1. Schoonover-Shoffner, Kathy

Article Content

In the previous issue of JCN (35:1), we published the article, "12-Hour Shifts: Literature Reviewed, Wise Use Challenged" by Dr. Betty Kupperschmidt. Nurses Christian Fellowship offered an online video Journal Club on the article for our members with free continuing education (a new NCF member benefit!). We discussed additional research on 12-hour shifts, shared our work experiences, and proposed ideas that could help mitigate the negative effects of 12-hour shifts.

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Recent research reports continue to raise questions about the safety of 12-hour shifts for nurses and patients. For example, nurses working >= 12-hour shifts relayed higher job dissatisfaction, poorer quality of care, and higher ratings of care left undone (Ball et al., 2017). However, a scoping research method review of literature from 1973 to 2014 by Harris, Sims, Parr, and Davies (2015) was inconclusive about the negative or positive effects of 12-hour shifts and noted a paucity of research focusing on patient outcomes, patient experiences of care, and work productivity.


What mitigates negative aspects of 12-hour shifts? A study of 12-hour shifts in Neonatal Intensive Care Unit nurses found that quality of sleep life significantly impacted nurses' sense of quality of life and their work sleepiness, fatigue, vigor, anger, tension, and confusion (Ferriera, Moreira, Guo, & Noce, 2017). Other research supports that less than 6 hours of sleep nearly doubles the risk for workplace injury, compared with >= 7 hours of sleep (Lombardi, Folkard, Willetts, & Smith, 2010). In addition, nurses who hydrated adequately during their shift were less sleepy; reported less tension, anger, fatigue, and confusion; and had more vigor. But only 39% reported adequate hydration (Ferriera et al.).


Several of the nurses who participated in the NCF Journal Club said they had worked more than three 12-hour shifts in a week (only three is recommended) and more than 12 hours in a shift. Participants relayed how difficult it was to get off work on time and how they were asked to stay later and/or work extra shifts. They said it was difficult to get enough sleep between consecutive 12-hour shifts and to eat well and stay hydrated while working.


We came up with things we could do to promote safe practice while working 12-hour shifts. Here's our list:


* As Christians, the Holy Spirit dwells within us (1 Corinthians 6:19-20); therefore, we must commit to physical, mental, emotional, and spiritual self-care.


* Like Jesus, who worked long hours dealing with tough situations, spend committed time in communion with God (i.e., Mark 1:32-37).


* Commit to the biblical practice of Sabbath (i.e., Exodus 16, 20, 31). Make regular times of rejuvenation, recreation, and whole-body rest.


* Share what we learned with other nurses, managers, and administrators.


* Refuse to work more than three 12-hour shifts in a week or more than three consecutive shifts.


* Take a water bottle to work, keep it filled; hydrate throughout the shift.


* Take a healthy meal/snacks to work.


* Practice sleep hygiene; learn and do what works for you to get adequate, restful, sleep.


* Educate nursing students about proper use of 12-hour shifts; socialize students away from the idea that to be a good nurse you must work long hours and overtime.


* Model for colleagues and students a balanced lifestyle; help change cultural expectations of overwork.



It will be challenging to implement this list and difficult to change the culture of nursing and healthcare work practices. At the end of the Journal Club, each one of us committed to doing at least one thing from the list.


What will you commit to do to make 12-hour shift work safer for nurses and patients?


Ball J., Day T., Murrells T., Dall'Ora C., Rafferty A. M., Griffiths P., Maben J. (2017). Cross-sectional examination of the association between shift length and hospital nurses' job satisfaction and nurse reported quality measures. BMC Nursing, 16, 26. doi:10.1186/s12912-017-0221-7 [Context Link]


Ferreira T. S., Moreira C. Z., Guo J., Noce F. (2017). Effects of a 12-hour shift on mood states and sleepiness of Neonatal Intensive Care Unit nurses. University of Sao Paula Brazil Journal of the School of Nursing, 51, e03202. doi:10.1590/S1980-220X2016033203202 [Context Link]


Harris R., Sims S., Parr J., Davies N. (2015). Impact of 12h shift patterns in nursing: A scoping review. International Journal of Nursing Studies, 52(2), 605-634. doi:10.1016/j.ijnurstu.2014.10.014 [Context Link]


Lombardi D. A., Folkard S., Willetts J. L., Smith G. S. (2010). Daily sleep, weekly working hours, and risk of work-related injury: US National Health Interview Survey (2004-2008). Chronobiology International, 27(5), 1013-1030. doi:10.3109/07420528.2010.489466 [Context Link]