Should hospital nurses be working 12-hour shifts?

Hospital leaders have bemoaned a nationwide shortage of nurses, and nursing leaders argue that more flexible scheduling would help keep nurses from walking away.

Increasingly, some nursing leaders say it’s time to move away from the 12-hour shifts employed by many hospitals. As National Nurses Week concludes, nursing industry leaders and advocates say health systems must develop other scheduling options.

Advocates for moving away from 12-hour shifts make several points. Those shifts are extremely difficult for nurses who have children. Some advocates say many nurses who have young children leave the profession, or at least get out of full-time roles, because it’s too difficult to manage 12-hour shifts when raising school-age kids. As nurses get older, the 12-hour shifts get more difficult, nursing leaders say.

• Related stories on nursing
• ‘Return nurses to being nurses’: A call to address burnout and shortages
• On National Nurses Week, many nurses say they don’t feel valued

Some say moving to shorter nursing shifts would improve patient safety, and federal officials have voiced concerns over declines in patient safety during the COVID-19 pandemic.

Some nurses have appreciated the 12-hours shifts that have become widespread in recent years. Many nurses work three 12-hours shifts each week, allowing four days out of the hospital. For younger nurses in particular, the schedule can be appealing, nursing leaders say.

Hospitals also have found it easier to schedule staff with 12-hour shifts, leaders say. (The story continues after the video.)

'The worst thing'

Vicki Good, executive director of nursing for Mercy Hospital in Springfield, Missouri, strongly advocates for moving away from 12-hour shifts. She’s a past president of the American Association of Critical-Care Nurses board of directors.

In an interview with Chief Healthcare Executive about challenges in nursing, Good said she could have a whole separate conversation about 12-hour shifts for nurses.

“It’s the worst thing from a safety perspective and from a long-term workforce perspective that we could have ever done in nursing,” Good said.

At a time when hospitals around the country are searching for nurses, Good said it’s time to reconsider the 12-hour shifts. Hospitals were facing a shortage of nurses before COVID-19 ever appeared, but the pandemic has driven more nurses to leave the profession due to the stress and fatigue. Many nurses say they plan to leave their practice within the next two years.

“We have to look at alternative staffing models,” Good said. “The traditional staffing models aren’t going to cut it in the future, unless we can look at an alternative way to get more nurses.”

The Nurse Staffing Think Tank - a coalition of five nursing organizations - released a report earlier this month outlining ways health systems can address the nursing shortage.

Among the top recommendations: Developing more flexible schedules for nurses.

The 12-hour shifts grow more challenging for nurses as they age, Good said. Nearly half of all registered nurses are over the age of 50, according to a recent federal report assessing the pandemic’s impact on hospitals and workforce staffing.

“If you look from a physical standpoint as the nursing workforce gets older, it’s much more difficult to be on your feet and doing patient lifts, etc., for 12 hours as opposed to 8 hours,” Good said.

Anne Dabrow Woods, the chief nurse of Wolters Kluwer’s Health, Learning, Research and Practice business, has spent 38 years in nursing. Hospitals and health systems solve a lot of scheduling hassles with 12-hour shifts, she said.

But given the shortage of nurses, Woods said healthcare organizations are going to have to consider other strategies in scheduling.

“Nurses are saying, ‘I need more flexibility in the hours I work, because I’m worried about my family, or other things,’” Woods said.

“We need to take a look at being more flexible with our scheduling and recognize 12-hour shifts are not going to be the answer for everyone, and we need to have more flexibility.”

• Related story: How healthcare systems can work to keep nurses

Risks to patients

Nurse advocates also say 12-hour shifts could raise the risks of affecting patient safety.

Researchers at the University of Pennsylvania found in a 2012 study that longer nursing shifts contributed to burnout and patient dissatisfaction. The study examined more than 22,000 nurses who worked at 577 hospitals.

“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 and to intend to leave the job,” the Penn researchers wrote. “Extended shifts undermine nurses’ well-being, may result in expensive job turnover, and can negatively affect patient care.”

Healthcare leaders should take a close look and see if there’s a link between longer shifts and negative impacts on patients, Woods suggested.

“If you have nurses that are working multiple 12-hour shifts, you need to see if you are seeing an error increase with them, and maybe the leaders need to step in and say, ‘We’re not going to allow our nurses to do that,’” Woods said.

“They’re not only putting their patients at risk, they are putting their license at risk,” she added.

Some nurses on 12-hour shifts regularly stay longer than their scheduled shift. With overtime and travel time, those 12-hour shifts can easily become 14- or 15-hour days, Good said.

“If you look at the research, the 12-hour shifts are probably not the best thing for patients,” Good said. “The human mind can only stay focused on something for basically 8-10 hours. Then you're asking that nurse to stay focused on patient care for 12 hours.”

Rebecca Love, chief clinical officer of IntelyCare, said 12-hour days are too draining for many nurses. “You are running for 12 hours, lifting 300-pound patients, lugging technology and equipment,” Love said. “These days are insurmountable.”

Seeking more options

Some nursing advocates say they’re hearing more from nurses who would like 8-hour shifts, 6-hour shifts, or even split shifts, where they would be able to go home for a few hours for family time and return to work.

With the stress of the job exacerbated by the pandemic, many nurses said they no longer recommend the profession, according to a recent survey by IntelyCare. Hospitals need to consider offering more part-time roles with benefits to help keep good nurses in their organizations, Love said.

Nicole Banister, senior vice president of transformation at Caravan Health, said healthcare leaders should look at flexible scheduling as a key retention strategy. She also pointed out technology platforms can help assist leaders in devising scheduling solutions.

Health leaders that are considering changing schedules should consult their nurses to develop better schedules.

“They might come up with things they’ve never thought of before,” Banister said.

Hospitals are facing no shortage of financial challenges, including higher labor costs and supplies.

But health systems are going to have to get creative in terms of better scheduling and compensation to keep veteran nurses, who bring valued experience to the table, Good said.

“Those nurses with 10 or 15 years experience come with a lot of institutional knowledge that you can’t replace with a traveler or a new graduate,” Good said.