We previously reviewed the available literature on the impact of 12-hour shifts for nursing (see our November 9, 2010 Patient Safety Tip of the Week “”) and concluded the literature to date really did not answer the question as to whether those shifts had a detrimental impact on patient outcomes.
Now a new study (Trinkoff 2011) has attempted to correlate patient outcomes with the duration of the nursing shift. The authors retrospectively looked at a number of AHRQ Quality Indicators at hospitals in two states where they had data on nursing shifts. They also analyzed survey responses from nurses working at those facilities. Indeed, they found that a number of undesirable outcomes, including mortality for select conditions like pneumonia, were higher in those hospitals where nurses reporting the longer shifts. Just as significant was the association between such undesirable outcomes and nurses’ lack of time off. This is very good work and adds to our increasing concerns about the 12-hour shift.
However, the question is still not resolved. The problem with almost all research to date on the issue is that there are too many confounding variables in retrospective studies. If we are asking the question “Are patient outcomes better with 8-hour work shifts better than with 12-hour work shifts?” we need to control for other factors such as time off and whether nurses are working the same shift each day or rotating shifts. The only way we are going to be able to answer that question is to do a randomized controlled trial where the only variable changing is the duration of the individual shift. It would require a well-designed study with hard outcome parameters done in a setting where a legitimate control group can be used (for example, implementing 12-hour shifts on one or several med/surg floors where the other comparable floors maintain their current 8-hour shifts). That will be a difficult study to actually carry out. But the time has come to get those critical answers.
Update: See our November 13, 3012 Patient Safety Tip of the Week “The 12-Hour Nursing Shift: More Downsides” and our July 29, 2014 Patient Safety Tip of the Week “The 12-Hour Nursing Shift: Debate Continues” and our October 2014 What’s New in the Patient Safety World column “Another Rap on the 12-Hour Nursing Shift”.
Trinkoff AM, Johantgen M, Storr C, et al. Nurses' Work Schedule Characteristics, Nurse Staffing, and Patient Mortality. Nursing Research 2011; 60: 1-8