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Long hours linked to patient deaths

 A study published in the January/February issue of Nursing Research links patient deaths with a lack of time off for nurses.

The study, “Nurses’ Work Schedule Characteristics, Nurse Staff and Patient Mortality,” examined the relationship between patient mortality and nurses’ work schedules. The researchers controlled for staffing levels (long known to be a factor in patient mortality) and found that longer shifts and lack of time off were independently associated with increased risk of patient death. Pneumonia deaths were more likely in hospitals where nurses reported long work hours. Death from abdominal aortic aneurysm was more likely when nurses reported a lack of time off of work. Congestive heart failure deaths appeared associated with nurses working while sick and heart attack deaths were positively related to what the researchers termed “weekly burden,” the number of hours per week or days in a row.

While previous studies (and nurses themselves) have linked nurses’ lack of sleep with poor patient outcomes, the current study suggests that 12-hour shifts or 7-on, 7-off schedules may not be the best for patients. The study also seems to emphasize the importance of time away from work for nurses.

In a previous series of articles, “Is It Time to Pull the Plug on 12-Hour Shifts?”, published in The Journal of Nursing Adminstration, study author Alison Trinkoff suggests a series of stategies to help minimize the risk of long shifts. Nurses’ time off must be maximized and protected, Trinkoff says. She recommends:

  • No overtime for 12-hour nurses
  • On-time departure. Leaving work on-time should be a guarantee, not an every-now-and-then thing.
  • On-the-job napping. Nurses who work 12-hour-shifts, especially night nurses, should be allowed short, 15-20 minute naps to refresh.
  • Real breaks. Nurses’ breaks should be sacrosanct and uninterrupted.

What do you think of the study? Do nurses need adequate time off to competently care of patients, or are 12-hour-and-beyond shifts no big deal?


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Jennifer Fink, RN, BSN

Jennifer is a professional freelance writer with over eight years experience as a hospital nurse. She has clinical experience in adult health, including med-surg, geriatrics and transplant; she also has a particular interest in women’s health and cancer care. Jennifer has written a variety of health and parenting articles for national publications.

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4 Responses to Long hours linked to patient deaths

  1. jose lebron

    This just confirms what we already know. Maybe people will start to listen now.

  2. Jeffrey Bodurka

    Hmm let’s break down those ‘recommendations’.
    1. No OT for 12 hour nurses- like hospitals worried about their bottom line will hire more nurses. Saying they can add more per-diem nurses and part-timers isn’t a solution either as this doesn’t do a thing for nursing grads who lack the experience necessary for those positions.
    2. On time departure- guarantee? HA! Patient loads continue to increase as well as the paperwork. Unless they come up with safe staffing ratio’s and hire more nurses, the odds of us getting out on time will continue to be nothing but a farce.
    3. On the job napping- well, umm, some do it already but for me, I’ll pass. It would only serve to make me more drowsy.
    4. Real breaks- the only way that real breaks will ever be ‘sacrosanct and uninterrupted’ is if they could implement what I stated early, hire more nurses and go with safe patient to RN ratios. When a nurse already has a full load of patients, it’s next to impossible to add more to that load by having them cover while one goes on a break.

    These recommendations are nothing new and definitely no surprise. We RN’s are only going to continue to take it on the chin until safe patient to nurse ratio’s are implemented, period. I would be extremely upset if I wound up going to an 8 hour shift that’s for sure. I enjoy only working 12 hours and if changed to an 8 hour shift it would basically mean I’m spending 10-11 hours a day between commuting (2 hours round trip for me) and working 5 days a week for a total of 50-55 hours instead of 3 days a week (4 once a month) which comes out to 52-55 hours a week but with longer extended periods of off time.

  3. Paula Johnson

    Just worked 3 12’s in a row; one day off and 2 12’s. Lost a whole week of my life. I think if we work 12 hour shifts it would be easier if they were grouped together so you actually have a day off that is not spent sleeping. As for break-what are those? Normal is 12 1/2 hours with NO break. I’ve only been an RN for 1 1/2 years – 46 years old and already feeling the burnout.

  4. T. Alloway

    As an experienced RN who works two12 hr night shifts per week by choice, would quit if forced to go back to 8 hr shifts. The paperwork is the same for an 8 hr shift as for a 12 hr shift. You therefor have more time to spend with your patients on a 12 hr shift.

    What I am finding is that many of the new nurses are there to visit and joke around, NOT for patient care,
    It occasionally scares me that many of the younger nurses do not have the appropriate attitude nor do they seem to care about the patients under thair care.
    That more than the hours worked, to me, is the reason for some of the patient deaths mentioned in the above article.

    I have seen nurses chat socially for literally hours, at the desk, without ever going in their pts rooms to check on them.

    The requirements to get into nursing school should never have been changed to a lottery system. It takes
    someone with a caring, giving personality to be willing to commit themselves to their patients while on duty, Not someone who heard that nurses make a good wage and are there only for the pay check, or just want to socalize, Some are only in nursing to find a doctor for marry, (I have seen marriages broken up by some young nurses willing to flirt, and whatever else it took, to get an MD to leave his wife for her.)

    Yes ther are still many dedicated nurses still working, and some new grads who will grow into excellent nurses, we can only hope that the rest of them find other jobs in the field where a persons life will not depend on their watchfulness,