More on Nurses Hours
I wrote this for Nurses Week for the Progressive Media Project. It’s an oped service that goes out to a number of newspapers nationwide.
Celebrate Nurses Week by not overworking them
By Suzanne Gordon, May 6, 2013
National Nurses Week is from May 6 to May 12, and we should honor the work that nurses do, and insist that they get their long hours reduced.
The hours worked by registered nurses (RNs) – the largestt profession in health care – have actually increased over the past several decades.
The average hospital nurse now works a 12-hour shift. Studies on nursing hours have documented that most nurses do not leave after 12 hours but actually work 13 or 14 hours. (In some hospitals, nurses are required to work mandatory overtime, which could mean another eight to 12 hours at work.) When combined with commute times, nurses may be spending 16 or even 17 hours at work and getting to work. This significantly limits the time they have to rest between shifts.
To make matters worse, there are no regulations limiting the amount of back-to-back 12-plus-hour shifts a RN works. As a result, many RNs suffer from chronic sleep deprivation.
Nursing unions have been adamant that banning mandatory overtime is critical, since working extra hours is unsafe to both nurses and patients. The Massachusetts NursesAssociation, for instance, has successfully lobbied for legislation banning mandatory overtime in the Commonwealth.
But bans on mandatory overtime, while certainly necessary, do not address the safety issues inherent in 12-plus-hour shifts. Errors that lead to patient harm increase after eight hours and rise dramatically after 12 hours, particularly when a nurse suffers from chronic sleep deprivation.
Plus, the harm to nurses themselves is significant. Fatigue increases the chance of a needlestick injury, makes concentration on complex tasks more difficult, and creates the kind of irritability that makes it hard for RNs to be empathic or function effectively. What’s more, numerous nurses suffer from injuries sustained
while driving home when fatigued.
Ideally, nurses should go back to the eight-hour shift that so many working people fought for over the last 150 years. Until that happens, 12-hour shifts should be banned at least for those working in critical care area – intensive care units, emergency rooms, and laabor and delivery.
Similarly, working more than three back-to-back 12-hour shifts should not be permitted.
Airline pilots aren’t allowed to fly for more than eight hours, and truck drivers aren’t allowed to drive for more than 11. Both professions have minimum rest periods between their shifts.
So how can we countenance 12-plus hour shifts for the RNs upon whose skill, alertness and judgment so many patients’ lives depend?
(Journalist Suzanne Gordon’s latest book health care or nursing is Beyond the Checklist: What Else Health Care Can Learn from Aviation Teamwork and Safety published by Cornell University Press. She is co-editor of the Culture and Politics of Health Care Work Series at Cornell University Press and can be reached at Lsupport@comcast.net)
Most nurses I know don’t want to give up the 12-hr shifts. Eight hour shifts would usually require “swing shifts” that most hate and find hard to live with. I feel so lucky to have a job that allows me four days off during the week. I agree with most of what you say, Suzanne, but must respectfully disagree on this. However, it should be noted that I rarely work overtime and haven’t ever been required to (Level 1 Trauma Center in metropolitan area).
The older I get, the more I realize that the only redeeming value 12 hour shifts have is the time off between them. I work night shift. My first day -and sometimes the second – is spent recovering. The 3 shifts I work just don’t make for doing anything other than eating, sleeping, and going back to work. But in this profession, everything is a tradeoff if you work at the bedside. We trade off those extra half days we work to have some time off that allows us to have some quality time at home. We trade off one holiday so we can have the one we really want. A nurse’s life is about tradeoffs. I’m not saying that to knock our profession. We have to provide care after hours and on weekends and holidays. It is what it is. The other commentator brought up swing shifts. We like them less than 12 hour shifts. It’s really not the 12 hour shifts themselves that contribute to fatigue. It’s the a workload that has become heavier and more accelerated over the past 3 years that’s killing me. On night shift, we used to be responsible for half the baths. Now, we do all the baths. This is an ICU. We no longer have phlebotomists. We do our own phlebotomy. Housekeeping doesn’t make the beds in clean rooms. We do. We’re filling out hourly checklists in addition to our charting. We’re filling out administrative forms. We don’t have turning help other than each other. No orderlies. We are handling many more total care patients than we used to. We’re being floated off our units on a regular basis. We no longer know where we’re going to be working most of the time. We are on rapid response teams that go to the floors to assess and treat patients who become more acutely ill suddenly. We’re stocking our own supplies. Those are the things that make our 12 hour shifts so much harder: the fact that we’re doing more with less support staff. Once upon a time, I actually left work not feeling too exhausted to go eat breakfast with a friend or even get in a workout. Those days are probably over for good, for me.