Nurses and Patients Both Suffer From Longer Nursing Shifts

Troy Brown

November 08, 2012

When nurses worked longer shifts, they were more likely to report higher levels of burnout, job dissatisfaction, and intention to leave the job, according to data from 22,275 registered nurses in the Multi-State Nursing Care and Patient Safety Study. Moreover, analysis of a second survey showed that when the proportion of nurses working long shifts was higher, patients were more likely to report higher levels of dissatisfaction with their care.

Amy Witkoski Stimpfel, PhD, a research fellow at the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing in Philadelphia, and colleagues published their results in the November issue of Health Affairs.

"Despite regulations on shift length and cumulative working hours for resident physicians and people in other industries, there are no national work-hour policies for registered nurses," the authors write.

The nurses in this study worked in 577 hospitals in California, New Jersey, Pennsylvania, and Florida. Most of the nurses (65%) worked shifts that were 12 to 13 hours long, 26% worked shifts that were 8 to 9 hours long, and the rest worked shifts that were either 10 to 11 hours long or more than 13 hours. Most nurses (>80%) across all shift length groups were happy with scheduling practices at their hospital.

However, as shift length increased, the percentage of nurses reporting burnout, job dissatisfaction, or intention to quit their job increased incrementally in multivariate analyses adjusted for age, sex, nurse staffing, size of hospital, and other hospital characteristics.

Compared with nurses working 8- to 9-hour shifts, nurses who worked 10 or more hours were up to 2.7 times more likely to report burnout, up to 2.4 times more likely to report job dissatisfaction, and up to 2.8 times more likely to report an intention to leave their job within a year.

Interestingly, nurses working 12 to 13 hours were more similar to those working 8 to 9 hours than to those working 10- to 11-hour shifts and those working more than 13 hours.

Patient Satisfaction

Shift length also was significantly associated with patient satisfaction when measured by the Hospital Consumer Assessment of Healthcare Providers and Systems survey. For this analysis, the researchers used fully adjusted linear regression models to analyze data from a subset of nurses (n = 16,241) and hospitals (n = 396), with an average of 41 nurses per hospital that completed the survey.

Increases in the proportion of nurses working shifts longer than 13 hours adversely affected 7 of 10 patient outcomes, including whether or not nurses communicated well, whether pain was controlled, and whether the patient received help as soon as he or she wanted it. Longer shifts also negatively affected patients' overall rating of the hospital and whether or not they would recommend the hospital to others.

When hospitals had higher proportions of nurses working shifts shorter than 12 hours, patients were more likely to be satisfied with their care compared with hospitals with shifts that were 12 hours or longer.

"[W]e found that the longer the shift, the greater the likelihood of adverse nurse outcomes such as burnout. Patients were less satisfied with their care when there were higher proportions of nurses working shifts of thirteen or more hours and were more satisfied when there were higher proportions of nurses working eleven or fewer hours," the authors write.

This research was supported by grants from the National Institute of Nursing Research and the National Institute for Occupational Safety and Health.

Health Aff. 2012;31:2501-2509. Abstract