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Since Nursing Review published this shift work article earlier this year, New Zealand researchers have released a major literature review of the error rates of nurses working 12-hour shifts. 

 

Condensing your working week into three days has definite appeal to some nurses. Working three 12-hour shifts instead of five eight-hour shifts may mean more time for the kids or garden and less time commuting and arranging childcare.

But are 12-hour shifts safe for patients and nurses? New Zealand research published this year in the International Journal of Nursing Studies by Dr Jill Clendon and Dr Veronique Gibbons indicates that they are not.

The pair’s systematic review examined the research evidence on the error rate for nurses working 12-hour shifts or longer, compared with nurses working shifts of less than 12 hours. The search through thousands of research abstracts was narrowed down to 13 quality studies: six studies reported higher error rates for nurses working more than 12 hours on a single shift; four reported higher rates of error on shifts of up to eight hours, and three reported no difference.

Clendon, a New Zealand Nurses Organisation researcher, said the six studies showing higher error rates for shifts going beyond 12 hours included the RN4CAST research that involved 31,000 nurses across 15 European countries. In total, the six studies highlighting concerns with 12-hour shifts involved 60,780 nurses – or 89 per cent of the review’s total sample size of just under 68,000 nurses. “You are talking about big numbers with robust data and robust methodology,” says Clendon.

Two of the studies found the likelihood of making an error after 12 hours or more was between double to three times above that for  those working shorter shifts. Another study found nurses were significantly more likely to suffer a needlestick injury when working 12-hour shifts; another that nurses working more than 13 hours were more likely to report frequent central line-associated bloodstream infections; and another that the longer nurses worked over 12 hours the less likely that a patient’s pain was controlled.

“Hospitals and units currently operating 12-hour shift systems should review this scheduling practice due to the potential negative impact on patient outcomes,” is the conclusion reached by Clendon and Gibbons. They added that further research is also needed into mitigating the risk of errors in situations where 12-hour shift schedules cannot be changed.

The most recent NZNO employment survey indicated that around 10 per cent of registered nurses work 12-hour shifts. The greatest concentration of 12-hour rosters are in public hospitals in Auckland and Wellington; and the most likely services to use 12-hour shifts are intensive or high dependency care units, child health, emergency departments and maternity.

 

Evidence should prompt rethink

Clendon is convinced the evidence is now strong enough for hospitals to start reviewing the use of 12-hour shifts. She says it is not new news that NZNO as an organisation doesn’t support 12-hour shifts and the collective agreement with the 20 DHBs has for some time spelled out that eight-hour shifts are preferred. “Ten and 12-hour shifts are not recommended as a standard rostering pattern and shall occur only where clear clinical/service rationale supports this practice,” says the MECA (Multi-Employer Collective Agreement), which also states 12-hour rosters should  “not compromise” those nurses who elect to work 8-hour shifts.

But while the organisation may not support 12-hour shifts, it does support its members and Clendon is aware that many nurses quite like or prefer 12-hour shifts as it suits their family needs and lifestyle. She is also well aware that apart from the evidence of increased risk to patients there are organisational and fiscal factors encouraging employers to consider shifting away from 12-hour shifts. One of these is the accrual of annual leave by nurses who can have four days off in every seven.

The Clendon research has featured in an article in NZNO journal Kai Tiaki, and been presented to nurse executives group NENZ, but Clendon says there is no active agenda by NZNO to push organisations to reschedule rosters.