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Ode to Evening Shift

My favorite shift, evening shift that ran from 3-11:30pm or 4p-12:30am, is disappearing from US hospitals. Evening shift was great.  If morning is not your best time of day, you can be assured that evening shift is your friend.  It gave you time to sleep and refresh from the evening before and attend to life's needs before going to work.  If the shift was crazy, you had time to calm down and still get sleep during normal sleeping hours.  During the shift, it might be admission or post-op care central as patients came in from the ED or back from the OR.  Nurses who worked evening shifts liked them, so you often had a steadier group of co-workers.  Working only 8 hours also meant you had more opportunities to get the same assignment of patients, get to know them, and improve continuity of care.

Evening shifts have gone by the wayside because most nurses seem to prefer working 12 hour shifts and management likes them because there is a 4 hour window for extra time worked that doesn't get counted as overtime.  The appeal of three days a week for work is hard to overcome too, even though an increasing number of research studies show that nurses usually work more than 12 hours as they try to finish everything up from the long day.  This translates to worse patient outcomes, increased rates of burnout, more work left undone, and less continuity of care for patients.  Health Affairs, the leading health policy journal in the US, has a number of good studies illustrating these trends.

As the research grows about the consequences of 12 hour shifts to patients, we may see start to see policy changes and new organizational experiments around RN scheduling.  The more I read the evidence, the more I think my previous blog post about the 32 hour work week for nurses is a better and better idea.

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