Pros and Cons of 12-Hour Nursing Shifts
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- The 12-hour shift is one of the most common shift lengths for hospital-based nurses.
- One advantage of 12-hour shifts is the flexibility to work three days a week with four days off.
- A major disadvantage of 12-hour shifts is that few of those shifts actually last only 12 hours.
Is the 12-hour shift really worth it, and is it even healthy for nurses to work for so many hours straight? Find out what a typical nurse’s schedule looks like, the advantages and disadvantages of the 12-hour shift model, and tips for nurses on this schedule.
What is a Typical Nurse's Schedule?
In the hospital setting, the typical nurse’s schedule is either 7am to 7pm or 7pm to 7am. This 12-hour nursing shift model is common in facilities that care for patients 24 hours a day. Each week, nurses with this schedule work three days and have four days off.
In some cases, nurses may work three consecutive 12 hour shift days, but this practice is generally discouraged as it can impact staffing ratios and may lead to burnout. Typically, nurses work two days in row, take 1-2 days off, and then work a third day.
While some facilities may have a three-shift-per-day model (i.e., 7am-3pm, 3pm-11pm, and 11pm-7am), this is increasingly rare in hospitals since they provide continuous patient care. In practice settings where nurses are less likely to work 12-hour shifts, schedules may look like this:
- Outpatient surgery nurses: Four 10-hour shifts per week is a common schedule for nurses in outpatient settings.
- Ambulatory care nurses: In clinics, community health centers, and medical offices, nurses will often work 8-hour shifts, perhaps 8am to 5pm, with an hour for lunch.
- Nurse managers and case managers: Case managers and nurse managers in acute care will often work 8am to 4pm or 8am to 5pm. Case managers in the outpatient setting will likely follow a similar schedule.
- Home health and hospice nurses: Nurses in home health and hospice may work 8am to 4pm or 5pm. Some nurses may perhaps begin work in the early afternoon (e.g.: 1pm to 9pm) if the agency has a second shift that goes later into the evening to accommodate more patients. Weekend shifts are also common.
- Nurse educators: Nurse educators typically work Monday-Friday, 8am to 5pm.
- Advanced practice registered nurses (APRNs): If working in primary care, APRNS can expect to work 8am to 5pm, although they may have unpaid hours of charting.
Advantages of Working 12-Hour Shifts
Every work schedule type has its own advantages and disadvantages. Hospitals follow the 12-hour shift model for various reasons, including providing round-the-clock care. Depending on their employer, nurses may or may not have much of a choice when it comes to their schedule. But, working three 12-hour shifts has several advantages, including fewer patient handoffs, greater flexibility, and less commuting time.
Fewer Patient Handoffs
When a facility has 12-hour nursing shifts, the number of patient handoffs is less than a facility with 8-hour nursing shifts. During a patient handoff report at the change of shift, crucial patient data is communicated from the outgoing nurse to the incoming nurse, and this transfer of data, both objective and subjective, is central to continuity of patient care and positive medical outcomes. According to The Joint Commission's 2017 report, the average teaching hospital experiences 4,000 handoffs per day. Failures in communication were a culprit in 30% of all malpractice claims, resulting in over 1,700 deaths. Handoffs are a core aspect of high-quality care, and limiting their number reduces patient mortality rates.
The flexibility of working three days followed by four days may offer nurses better work-life balance. Nurses can use this time to tend to their own personal needs, such as attending doctor’s appointments, home maintenance, banking, and caring for family members. Working three days a week also allows for more flexibility in terms of travel, pursuing advanced education, being involved in children’s schools, or volunteering.
Many RNs with young children may also choose to work night shifts as it lessens the burden of childcare. This can allow some households to split parenting responsibilities. Night shifts also typically pay 5% more in shift differentials than day shifts.
Less Time Spent Commuting
Commuting to work can quickly add up in a week. The average commute time ranges from 24.5-31.2 minutes each way, according to a Center for Health Workforce Studies 2020 report.
