The Nursing Issue to be Presented - Research Paper

Introduction

The issue presented here is on the effects of 12-hour shift where the position taken is that these shifts are more detrimental than beneficial to the patients, staff and healthcare organizations. In the recent past, the number of hours that nurses work in a medical institution has been changing with more hospitals now implementing longer 12-hour shifts for a fewer number of days per week. Nonetheless, in as much as some nurses may prefer this mode of working going by the perception that it boosts their work-life balance, others opt for shorter shifts, such as the 8-hour shift, but for more days per week. In addition to the welfare of the nurses, the working mode chosen will definitely have a bearing on patient outcomes. This paper focuses on the potential adverse outcomes and risks associated with 12-hour shifts that need to be considered cautiously and mitigated against.

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The Public Perception of this Issue

Ball, Dall'Ora and Griffiths (2015) acknowledge that, in recent years, there has been a pattern where some healthcare facilities are adopting longer working shifts. The 12-hour shift is one of these new approaches that these facilities or hospitals are employing with the aim of enhancing productivity. The overall perception toward the 12-hour shift is that it increases the effectiveness of the nurses and other employees owing to a supposed reduction in overlap between shifts and fewer handovers. Besides, there is also a perceived improvement in the work-life balance for the nurses by compressing their work into fewer days for every week. All in all, this issue has been subject to divergent opinions with some nurses voicing their support for this working system while others did not support it (Griffiths et al., 2014).

Dall'Ora, Ball, Recio-Saucedo and Griffiths (2016) point out an exploratory study that aimed at assessing the perceptions of nurses in a healthcare unit after the implementation of 12-hour working shifts. Contrary to the stance taken in this presentation that these shifts are detrimental to the nurses' well-being, half of the participants of this study reported no perceived changes in the quality of nursing care that they delivered. The other half agreed that their service delivery had actually improved. However, these perceptions cannot be generalized since the study was conducted at a point in time, 3months into the implementation of the new shift pattern.

Why the Above Perception is a Concern for the Nursing Profession

In spite of the perception that the 12-hour shift ameliorates the efficiency of nurses and improves their work-life balance, imposing this compressed work schedule raises concerns, especially among nurses, when it starts taking the toll on them. The above perceptions are not supported by evidence-based studies. Amendola et al., (2011) purport that in another case, nurses on 12-hour shifts recounted negative perceptions about the value of this compressed work week schedule. Their perceptions included guilt feelings arising from the need to spend some time away from the patients, the inability to keep a routine exercise schedule and not having enough time to socialize with friends and family.

Manderscheid (2008) argues that fatigue is a significant concern in the workplace. One of the factors that contribute to fatigue is work-related. Extended shifts and long working hours play a crucial role in intensifying the levels of work-induced fatigue. As such, nurses who adopt the 12-hour shifts have a higher probability of feeling fatigued compared to those in 8-hour shifts. Additionally, the 12-hour shifts result in interrupted diurnal rhythms and sleep deprivation. Ultimately, nurses who work in the 12-hour shifts will have an inadequate amount of time to recover and slower reaction time from the high fatigue levels.

To support the above claim, Belenky et al., (2003) studied the patterns of the performance of 66 volunteers who were partially sleep deprived for 7nights. The results indicated a degradation of the psychomotor vigilance performance during waking time. This degradation is due to an increase in musculoskeletal disorders and a diminishment in motor skills. Moreover, Thompson, Matt, Victoria and Chibuzo (2016) explored the effect of a demanding work schedule on the reaction time of nurses. The study participants, who were nurses, were required to work for 3 12-hour shifts within 4 days after which they were given questionnaires to identify musculoskeletal disorders or injuries of the back, shoulders and neck. Balance and reaction time tests were also carried out before and after the work period. The outcomes showed errors in balance performance and reaction time tasks as well as a diminishment in the reaction time. Also, the occurrence of musculoskeletal disorders was higher at the end of the work period.

One of the properties of a powerful nursing practice is in the recognition that nurses play a unique role in the provision of family and patient-centered care (Ponte et al., 2007). In this line, the power of nurses is enhanced by concentrating on patients and families as well as bolstering the outcomes of patient-centered care. Working for 12-hours shifts diminishes this power going by the premise that such a highly-demanding work schedule immensely contributes to nurses becoming burned out, which jeopardize their ability to provide top-notch patient care services. Griffiths et al., (2014) stipulate that part of the costs that nurses are paying for the provision of health services through burnout due to working for long hours and unpaid overtimes lead to poor delivery of safe and quality care to their patients. This creates an ethical issue in the nursing profession since they will not be giving their patients the level of care that they deserve.

