom-line is that ideal shift length depends on the individual. The shift that caters best to my lifestyle, professional and personal preferences, and sleep schedule, changes over time. Each nurse practitioner must evaluate how best to pursue a career while balancing other interests, and, well, sleep! So, when it comes to 12-hour shifts, I say love 'em. As a nurse practitioner I have always enjoyed having many options available to me when it comes to practice setting and schedule. The freedom to choose among different scheduling options is irreplaceable

What do you think about 12-hour shifts? Should nurse practitioners love 'em or leave 'em?

 

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