The Pros (and Cons) of the 12-Hour Shift in Nursing

BY MICHELE WOJCIECHOWSKI

For about 50 years, one thing has remained the same in the nursing field: the 12-hour shift—at least in hospitals and medical centers. The typical work week for these nurses is 7:00-7:00, either a.m. or p.m., for a total of 36 hours a week.

But is it the best type of schedule to be working?

“This approach to scheduling nurses started in the 1970s to address staffing challenges and caught on with health care systems, as it enabled easier scheduling practices when each nurse needed fewer shifts per week,” explains Kathryn Kay, DNP, RN, PCCN-K, Vice President, Academics at Emeritus Healthcare. “The longer shift also provides greater continuity in care, fewer hand-off reports, and supports the primary nursing care model that has been around for decades.”

There are lots of benefits to this 3-days-on, 4-days-off schedule. “Having the extra days off allows for shopping during the week to avoid crowds, attending doctors’ appointments, or taking your children to theirs,” says Elizabeth Cantu, RN, BSN, who works at Float Healthcare and is a Certified Transformation Coach at Invida Coaching LLC who works with nursing suffering from burnout. She says some other benefits are making time for a hobby or side hustle

“The longer shift also provides greater continuity in care, fewer handoff reports, and supports the primary nursing care model that has been around for decades.”

or having the time to pursue higher-level education.

“The importance of worklife balance with bedside

“The importance of worklife balance with bedside nurses is a major draw to this type of scheduling practice,” says Kay.

nurses is a major draw to this type of scheduling practice,” says Kay.

That said, there are cons to the 12-hour shift as well. For example, while the shift is technically 12 hours, Cantu says that it’s often closer to 15-16 hours. “The cons can include prolonged exposure to stress, an empty self-care tank at the end of the day, disconnection from family and friends, and the time spent away from the home, with drive time, can be longer than a typical 40-hour week. Long, fast-paced shifts keep you in high-stress mode, making it more difficult to close the stress cycle after a long day,” Cantu says.

Research has shown that these longer shifts can be harmful not only to nurse, but also to their patients. “Evidence has demonstrated that while nurses prefer to work twelve-hour shifts because of perceived work-life balance, those working that schedule are more likely to experience burnout than those working shorter shifts. Evidence also demonstrates that the further out the shift gets from eighthours, the greater the risk for a patient safety event. Overall, longer-shifts are demonstrating a cumulative negative impact on nurses’ well-being,” says Kay.

As for patients, studies show how they can be affected negatively as well. “There is an overwhelming amount of evidence that demonstrates that nurses and providers are at greater risk of a patient safety errors after the first eight hours of their shift. Sentinel Event Alert 48: Healthcare Worker Fatigue and Patient Safety particularly calls this out,” Kay says.

Maile Mercer, MSN, RN, CCRN, a PhD Student at NYU Rory Meyers College of Nursing, shares more evidence that long shifts aren’t good for nurses or patients. She explains, “While at work, nurses often run nonstop through their shifts, skipping meals and even bathroom breaks. University of Pennsylvania researchers found that longer shifts can lead to burnout and job dissatisfaction and can push some to leave the profession altogether. Long shifts can also lead to health problems that reverberate across nurses’ lives, including fatigue, injury, cigarette smoking, increased alcohol use, sleep deprivation, and episodes of drowsy driving.”

Research has shown that these longer shifts can be harmful not only to nurse, but also to their patients.

“Some of the issues related to 12-hour shifts may spill over to patients as well. Evidence suggests that nurses are more likely to make mistakes when they are nearing the end of a long work shift. One study led by researchers at the University of Pennsylvania found that hospital nurses were three times more likely to make an error when their shifts exceeded 12.5 hours,” says Mercer. “There are other professions—pilots and truck drivers, for example—that have limited consecutive work hours for safety reasons. This may be worth considering

But the problem that arises is: if nurses weren’t working 12-hour shifts, how many hours should they work?

for the nursing profession as well.”

But the problem that arises is: if nurses weren’t working 12-hour shifts, how many hours should they work? “Eight to nine hours per shift seems to be a consistent theme in the literature as not impacting nursing or patient well-being. However, I would challenge we should still explore alternate and more creative staffing approaches that promote the work-life balance the nursing profession looks for with their scheduling,” says Kay. “Promoting technology that allows for creative scheduling practices is one way to explore alternative ideas to the traditional twelvehour scheduling practice we have come so accustomed to. Staffing shortages are going to be around for the next several years, and we need long-term and short-term approaches

to solving this challenge. Valuing nurses’ desire for scheduling flexibility and work-life balance should be at the forefront of nursing and health care leaders’ strategic plan in recruiting and retaining a high performing team.”

Michele Wojciechowski is a national award-winning freelance writer based in Baltimore, Maryland. She loves writing about the nursing field but comes close to fainting when she actually sees blood. She’s also author of the humor book, Next Time I Move, They’ll Carry Me Out in a Box.