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Time to pull the plug on 12-hour nursing shifts

Posted by Rob Anderson  May 27, 2011 01:04 PM

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nurse.JPGAll over the world during the month of May, time is set aside to celebrate nurses. But this month, the news for nurses is not what Florence Nightingale would have wished it to be. It’s not just that nurses have had to struggle to maintain safe staffing ratios at hospitals like Tufts New England Medical Center in Boston and Saint Vincent’s in Worcester. The bad news comes in yet another study — this time from Britain but funded by the US National Institute of Aging — documenting the impact of long work schedules on the human brain.

The study, entitled Change in Sleep Duration and Cognitive Function: Findings from the Whitehall II Study, which appeared in the May issue of the research Journal Sleep, should make all nurses reconsider their commitment to the 12-plus hour day.

In Europe, most nurses work a 37 hour week. In this country and in Canada, nurses increasingly work twelve hour shifts, usually back to back, sometimes for up to four or five days in a row. And very few nurses get out of the hospital after only 12 hours. Studies have documented that nurses routinely work 13 or more hours — and that’s without either voluntary or mandatory overtime. Add a commute to the RN work schedule, plus duties at home, and nurses simply don’t sleep enough.

Researchers Alison Trinkoff and Jeanne Geiger-Brown at the University of Maryland School of Nursing have confirmed that nurses who work 12-plus hour shifts aren’t getting enough sleep. Many nurses, these researchers report, work such long shifts that they simply don’t get the “opportunity to sleep” the seven or eight hours adults require for their health and well-being. In a study of nurses’ sleep habits, Geiger-Brown found that 58 percent averaged only 5.5 hours of sleep. When they work three or four 12-plus hour days, they are also unable to easily reestablish a “consistent sleep schedule.”

When the voluntary abandonment of the opportunity to sleep is compounded with overtime things become even more complicated for nurses and patients. Sleep studies document that errors go up. Nurse researcher Ann Rogers has reported that “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.” But the impact of lack of sleep isn’t only on patients. It’s on nurses themselves.

Nurses who work such long hours have more back, neck and shoulder injuries, suffer from more depression and are also at risk for other health problems. A 2007 study has documented that lack of adequate sleep puts people at twice the risk for cardiovascular problems and early death.

And now we have this new study that tells us that people who don’t get enough sleep suffer from greater brain aging. If you don’t get your seven or eight hours, you can suffer as much as a four to seven year increase in age. Even before this study came out, Geiger Brown and her colleagues asked the question, “Is It Time to Pull the Plug on 12-Hour Shifts?”

My recommendation? Before the month is over, nurses should take a visit to an exhibit at the American Textile History Museum in Lowell, Massachusetts. The museum is a monument to American fabrics and to the workers whose sometimes backbreaking labor produced them. One glass case exhibits a letter written to a mill official in 1867 and signed by dozens of mill workers. It reads as follows:

To the treasurer of the Appleton Corporation. We, the undersigned operatives in your employ, believing that 11 hours a day is inimical to our best moral & physical interests, would most earnestly request you to reduce the term of labor from 11 to 10 hours per day & your petitioners as in duty bound will ever pray.”

When you read this and combine it with all the documentary evidence, the answer to Geiger-Brown’s question — “Is It Time to Pull the Plug on 12-Hour Shifts?” — ought to be an enthusiastic “yes.”

Suzanne Gordon is editor of the Culture and Politics of Health Care Work series at Cornell University Press and co-editor of a forthcoming book on patient safety.

Globe file photo: Sasha DuBois, a nurse at Boston's Brigham and Women's Hospital, late last year.

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ABOUT THE ANGLE Online commentary and news analysis from the Boston Globe. The Angle is produced by Rob Anderson and Alan Wirzbicki. You can follow Rob on Twitter at @rcand.

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