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The 32 Hour Work Week for Nurses

Sometimes it's nice to see research that confirms a hunch you've had for a few years.  A recent study in Health Affairs, one of the most influential health policy journals in the United States, looked at the effects of 12 hour shifts on patient satisfaction and nurse burnout rates.

Turns out, results are not good.  The longer nurses worked in a day, the less satisfied patients were with the quality of care.  In addition, nurses working 12 hour shifts were more likely to become burnt out than those working fewer hours.

On the overtime policy front, that's good news for nurses.  The study adds just one more reason why mandatory overtime is bad policy.  It should create incentive for staffing units appropriately and closer to the California standards.

From another perspective, we know why nurses like 12 hour shifts.  Let's face it, 3 days a week of work and then a bunch of days off in a row, so many sometimes that you don't have to use vacation days if you can set your schedule right --it can be great for many kinds of lifestyles.  Managers like 12 hour shifts because scheduling two shifts is easier than three.  There are fewer fights over rotations and it's a big staff satisfier.  Plus it can mean overtime savings --as long as nurses aren't so burnt out that they're calling out sick.

Then there is the other side of 12 hour shifts.  Heavy patient loads due to high acuity mean that on a medical-surgical unit (or similar), hour 9 you start to feel the toll on your body and mind.  Even if you ate your meal and got a break, making that last for another few hours can leave you feeling like you're running on fumes.  Remembering details becomes harder, increasing your risk for missing patient care or making mistakes.  And you've felt it yourself, seen it in your colleagues --even the ones who are in the best physical shape.

And what about the drive home?  Other studies have shown that nurses working 12 hour shifts who have to drive 30 minutes or more to get home after a long shift are at increased risk for accidents and the drive adds to their burnout.

From my own experience,  when I first started working I worked 8 hour rotating shifts.  It was nice to get out early but the rotations were often non-sensical and when you got a bad schedule, it was hard to have a life.  I started to blend 8s and 12s to try and get more balance, and that worked for awhile.  Then when I turned 30 I decided I wasn't going to do 12 hour shifts any more.  I felt too tired and drained when I got home and the effects of the long shift seemed to bleed into the next day, making a day off not really one.  Luckily, I worked at a place where 8 hour shifts were still an option.  I worked evening shift instead, 3p to 11:30p, and it worked out great for my life at that time.  I also noticed that the nurses with the most seniority on my floor tended to work part-time, 8 hour shifts.  Their hourly rates meant they could afford it because of their seniority.  If they wanted extra shifts, there was always a need for non-overtime workers.

If you're young with student loans to pay off, however, part-time work just won't do it.  If you are a single parent, you probably need the full time work too.  The dilemma is three 12s increases burnout, but 5 eights can take the same physical toll.

So, what's the solution?

I propose the 32 hour work week for hospital nurses.  That would be full time with benefits, all positions.  Per diem staff could fill in the rest.  It combines the best of both worlds: the opportunity for multiple days off in a row to really feel like you had a break and reduces shift time.  A 32 hour employee with benefits also reduces the number of people and families without insurance, something that hospitals can afford to offer employees now that we know the Affordable Care Act is here to stay.

From a management perspective, while 8h shifts and rotations are more of a scheduling challenge, the added flexibility of allowing voluntary 8h shift pick ups can help keep overtime in check.

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