Shift Length: Patient Safety and Nurse Satisfaction

Categories: Health CareNursing

Nurses usually work twelve hour shifts and it has become a common policy of shift rotation in majority of hospitals and other health-care facilities in United States and it is also being followed in several countries all over the world. When compared, there are several advantages and disadvantages for the patients and also for the nurses on both shift policies. Nursing itself is a stressful profession. Towards the end of a long hour shift nurses can be physically and mentally tired and less focused.

Long hour shifts increases the stress level and causes burnout, fatigue, and it can also affect patient safety.

Effects of long and short hours shifts

This research will evaluate the effects of long hour shifts and short hour shift on patient care and also its impact on the nurses. Surveys were done among patients and nurses in the different units of the same hospital where long hour shifts and short hours shifts are employed. Surveys were also done on floors where long hour shifts and short hour shifts were employed at different point of time to see how patient responded to questions on the kind of care they received.

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The outcome of the research give indications suggesting what kind of shifts will be better for safe patient care.

Statement of Purpose

In health care system patient safety and satisfaction has to be given priority. Patient outcome is related to the quality of care given by the nurses and other health care providers. The patients are at risk if nurses get burned out, as there are possibilities that nurses can make errors in medication administration and other areas of care.

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The nurses’ shifts usually do not end in exact timing as it depends on the acuity of the patients and the time taken during the shift change handover report.

Evidenced based studies show that “while the 12-hour work day has become the norm for nurses, there is new evidence that such longer shifts are not necessarily a good idea, especially when nurses work several consecutive days involving 12-hour shifts, or they are required to put in excessive amounts of overtime. ” (Study:Long nursing hour shifts, 2013). The researchers further found out that “not only are patients less satisfied when the nurses who are caring for them work longer shifts, but patient outcomes are negatively impacted, too.

” (Study:Long nursing hour shifts, 2013). There are several benefits of working twelve hour shifts and that is the reason why nurses prefer to work longer shifts. Nurses get more time to spend with family when they work twelve hour shifts as they will have to work only three days a week or four as per need. In the work place also the twelve hour shifts gives nurses enough time to finish their work and have job satisfaction. The patients will also get continuity of care and they will have enough time to build trust which will increase patient satisfaction.

In a survey the nurses reported that “12-h shifts provided more time for performing hygiene and patient care, and for talking to patients and relatives. ” (Richardson, Dabner & Curtis, 2003, pg. 104). It is also good for the healthcare organizations to have the employees work twelve hour shift, that way there will not be an issue of over-lapping and thus less number of employees and it can be cost effective.

Problem Statement/Hypothesis

All healthcare facilities have different shift policies for nurses.

Some of them follow eight hour shifts policy and others follow twelve hour shift policy. However, it is not very clear what is the basis for choosing a shift policy. The expected basis for choosing a shift policy must be based on the quality of patient care and customer satisfaction. A secondary important aspect is the job satisfaction level of the nursing staff as it has direct impact on the quality of the patient care. Most of the time nurses do not realize that they are fatigued or tired and keep working extra shifts and overtime.

The brain is tricky, they may feel they are able to work safe, not knowing that their brain is impaired and there are chances that they may make mistakes. The nurses have to schedule their shifts wisely, so that they are not burned out or fatigued and also have enough time for their family and self. There are nurse who work three or four consecutive days which is not safe for the patients and themselves. The managers should evaluate the employee scheduling and make sure the nurses are taking days off and that they are not working excessive hours of overtime.

Even though patients may build trust and confidence in nurses by getting them to know for longer period of time, the patients are at risk and most of the time they know that and may not be satisfied with the care they get during their hospital stay. The ultimate question to be answered is: what kind of shift facilitates or produces better patient care and customer satisfaction.

Nursing Theorist/Theory

It is important for a nursing leader to know what kind of shift is better for excellent patient care.

If long hour shift is better for maximum patient care, ethics of nursing theory demands that long hour shift should be employed in health care profession. On the other hand, if shorter shift is better for effective patient care, ethics of nursing theory requires that shorter shifts should be employed in health care profession. In essence, the length of the shift should not be based on what works better for the hospital or the nurses, but depending on what works better for the patients.

In the same way, importance should be given to aspect of relationship between patient and nurses. Nursing theory requires that good relationship must be achieved between the nurse and the patient. The nurse can stay focused and physically fit for a shorter shift. However, during a shorter shift, the nurse may not get adequate time to build relationship with the patient, which is an important factor of nursing care according to the nursing theory of Joyce Travelbee. (“Nursing theories: A comparison. ”, 2012).

Such a trust can come only between the patient and a nurse who is consistently treating him or her. If the nurses are going to change every eight hour, the patient may not be able to build a trust in the nurse and this might affect the care-giving process, patient satisfaction and the recovery process of the patient. In essence, nursing theory requires that the shifts should primarily benefit the patient, even if it may not be what the nurses prefer. Patient safety and patient satisfaction should be the primary focus.

