There has been an increase in the use of 12 hour nursing shifts that potentially put care quality at risk, according a review commissioned by England’s chief nursing officer.
The review, undertaken by researchers from the National Nursing Research Unit at King’s College London and Southampton University, investigated the prevalence and impact of 12 hour shifts in nursing, looking at links between shift length and patient outcomes.
It concentrated predominantly on registered nurses but the researchers said there was no reason to suggest the findings did not also apply to healthcare support workers.
It appears to confirm anecdotal evidence of a rise in popularity of longer shifts and acknowledgement by staff that they leave them feeling more tired than eight hour shifts, HSJ’s sister title Nursing Times reports.
The study said 12 hour shifts have become more prevalent in the NHS – 52 per cent of staff nurses on wards reported working 12 hour shifts in 2009 compared with 31 per cent in 2005.
For independent care homes, there was an increase from 41 to 69 per cent over the same period.
The study also highlighted the risks of long hours on performance and patient safety due to fatigue and stress.
The research follows a gradual shift over the last 20 years away from work patterns based on three eight hour shifts per day.
Many hospitals have moved to 12 hour shifts because managers believe it is a more cost effective way of providing 24 hour care, with lower costs and greater continuity of staffing.
Some nurses also prefer to work longer daily hours with fewer shifts, which gives them greater flexibility and more days away from work.
The review was commissioned in 2013 by NHS England chief nursing officer Jane Cummings as part of work set out in the national nursing strategy.
The researchers reviewed 26 studies carried out between 1982 and 2014 in the UK, US and Europe.
The researchers warned that the level of evidence they found on the impact of different shift lengths was “weak to moderate”.
However, in general, most of the studies appeared to show “some degree of negativity” linked with 12 hour shifts – either for nurses, patients or both.
Nurses working 12 hour shifts were found to be at increased risk of occupational hazards, including needle stick injuries and musculoskeletal disorders.
The report said: “Many of the adverse outcomes studies relate to fatigue, which can also jeopardise patient safety. Other factors can affect the quality and safety of nurses’ work, such as shift rotation, hours and the number of consecutive days worked, and unplanned or extended shift times.”
Jill Maben, chair of nursing research King’s College, said: “Our work shows that in spite of limited evidence, 12 hour shifts have increased across the NHS without fully understanding the risks to patient safety and staff wellbeing.”
Lead author Jane Ball, principal research fellow at Southampton University, added that the analysis found that working shifts of 12 hours or longer was associated with care being rated as “poor quality” and an increased risk that necessary nursing care was left undone.
“It seems clear that there are risks associated with a move to longer shifts and they need to be managed very carefully,” she said.
Ms Cummings said: “This report is a welcome addition to the work we are undertaking as part of the [national nursing strategy] and its findings will be carefully considered.”
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