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Long shifts for RNs can lead to patient dissatisfaction

Tuesday November 6, 2012
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Longer shifts make nurses more likely to experience burnout and job dissatisfaction and also make patients more likely to be dissatisfied with care, according to a study.

In what was described as the first study to examine the relationship between nurse shift length and patientsí assessment of care, researchers from the University of Pennsylvania School of Nursing reported that nurses working shifts of 10 hours or longer were up to 2.5 times more likely than nurses working shorter shifts to experience burnout and job dissatisfaction.

When shifts of 12 hours or longer "are combined with overtime, shifts that rotate between day and night duty and consecutive shifts, nurses are at risk for fatigue and burnout, which may compromise patient care," Amy Witkoski Stimpfel, RN, PhD, a post-doctoral fellow at Penn Nursingís Center for Health Outcomes and Policy Research, said in a news release.

Nearly 23,000 RNs took part in the study over a three-year period in California, Florida, New Jersey and Pennsylvania, states that represent about 25% population and 20% of annual hospitalizations in the U.S.

Survey data showed more than 80% of the nurses were satisfied with scheduling practices at their hospitals. However, as the proportion of hospital nurses working shifts of more than 13 hours increased, patientsí dissatisfaction with care increased.

The percentages of nurses who reported burnout and intention to leave their job increased incrementally as shift length increased, the researchers wrote. In hospitals with higher proportions of nurses working longer shifts, higher percentages of patients reported that nurses sometimes or never communicated well, pain was sometimes or never well controlled, and they sometimes or never received help as soon as they wanted.

Witkoski Stimpfel and co-authors recommend restricting the number of consecutive hours worked. They also said state boards of nursing should consider whether restrictions on nurse shift length and voluntary overtime are advisable, and nurse management should monitor nursesí hours worked, including second jobs.

"Nursing leadership should also encourage a workplace culture that respects nursesí days off and vacation time, promotes nursesí prompt departure at the end of a scheduled shift and allows nurses to refuse to work overtime without retribution," Witkoski Stimpfel said. "These types of policies that facilitate manageable work hours can contribute to the development of a healthier nursing workforce [that is] prepared to manage the complex care needs of patients and their families."

The study appears in the November issue of Health Affairs. The study abstract is available at http://content.healthaffairs.org/content/31/11/2501.abstract.


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