Review of the Literature

In the journal ‘Clock watching: Do longer hour shifts jeopardise patient safety’ (Kendall-Raynor, 2013), the researchers deal with the advantages and disadvantages of long hour shifts as opposed to short hour shifts and their impact on patient safety. The research deals with a similar topic as that of this research. While the journal is conclusive about what is a better choice for shift policy, most of the arguments submitted are in favor of short hour shifts. However, the usual focus of those arguments is on the safety of nurses.

They also deal with the risks patients face when a nurse might become tired or sleepy towards the end of a shift. While the hypothesis and the conclusion of this research is in agreement with others- that the short hour shifts are better for patients and nurses, this research gives more focus on the patient safety and customer satisfaction. In a reference report submitted by the Georgia Nursing Association, Brown and TVinkoff quotes Scott’s statement that “Nurses working 2. 5 hours or more had twice the odds of drowsy driving and of an MVC or near miss when compared with those working 8.

5 hour shifts. There is evidence that nurses are at risk for making more errors, experiencing more needle stick and musculoskeletal injuries, drowsy driving, sleep deprivation and fatigue with longer work shifts. ” ("12-hour shifts an," 2012). In another research done among “a population based sample of 393 staff nurses covering 5,317 shifts, Rogers, Hwang, Scott, Aiken and Dinges (2004) determined that nurses working 12 hours or more reported over three times the odds of making errors versus nurses working only 8 hours or less. ” ("12-hour shifts an," 2012).

The focus of this research also was on the opinions of nurses and their safety rather than the patients. A similar study was done “in critical care areas by Scott, Rogers, Hwang and Zhang (2006) and nearly identical results were found. ” ("12-hour shifts an," 2012). The focus of this study also was based on the responses of the staff and not the patients. Most of the researchers and the author of the work reviewed here agree with the outcome of this research that short hour shifts are better when patient safety and patient satisfaction are the primary considerations for make a shift policy.

Research Outcomes

The research has found that eight hour shifts is better than twelve hour shifts in producing better patient care within a hospital setting. While asked if they would like to have a nurse taking for of them for straight 12 hours or eight hours, 282 of the 348 respondents indicated that they would not like someone to give them care for more than 8 hours in a stretch. The main reason for their comment was the fear that long hour shift might make someone tired and that it might result in nurses making errors.

The research also looked at the opinion of nurses who provide patient care in order to make sure that just is done to the receivers of care and the care-givers to arrive at a balanced opinion. The research also considered what kind of shifts facilitated more relationship and trust development between patients and family members. The research also looked at the aspect of continuity of care in different shift methods. When it came to continuity, relationship building and trust development, long hour shift was a winner.

The survey also evaluated the opinions of nurses to see how their body, mind and emotions vary in relation to the number of hours they work on a day and how long hour or short hour shift affect their patient care. Out of 42 nurses surveyed, 25 of the nurses admitted that they feel tired during the end of a long hour shift. They also expressed that, given a choice they would prefer eight hour shifts, even though that demands two days of extra work in a week. On the other hand, 17 nurses indicated that they have been used to working long hour shifts and would prefer it as they are free for the rest of the week after working three or four days.

The also indicated that working long hour shifts allows them to do PRN jobs in other hospitals. As a result of the surveys among patients and nurses, the preferred method of shifting seems to eight hour shift if patient satisfaction and patient safety is the primary considerations while making such policies. It was also indicated by some patients that the knowledge that someone gives them medical care for more than eight hours in a day scares them about the quality of care they would receive.

Research Design Experimental Design

The plan for this research was to do surveys among patients and nursing staff to get their feedback on the research subject. Two medical-surgical units were taken as samples for the research. One of the selected units is practicing eight hour shift and other one is practicing twelve hour shift. The survey was done periodically every other week for tow months. The survey questionnaires were given each patient in both units. The survey was also be done among the nurses of the two selected units by computer questionnaires and by individual interview method.

(Nieswiadomy, 2012, pg187). The data collected was entered to a spread-sheet to make a comparative analysis.

Recruitment of Subject and Sampling Technique

A comparison and differentiation of feedbacks received from patients and nurses in the sample units show that both patients and nurses have clear preferences. The responses to the questions were designed to find out what kind of shifts produced better patient care, facilitated development of relationship and trust between nurses and patients and resulted in better patient safety and satisfaction.

Another area of survey was on a floor where a change of shifts has been employed recently. The nurses were asked to respond to questions that helped the researcher to find out what kind of shift resulted in more job-satisfaction and better care-giving possibilities. This was done by comparing the current patient satisfaction rates of the unit with similar rate in the past before the change came into effect. It was found that the current job satisfaction rate of the unit was 8% more than it was before the change of shift policy became effective.

