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For doctors and nurses, long hours mean more errors

by Mark Miller May 23, 2016

For doctors and nurses, long hours mean more errors

Even though the practice of making internist doctors work 24 to 48 hours has been discontinued in recent years, some doctors and nurses still work long shifts.—up to 16 hours. That’s bad for them, and studies have shown it can affect patient care too. Long hours mean more errors, studies show.

Patient errors increase 3-fold when nurses work 12 hours shifts as compared to 8.5-hour shifts, according to one study. And other studies have found similar odds. A lot has been written in scholarly studies and on the Internet about the effect of sleep loss on health care practitioners and their patients.

12-hour nursing shifts are the norm

According to AHC Media, 12-hour shifts for nurses are the norm.

Not only do the nurses and doctors suffer from working such long hours, some nurses report they are burned out on nursing because of it and want to quit the field.

The Joint Commission, which accredits hospitals, published a report ( PDF) in 2008 that noted much research has been done on sleep deprivation in general. And the news about sleep deprivation for care providers and their patients is not good.

The Joint Commission’s report stated:

Although an extensive literature on sleep deprivation, circadian misalignment, and human performance has accrued during the past three decades, debate on the effects of these factors on physicians and nurses has persisted. The notion that providers’ long work hours might have an adverse effect on their performance and safety is not new. More than 35 years ago, it was recognized that extended work hours adversely affect medical and surgical performance. Subsequent studies have also documented additional adverse effects on provider health and well-being.

16-hour shifts

Even though a governing body has restricted the number of hours interns (doctors in their first years of practice) may work from 30 to 16, there are still concerns about medical personnel working 16- or even 12-hour shifts. Interns also may not work more than 80 hours a week.

The Joint Commission report said:

During the past three years, a series of studies have demonstrated the risks to patients and providers of long work hours in health care. Compared with nurses working shorter hours, nurses working greater than 12.5–13 consecutive hours report (1): a 1.9- to 3.3-fold increased odds of making an error in patient care; (2) a significantly increased risk of suffering a needlestick injury, exposing them to an increased risk of acquiring hepatitis, HIV, or other bloodborne illnesses; and (3) significant decrease in vigilance on the job.


It’s no wonder that health authorities ended 24-plus-hour shifts for interns. The automobile accident rate was more than double for doctors who worked those long shifts, according to this graph from the Joint Commission.

The article references 24-hour-plus shifts in vogue for doctors in training in 2008, but in 2015 more than 40 hours per week were considered excessive for nurses, according to another publication, Health Affairs. That journal published an article in May 2015 titled The Working Hours Of Hospital Staff Nurses And Patient Safetythat stated:

The use of extended work shifts and overtime has escalated as hospitals cope with a shortage of registered nurses (RNs). Little is known, however, about the prevalence of these extended work periods and their effects on patient safety. Logbooks completed by 393 hospital staff nurses revealed that participants usually worked longer than scheduled and that approximately 40 percent of the 5,317 work shifts they logged exceeded twelve hours. The risks of making an error were significantly increased when work shifts were longer than twelve hours, when nurses worked overtime, or when they worked more than forty hours per week.

Both errors and near errors are more likely to occur when hospital staff nurses work twelve or more hours at a stretch.

Long hours mean more errors

The researchers found “that work duration, overtime, and number of hours worked per week had significant effects on errors. The likelihood of making an error increased with longer work hours and was three times higher when nurses worked shifts lasting 12.5 hours or more (odds ratio =3.29, p =.001). Working overtime increased the odds of making at least one error, regardless of how long the shift was originally scheduled (OR = 2.06, p = .0005).

Another study, in Nursing Times, says:

We found that both longer shifts and working overtime were significantly associated with lower quality of care, worse patient safety reports and more care left undone (p<0.05). Compared with nurses who were working eight hours or fewer, the odds of nurses who worked 12 hours or more on their most recent shift describing the quality of nursing care in their unit as “poor” or “fair” increased by 30% and the odds of them reporting “failing” or “poor” patient safety in their units increased by 41%.

Oh, the humanity

Plus, it’s inhumane to make people work such long shifts.

An editor at NurseTogether.com wrote in the comments:

I am in favor of nap rooms for 12 shifts. If flight attendants on long flights have mandatory rest, why can’t we implement this for the nursing profession?

To which another apparent nurse replied:

Nap? Sounds great, but too often even getting lunch is challenging.

(It’s not an urban legend that flight attendants are required to take naps on long flights. Pilots also have nap quarters, according to a 2015 article in Huffington Post.)

‘Slave labor’

The Daily Mail, an English newspaper that is a bit on the sensational side, had this headline on an article from 2015: 12-hour nursing shifts are “slave labour”: Nurses’ health “put at risk” while patient safety suffers, union warns.

Some nurses prefer 12-hour shifts

All that said, six of seven nurses writing in a comment section of the site PackBackBooks.com said they would rather work 12-hour shifts. Some like the three-day-a-week work schedules. Others said they get to see how their treatments are working over a longer shift.

Megan B. wrote:

I am partial to 12hr shifts. One of the positives of 12hr shifts is the shorter work week (only 3 days!). This leaves you with the opportunity (if you wanted to), to have a different part time nursing job or to just spend more time with your family etc. Also with working 12hr shifts, you have better continuity of care and have more of an opportunity to evaluate the effectiveness of the interventions implemented. However, I do think there should be a limit on how many 12hr shifts you can work in a row.

Mark Miller
Mark Miller



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