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


The pilot project has stimulated discussion at the hospital level among nurses, nursing support staff, and ancillary staff. The CNO supported the plan of the nursing leadership to post 8-hour positions for hiring when vacancies occur given the significant evidence in the literature. A 0.8 fulltime equivalent (FTE), or 32 hours per week, may be more appealing to nurses than working 5 days per week. This would have them work 1 more day per week, or 2 per pay period, versus 3 per pay period with the 0.9 FTE used in this pilot. At this health care system, a 0.8 FTE is eligible for full-time benefits, also appealing to nurses.

One of the next steps includes a plan to conduct focus groups to explore why nurses want 8-hour shifts and why they want 12-hour shifts, as well as why they would not want these shifts. This would be done with the nine participants in this project for preliminary information. In addition, a study that would build on this project would be appropriate to determine outcomes from a study that is powered appropriately.

Lessons learned from this experience include (a) nurses are agreeable to try a proposed change, (b) numerous ideas should be tried to develop additional innovative solutions to the issue of nurse fatigue, and (c) nurses may not want to work 5 days per week. As evidenced in the literature, change management principles include involving those impacted by the change to increase their buy-in. The nurses in this pilot were able to develop their schedule among the team of three nurses. This gave them a sense of control in that they determined and agreed to their days off as well as weekends to work. The issue of nurse fatigue is complex and there will need to be multiple innovations designed to address the many facets of the contributing factors. Shift length is but one variable in the mix. The literature addresses areas of opportunity to explore as well. Anecdotally, nurses indicated they do not want to be in the work environment 5 days a week as it makes them feel as if they are "always at work." This has implications not only for addressing nurse fatigue, but also for the future nurse leader role as traditionally those in leadership are expected to work 5 days per week.