Hospitals face an extraordinarily difficult problem in finding the right shift length for staff nurses and physicians. There is an enormous amount of work to be done during a shift change in a busy hospital: incoming staff must be notified of all major changes in patients’ conditions. Some patients may require transfer to a different wing, different medications, changes in dosage, or different treatment entirely. Even with the rigorous recordkeeping and networking systems that most metropolitan hospitals have in place, a shift change raises the possibility of mistakes that will have serious (even life-threatening) consequences for patients.
As such, many hospitals make as few shift changes as possible. This reduces the number of times incoming hospital staff must be brought up to speed on specific patient conditions, but it also stretches shift length far beyond the norm for medical professionals. Many hospital staff (such as nurses) now work twelve-hour shifts rather than the traditional eight-hour professional workday, while physicians may functionally be on-call for days at a time. This certainly reduces the number of overall shift changes for the hospital, but at what cost? How are the work-life balances of medical professionals affected by these changes? Do tired doctors and nurses make more mistakes and can those mistakes be addressed (and consequently, can patient outcomes be improved) by changing hospital shift length?
Studies of hospital nurses have differed in their findings, but some have suggested that an extended shift length may cause more harm to patient outcomes than does a shorter shift length and a greater number of weekly shift changes. A University of Pennsylvania study of 393 registered nurses found that, on average, hospital nurses work significantly longer shifts than their established schedules indicated. Overall, the respondents left their jobs at the scheduled time on less than 20% of total shifts. This means that during shifts that are already 1.5 times the length of the average workday, most nurses still consistently find themselves working beyond the twelve-hour mark.
A portion of these and similar study results can be attributed to uncertain patient demand. Injuries and illnesses are difficult to predict and hospital nurses often find themselves having to make up the difference between short staffing and increased patient demand. The University of Pennsylvania study showed statistically significant correlation between shift length and work-related errors for hospital nurses. Frequent meetings between hospital administrators and staff can address the problem before it seriously affects patient outcomes, but this requires honest communication among staff and administration, as well as a commitment by hospital administrators to revise shift length depending on the staff’s recommendations.