Since the research will looked at nurses and the patients’ feedbacks, the indications given should be able to help someone pick a kind of shift that will guarantee better patient care and better job satisfaction.

Analysis of Collected Data

The plan was to do surveys among patients and nursing staff to get their feedback on the research subject. Two medical-surgical units were taken as sample for the research. One of the selected units was practicing eight hour shift and the other one was practicing twelve hour shift.

The survey was done periodically every week two months. The survey questionnaires were given each patient in both units. The results of the survey show that majority of the patients would feel better to know that they would feel better to know that there giver does not work for more than eight hours in a day. The nurses also indicated that, though there are someone benefits associated with working eight hours shifts, when patient safety is in question, the short hours shift is the preferred method of shift rotation.

Interpretation of the Data

Descriptive statistics measures was used to analyze and study the collected data to see which model of staffing- twelve hour shift or eight hour shift results in better patient satisfaction. Also, the response of nurses was analyzed to see which staffing method gives them more job satisfaction and facilitates their ability to focus on patient centered care. “Description always depend on the perception, inclinations, sensitivities, and sensibilities of the describer. ” (Sandelowski, 2000, pg. 335).

The response of the patient was analyzed to see how they felt about the care they received in being treated by nurses who works eight hours and nurses who work twelve hours. The statistical interpretation was done looking at the patient satisfaction on two different units in the research sample. The interpretation considered how the patient satisfaction fluctuated depending on the length of hours nurses worked on those two units within the same hospital. The data was condensed using the frequency distribution as there was a large number of responses.

data. “In a frequency distribution, all values or scores are listed, and the number of times each one appears is recorded. ” (Nieswiadomy, 2012, pg. 205). Fair Treatment of Human Subject Ethics of nursing demands that the best possible care is given to the patient. At the same time, the care-givers also should be given humane treatment. A health care system cannot provide good patient care without well maintained staff that is healthy and happy in order to disperse the service that is demanded in their profession.

Focus on patient safety and satisfaction and the well-being of nurses are inseparable parts in health care like two sides of a coin for affecting excellent patient care that is safe and satisfactory. Conclusion The objective of this research paper was to find out whether eight our shifts or twelve hour shifts of nurses in health care systems result in better customer satisfaction. The research methods employed included patient surveys, employee surveys, research of articles books and articles, past records of patient satisfaction surveys, etc.

After considering various comments, opinions of patients and staff, arguments for and against different shifts methods, the researcher of this paper has found that the nurses prefer twelve hour shifts as it provides them more free days every week and gives longer periods of time with the patients to develop relationship and trust with the patient. However, the researcher has been convinced that short hour shifts or eight hour shifts facilitates better patient safety and reduces procedural errors from the end of the nurses. Therefore, shorter shifts or eight hour shifts is recommended for the health care system where this research was done.


(2012). 12-hour shifts an fatigue. Georgia nursing, 72(1), 7-8. Retrieved from http://web. ebscohost. com/ehost/detail? sid=7b81adf1-10ec-48c5-9284-d1d5b1f48659@sessionmgr10&vid=3&hid=10&bdata=JkF1dGhUeXBlPXVybCxjb29raWUsaXAsdWlkJnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl (2013).

Study: Long nursing shifts linked to burnout. Case management advisor, 24(3), 33-35. Retrieved from http://web. ebscohost. com/ehost/detail? sid=5dc76c19-3738-4b60-9e07-4ce552e406f0@sessionmgr10&vid=1&hid=14&bdata=JkF1dGhUeXBlPXVybCxjb29raWUsaXAsdWlkJnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl

Kendall-Raynor, P. (2013). Clockewatching: Do longer nursing shifts jeopardise patient care. Nursing standard, 27(22), 12-3. Retrieved from http://web. ebscohost. com/ehost/detail? sid=208b15c7-e273-434e-aa9f-30c202a5ac14@sessionmgr10&vid=1&hid=10&bdata=JkF1dGhUeXBlPXVybCxjb29raWUsaXAsdWlkJnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl

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Richardson, A. , Dabner, N. , & Curtis, S. (2003). Twelve-hour shift on itu: A nursing evaluation. Nursing in critical care, 8(3), 103-8. Retrieved from http://web. sid=b2177176-18e0-4b65-8968-2fccea980b0c@sessionmgr14&vid=1&hid=26&bdata=JkF1dGhUeXBlPXVybCxjb29raWUsaXAsdWlkJnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl

Sandelowski, M. (2000). Focus on research methods: Whatever happened to qualitative description?. Research in nursing & health, 23, 334-340. Retrieved from http://www. wou. edu/~mcgladm/Quantitative Methods/optional stuff/qualitative description. pdf

Updated: Nov 20, 2023
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Shift Length: Patient Safety and Nurse Satisfaction. (2016, Jul 30). Retrieved from

Shift Length: Patient Safety and Nurse Satisfaction essay
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