"What is good for the patients and families is good for nursing practice" (Ponte et al., 2007: par 26). This comment by one nurse leader shows one attribute of a powerful nursing practice where the duties of nurses have a strong link with patients' well-being and outcomes. However, with the implementation of 12-hour work shifts, this attribute is greatly compromised. Nurses are unable to give their best care to the patients and families owing to the attrition caused by this demanding work schedule. Nurses are among the chief priorities of healthcare institutions. However, in light of the stress associated with the 12-hour shift, they cannot be able to satisfactorily advocate for quality healthcare from the families' and patients' perspective.

Similarly, Dall'Ora et al., (2015) studied the connection between 12-hour shifts and burnout among nurses and found out a positive correlation whereby these shifts are linked to more reports of burnout among nurses. This study quantified work-related burnout using the Maslach Burnout Inventory (MBI), which incorporates three subscales namely: personal accomplishment, depersonalization and emotional exhaustion. Burnout is denoted by high scores on depersonalization and emotional exhaustion, which are 13 and 27 respectively and low scores on personal accomplishment, which is 31. The findings indicated a connection between 12-hour shifts and the three subscales. Nurses may show a preference toward three 12-hour work shifts per week but it takes a toll on their psychological well-being. Such nurses provide a poor quality of healthcare and are at a greater risk of committing medical faults thereby compromising the properties of a powerful nursing practice.

Apart from burnout, 12-hour shifts are also associated with job dissatisfaction. Dall'Ora et al., (2015) state that working shifts longer than 8hours negatively affect job satisfaction among nurses despite the perception that nurses who work in the 12-hour shift are more contented with their jobs. Results of the study of the association between 12-hour shifts and job satisfaction showed that the likelihood of nurses reporting job dissatisfaction was higher among nurses working in shifts or longer than 8hours. Additionally, the chances of nurses working in shifts of 12hours and more reporting job dissatisfaction rose by 40% compared to those working in 8-hour shifts. When the level of job dissatisfaction is high among the nurses, most of them will ultimately show intent to leave. A lack of flexibility in the 12-hour work schedule further adds onto the cause of job dissatisfaction.

Those nurses who opt to sacrifice job satisfaction with the perception that they will gain from other areas of life are likely to suffer from a deteriorated mental and physical well-being. The stressful schedule that comes with long working hours and the recovery time will possibly offset any supposed benefit (Dall'Ora et al., 2015). Besides, the inflexible work schedule that characterizes the 12-hour shift and job dissatisfaction will have a negative bearing on patient outcomes. Wong (2015) purports that nurses who work in 12-hour shifts or more have a higher chance of leaving more patient care duties undone, will find it difficult to guarantee patient safety and show a dismal performance with regards to the overall quality of healthcare that they provide.

To further demonstrate the effect of 12-hour shifts on patient outcomes and safety, Ball et al., (2015) reviewed the employment surveys done by the Royal College of Nursing, published literature and an analysis of nurses in an arbitrary sample of hospitals in the UK. Reviews of these three sources relate to the nurses' work shift trends. These sources were searched in various databases such as ASSIA, Web of Science and CINAHL with a total of 205 relevant papers identified. Out of the 205 papers, 11 of them discussed the impact of 12-hour shifts on patient outcomes that mainly included their experiences, injuries inflicted on them by nurses, medication errors and the overall quality of care. One of the studies reviewed had hypothesized that the level of patient care provided by nurses working in the 12-hour shift would be higher than that provided by those working in the 8-hour shift. However, the outcomes nullified this hypothesis as it was observed that patients received a higher quality of care from nurses in the 8-hour shift. Also, during the last two hours of each shift, nurses working in the 12-hour shift provided poorer quality of patient care further validating the study results indicated earlier that the 12-hour shift nurses had a higher chance of feeling fatigued as their shifts came to an end.

Finally, with regards to patient safety, the attrition and burnout associated with 12-hour shifts increased the likelihood of nurses making errors (Ball et al., 2015). Furthermore, the occurrence of injuries inflicted on patients by nurses was higher for those who worked for more than 8hours per day. Similarly, for the needle stick injuries sustained by US Nurses, the probability of these injuries increased among nurses working in 12-hour shifts or longer. Another paper reviewed by Ball et al., (2015) examined the impact of work shifts on mortality rates, specifically those caused by stroke, heart failure and pneumonia. The results revealed that long shifts (12-hour and above) contributed immensely to an increase in mortality rates with more deaths being reported as a result of pneumonia. All these findings reveal the adverse effect that 12-hour shifts have on patient outcomes and safety. Combined with the issues stated earlier about the connection between 12-hour shifts and an increased fatigue, reduced recovery time, slower reaction time, burnout, attrition and job dissatisfaction, one can confidently conclude that the detrimental effect of such long working hours counterbalances and, perhaps, outweighs any perceived benefits. Ther...