Nurse Fatigue and Shift Length: A Pilot Study

Deborah Maust Martin, DNP, MBA, RN, NE-BC, FACHE


Nurs Econ. 2015;33(2):81-87. 

In This Article


Increasing emphasis on patient quality and concerns about the impact of health care worker fatigue has stimulated efforts for leaders to address patient quality and caregiver satisfaction. At a hospital in a large metropolitan area in the southwestern United States, the chief nursing officer (CNO) and the progressive care nurse director indicated a willingness to examine shift length. The nurse director managed progressive care units where the nurses assigned to these units are scheduled 12-hour shifts with no other shift length options. The CNO and the nursing director were interested in a pilot project to explore if there are differences in fatigue levels when the nurses voluntarily change from 12-hour shifts to 8-hour shifts.

In 2011, the Joint Commission issued a Sentinel Event Alert to call attention to health care worker fatigue as it relates to patient safety, noting a link between health care worker fatigue and adverse events. In addition to patient safety concerns, there is an increased risk of injury in fatigued health care workers. Rogers, Hwang, Scott, Aiken, and Dinges (2004) recommended the "routine use of twelve-hour shifts should be curtailed" (p. 210).

An extensive review of the literature revealed 35 studies related to nurse fatigue and shift length that were included in this project. The literature review indicated shift length is associated with nurse fatigue and is a growing concern in the United States with the routine shift length of 12 hours. The dependent variables were consistent in describing outcomes correlated with shift length, and related to either the nurse or patient. Factors related to patients were errors and near errors, and for the nurse, factors included physical and mental fatigue, need for recovery between shifts, injury to self, and job satisfaction.

Fatigue is correlated to nurse performance and chronic fatigue is related to the number of hours worked (Barker & Nussbaum, 2011). Longer work hours increase risk for errors and decrease nurse vigilance (Scott, Rogers, Hwang, & Zhang, 2006). There is also evidence nurses who work consecutive 12-hour shifts do not recover between shifts (Geiger-Brown et al., 2012).

Nurses who work long shifts are more likely to be burned out, dissatisfied with their job, and intend to leave their job within a year (Stimpfel, Lake, Barton, Gorman, & Aiken, 2013; Stimpfel et al., 2012), even though the authors also reported 80% of these nurses reported being very satisfied with working 12-hour shifts (Stimpfel et al., 2012).

Extended work hours were a contributing factor in needlestick injuries among nurses (Trinkoff, Le, Geiger-Brown, & Lipscomb, 2007). In a study exploring the variables associated with worker injury, those working 12-hour shifts had a higher medical cost per injury than those who worked 8-hour shifts (Brown & Thomas, 2003). Nurses driving while drowsy can contribute to accidents (Scott et al., 2006), a cost to both property and people.