Nursing hours of practice: how long is too long?

1 July 2013

Christchurch nurse MICHAEL McILHONE reflects on just what is a typical nursing working day and asks when working long hours becomes counterproductive both personally and professionally.

Labour Day commemorates the struggle for an eight-hour working day.

New Zealand workers were among the first in the world to claim this right when in 1840 the carpenter Samuel Parnell won the right to work an eight-hour day in Wellington. Labour Day was first officially celebrated in New Zealand on 28 October 1890, when several thousand trade union members and supporters attended parades in the main centres.

For many years, the eight-hour working day became entrenched in the New Zealand employment culture. There were always exceptions, particularly in the medical and nursing professions. It wasn’t uncommon for our medical colleagues to find themselves working up to 16-hour days and 80-hour weeks. Fortunately the length of shifts and the number of hours worked during a week have been reined in by active professional bodies.

Nursing has faced its own challenges over the years and now it is not uncommon to find many nurses in acute care areas such as Emergency, ICU, Paediatrics, and Neonatal working 12-hour shifts as a matter of personal choice. There are two very opposed camps in the effectiveness and safety of working 12-hour shifts and examples of this are well documented in the international literature (most recently by an article by Stimpfel this year looking at the impact of shifts on paediatric outcomes).

Over the past couple of years, Nursing Review has been publishing a series of “A day in the life...” articles that I have found to be very interesting and also, at times, providing relevant and useful insight into areas of nursing that I have little knowledge of. It appears to be an excellent avenue for nurses to extol their profession, and indeed, their expertise.

Some of the profiles have got me thinking, and in line with my opening paragraphs, I hope to generate some discussion and opinions relating to the length of shifts and working hours that nurses currently undertake. I don’t want to get into the argument relating to 12-hour shifts as I do accept that this is an individual choice driven by both the culture and requirements of individual clinical areas (while at the same time recognising that legally, the eight-hour shift is the default if an individual doesn’t want to work 12 hours). But I have noticed a ‘creep’ by some nurses, particularly in advanced nursing roles, to work well over the 12-hour threshold.

An example of this was demonstrated by a senior nurse who arrives at work at 6:15 am and leaves at 8:00pm. This equates to nearly a 14-hour shift. Of course there will always be emergencies and situations that require us to go the ‘extra mile’ but neither of these reasons were apparent in this “Day in the life” profile. It appeared to be a routine day.

My question is what sort of message do senior nurses who work these kind of hours give our colleagues and our employers? Is working extra long hours disguising the need that the organisation really requires more staff to cover the role? Is there a blurring of boundaries to the point that the nurses consider themselves so integral to the role that if they don’t stay longer and complete the task(s) then nobody else can or will? Is there an element of competitiveness? Or is a statement being made that “I can match any profession in the length of hours that they work”? Most importantly, how much does working extended hours impact on senior nurses’ work/life balance?

As younger nurses graduate and enter the profession, they look at senior nurses both as role models and mentors. We highlight the need for professional boundaries and a good work/life balance; we are also attempting to make advanced clinical nursing roles attractive and sustainable. I’m not sure that consistently working extended hours sends the right message.

In the immediate aftermath of the February earthquake in Christchurch 2011, I was part of, and witnessed, hundreds of nurses across the Canterbury health sector consistently working extended hours to maintain a health system and achieve our number one goal of providing healthcare to our community. This in some cases went on for several weeks (aged care springs to mind), and I would expect no less either from myself or my colleagues. However, as soon as we were able to, it was important that the length of time that nurses spent at work was curtailed to pre-quake levels. It is all about sustainability and that elusive ‘work/life’ balance.

Reed in the January edition of the American journal Nursing provides further discussion points and several steps to safety when considering healthy work hours. Although catering for the American nursing profession, many of the messages will resonate with a New Zealand audience.

So what do you think is a healthy working day? And how long is too long and why?

Author: Michael McIlhone, RN, PGDipHealSci, Canterbury District Health Board

*Full references available on request