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'Decision Regret' in Nurses Linked to Fatigue

Alexandra Wilson Pecci, for HealthLeaders Media, January 14, 2014

"This would be an important thing for health leaders to consider. Even though space is a premium, it's an opportunity to make an investment in your staff," Scott says of creating sleep spaces. "Completely relieved breaks should be mandatory, and anything we can do to break up consecutive awake hours should be strongly encouraged."

She also says nurse leaders should consider natural circadian rhythms when scheduling. For instance, shifts that start 3:00 am, when the body naturally wants to be asleep, set nurses up to be fatigued. Twelve-hour shifts and not leaving enough rest time between shifts can also contribute to fatigue.

Reconsider 12-Hour Shifts
"Twelve-hours shifts is probably one of the worst things we ever did," she says. "It's thinking about doing things differently. [Nurse leaders should be] partnering with the staff instead of punishing them for taking breaks or covering for each other."

Scott acknowledges that cultural factors can stand in the way of taking breaks or naps. She says nurses often say they "don't get fatigued, or they just keep going or they force themselves to stay awake. That's almost physiologically impossible to do."

And although many nurses say they like working successive 12-hour shifts, and having long stretches of time off, Scott says picking up extra shifts on days off is common.

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14 comments on "'Decision Regret' in Nurses Linked to Fatigue"


Sara-Ann Lipson (5/7/2014 at 5:20 PM)
When we started doing 12 hour shifts in San Francisco, when I worked there, we got a total of 1.5 hours in breaks. Some nurses used their breaks for a power nap. In Nevada you are lucky to get your 30 minute lunch. Also when these long shifts were started we were not allowed to work more than 2 shifts in a row. It is quite common in Las Vegas for nurses to have 2 full time jobs. The rest of the world works an 8 hour day. So nurses are working 1.5 days every shift. Patients deserve to have well rested nurses, on their toes. Too much is riding on their alert minds for them to be sleep deprived at all let alone on a long term basis. I loved 8 hour shifts. Sure, I like the idea of having to go in only 3 days a week but we owe it to our patients to have a nurse that is alert. I think the real reason the 12 hour shifts caught on, like everything else is it was a huge benefit to the hospital's bottom line. Cut out an en tire shift? Cut out all those dollars in benefits? They couldn't wish for a better moneymaker.Has anyone done a study on the amount of nurses working 12 hour shifts to see if divorce rates have increased, substance abuse increased other mental health issues have surfaced?I doubt the outcome of such studies reflect positively. People who work 12 hour shifts also bring up continuity of care. So they take really good care of a group of too many patients and then they are off for 4 days? When we worked 8 hour shifts we had much better continuity of care because we worked more days than we had off.There is a lot to be said about working 8 hour shifts. I would even say 10 hour shifts are OK but there just are not enough hours in the day for 12 hour shifts to be appropriate or safe for the nurses OR the patients. We have not taken into account that they are 12.5 hours, the commute time to and from work, the household chores/upkeep even for single nurses. It is past time to reevaluate the long term effects of long term sleep deprivation and think about the nurses, patient safety and NOT how much money can be trimmed from the nursing budget so administrators can have huge paychecks.

mary koloroutis (4/20/2014 at 8:29 PM)
I have been troubled in the disruption in continuity on some units due to 12 hour shifts [INVALID] obviously some patients are benefited by 12 hour shifts such as labor and delivery and emergency departments [INVALID] continuity is improved. What has really troubled me is hearing that there is a practice of nurses working as per diem nurses in other hospitals after also working 3 twelve hour shifts [INVALID] so literally working 5-6 12 hour shifts per week. Nursing leaders tell me there is nothing to be done about what nurses do in their time off schedule, but I do believe that if this is, in fact, a common practice, that safety and nurse burnout are hugely impacted [INVALID] pilots have limits for the safety of their passengers. What is a reasonable "limit" for nurses to safeguard both patient and their own well being?

David Ascherl RN (4/8/2014 at 11:13 PM)
I for one feel that 12 hr shifts are one of the Perks of being a nurse. Where else can you work 3 days a week & have 4 days off. Yes I get tired at times but not so tired that I am not able to make critical decisions. I have worked in ICU's & ERs for the last 23 yrs and would not take a position if it was an 8 hr/day, 5 day a week job. I love having 4 days off with my family. The trick is my wife and I had an aggreement when we were raising our children. Whoever was working that day or night had no other responsibilities than to come home and sleep. The parent that was at home was in complete 100% charge of the house and children. The mistake I see most nurses makeing is that they try to be SUPERMOMS!! They work 13 hr shifts and then come home and make breakfast or supper, help with the homework, or clean house. Then they get inadequate sleep and expect to be able to go back to work again and be productive. That is just crazy. I loved our set up because then I also was able to experience my children as they grew up instead of just being the bread winner. Now that my children are grown my wife and I try to schedule our days together so we can have our days off together. And 4 days a week off with the woman you love is a heck of a lot better that just 1 or 2. Sure for single moms this may not be an option and I feel for their situations. Nut please don't advocate taking away my 12 hr shifts after I've worked the last 23 yrs to finally get to a point where my wife & I can enjoy it.