12 h shifts and rates of error among nurses: A systematic review

doi:10.1016/j.ijnurstu.2015.03.011

International Journal of Nursing Studies

Volume 52, Issue 7, July 2015, Pages 1231-1242

https://doi.org/10.1016/j.ijnurstu.2015.03.011 Get rights and content

Abstract

Objective

To determine the effect of working 12 h or more on a single shift in an acute care hospital setting compared with working less than 12 h on rates of error among nurses.

Design

Systematic review.

Method

A three-step search strategy was utilised. An initial search of Cochrane, the Joanna Briggs Institute (JBI), MEDLINE and CINAHL was undertaken. A second search using all identified keywords and index terms was then undertaken across all included databases (Embase, Current contents, Proquest Nursing and Allied Health Source, Proquest Theses and Dissertations, Dissertation Abstracts International). Thirdly, reference lists of identified reports and articles were searched for additional studies. Studies published in English before August 2014 were included.

Findings

Following review of title and abstract of 5429 publications, 26 studies were identified as meeting the inclusion criteria and selected for full retrieval and assessment for methodological quality. Of these, 13 were of sufficient quality to be included for review. Six studies reported higher rates of error for nurses working greater than 12 h on a single shift, four reported higher rates of error on shifts of up to 8 h, and three reported no difference. The six studies reporting significant rises in error rates among nurses working 12 h or more on a single shift comprised 89% of the total sample size (N = 60,780 with the total sample size N = 67,967).

Conclusion

The risk of making an error appears higher among nurses working 12 h or longer on a single shift in acute care hospitals. Hospitals and units currently operating 12 h shift systems should review this scheduling practice due to the potential negative impact on patient outcomes. Further research is required to consider factors that may mitigate the risk of error where 12 h shifts are scheduled and this cannot be changed.

Section snippets

Introduction/background

Work schedules should be optimised for both employees and patients. The introduction of 12-h shifts into rostering/scheduling systems has been one approach implemented in workplaces with the intention of improving the flexibility of work hours for nurses. The approach has proven popular, with many proponents citing good quality time off work, ease of travel to work, improved relationships with patients, and better family time as benefits (Estryn-Béhar et al., 2012, O’Connor, 2011, Richardson et

Literature review

Previous reviews have explored links between shift length and patient outcomes with results described as inconclusive (Bae and Fabry, 2014, Estabrooks et al., 2009). Bae and Fabry examined the relationship between nurse work hours/overtime and nurse and patient outcomes. They determined there is strong evidence supporting a positive relationship between working long hours and adverse nurse outcomes; however, their findings regarding shift length were not definitive – while they note that

Aim

The aim of this systematic review was to determine the effect of working 12 h or more on a single shift in an acute care hospital setting compared with working less than 12 h on rates of error among nurses. The question posed was: what is the effect of working 12 h or more on a single shift in an acute care hospital setting compared with working less than 12 h on rates of error among nurses?

Method

The review is based on the Joanna Briggs Institute systematic review process. This approach covers search strategy, inclusion/exclusion criteria, methodological quality, results and data synthesis.

Description of studies

Of the 13 studies included, two were from Japan (Arimura et al., 2010, Tanaka et al., 2010), one was from Australia (Dorrian et al., 2006), one was from Canada (Wilkins and Shields, 2008), one was from Europe (Griffiths et al., 2014), and eight were from the United States of America (Mills et al., 1983, Ritter, 1981, Rogers et al., 2004, Scott et al., 2006, Stone et al., 2006, Trinkoff et al., 2007, Witkoski Stimpfel et al., 2012, Witkoski Stimpfel et al., 2013). For the purposes of critical

Discussion

This systematic review has examined the relationship between shift length and error amongst nurses working in acute care settings. While earlier studies have examined the relationship between nurse work hours/overtime and nurse and patient outcomes (Bae and Fabry, 2014) and between shift length on quality of patient care (Estabrooks et al., 2009), a specific review of studies examining 12 h shifts, error and nurses has not previously been done. Our findings regarding shift length and error

Conclusion

In conclusion, this review shows that rates of error appear higher among nurses working 12 h or more on a single shift in an acute care hospital. Although this review did not explore other potential variables that may mediate or moderate this pathway such as fatigue, stress, skill mix or scheduling practices, it is clear that a relationship does exist. As such, we recommend workplaces review current scheduling practices with a view to limiting shift length to 8–10 h where possible. We also

Acknowledgements

The authors wish to acknowledge the New Zealand Nurses Organisation, the British Commonwealth Nurses War Memorial Fund, and Dr Léonie Walker for her assistance with preparing this manuscript.

Conflict of interest: None.

Funding: New Zealand Nurses Organisation (funded time of first researcher). British Commonwealth Nurses War Memorial Fund (funded JBI systematic review course).

Ethical approval: None.

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View full text

Review12 h shifts and rates of error among nurses: A systematic review

Abstract

Objective

Design

Method

Findings

Conclusion

Section snippets

Introduction/background

Literature review

Aim

Method

Description of studies

Discussion

Conclusion

Acknowledgements

Lancet

Nursing Outlook

Int. J. Nurs. Stud.

Sleep, mental health status, and medical errors among hospital nurses in Japan

Ind. Health

Individual, practice, and system causes of errors in nursing: a taxonomy

JONA

Hospital nurse staffing models and patient and staff-related outcomes

Cochrane Database Syst. Rev.

Physiological and behavioural response patterns at work among hospital nurses

J. Nurs. Manage.

A pilot study of the safety implications of Australian nurses’ sleep and work hours

Chronobiol. Int.

Nursing handovers as resilient points of care: linking handover strategies to treatment errors in the patient care in the following shift

J. Adv. Nurs.

Effects of shift length on quality of patient care and health provider outcomes: systematic review

Qual. Saf. Health Care

Effects of extended work shifts on employee fatigue, health, satisfaction, work/family balance, and patient safety

Work

Nurses’ practice environments, error interception practices, and inpatient medication errors

J. Nurs. Scholarsh.

Is it time to pull the plug on 12-hour shifts? Part 1, the evidence

JONA

Nurses’ shift length and overtime working in 12 European countries: the association with perceived quality of care and patient safety

Med. Care

Strategies to reduce medication errors with reference to older adults

JBI Libr. Syst. Rev.

Reviewers Manual

Review
12 h shifts and rates of error among nurses: A systematic review