A nurse working three 12-hour shifts per week will spend significantly less time commuting than a nurse working four or five shifts. Aside from the time spent traveling to and from the workplace, the cumulative cost of gas is also less.
Disadvantages of Working 12-Hour Shifts
While there are obvious advantages of working 12-hour nurse shifts, there are certainly disadvantages to this type of schedule. Nurses must evaluate for themselves what type of schedule they prefer and which workplaces offer the best arrangement for their personal needs.
Short-Term and Long-Term Health Risks
There are clearly documented health risks associated with 12-hour shifts (especially 7pm to 7am). Shift Work Sleep Disorder (SWSD) impacts a considerable number of workers with nontraditional schedules and can result in difficulty with getting to sleep, staying asleep, or sleeping when the individual wants or needs to.
SWSD can lead to cardiovascular and other complications, as well as accidents, work-based errors, and unstable mood. Night-shift workers have considerably lower levels of serotonin, according to the American Academy of Sleep Medicine.
Nurses may also find it challenging to eat and hydrate themselves during a 12-hour shift. Some hospitals may only provide nurses with a 30-minute unpaid lunch. This in combination with the ramifications of frequent fatigue, a higher risk of burnout, and the physical exertion of 12-hour shifts can take a toll over time.
12-Hour Shifts Rarely Last Only 12 Hours
In reality, 12-hour shifts rarely last only 12 hours, and long hours can contribute to the feeling of burnout.
For instance, during a 12-hour nursing shift, a nurse arrives at 6:30 or 6:45 am for their shift. At 7am they’ll clock in and receive a handoff report from an exhausted nurse who has been on duty for the previous 12 hours. Unfortunately for that exhausted nurse, catching up on charting may cause their 12-hour shift to stretch into 13 or more hours (even though they’re only paid for their scheduled 12). Meanwhile, the nurse who arrived at 6:30am for their 7am shift will likely work well beyond 7pm for the same reason — giving a change of shift report to the oncoming nurse and then catching up on charting before leaving for the night.
Increased Potential For Error
Patient safety is an ongoing concern in healthcare, which brings up questions about whether nurses really should work 12-hour shifts. If nurses’ health suffers from these long shifts and their ability to focus is decreased, the increased potential for error is a factor that requires attention. If nurse burnout indeed leads to a feeling of cynicism and negativity about one’s job, a burned out nurse may be more likely to make errors. Nurse fatigue, insufficient sleep, and long hours put patient well-being at risk, according to the National Library of Medicine. Researchers found a 3.4% chance of an error when nurses received six or fewer hours of sleep in the previous 24 hours and 12 or fewer hours of sleep in the previous 48 hours. This translates to 34 incidents per day in a teaching hospital with 1,000 shifts per day.
Resources for Nurses Working 12-Hour Shifts
Coping with long nursing shifts involves using strategies to mitigate negative effects. While finding a new job in a different setting with a better schedule is sometimes an option, this isn’t always possible for a variety of reasons. Nurses may want to employ positive coping methods to decrease the negative impact of long shift work. Striving to improve the quality of your sleep is a good place to start, and eating well certainly can’t hurt. Fatigue has shown to increase risk of making medical errors. If you want to maintain good relationships, have time with your family, and not suffer long-term health consequences of nontraditional shift work, there are several small steps you can take for a better quality of life and a happier nursing career.
Resources for Nurses Working 12-Hour Shifts
- Dahal, Arati, et al. (2020). What Commute Patterns Can Tell Us About the
- Supply of Allied Health Workers and Registered Nurses. Center for Health and Workforce Studies, University of Washington
- Journal SLEEP: Rotating Shift Workers Have Lower Levels of Serotonin (2007). American Academy of Sleep Medicine
- Rogers, Ann E. (2008). The Effects of Fatigue and Sleepiness on Nurse Performance and Patient Safety. National Library of Medicine
- Seminal event alert: Inadequate hand-off communication (2017). The Joint Commision
Page last reviewed on February 11, 2023
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