Long Work Hour Shifts

West, Ahern, Byrnes and Kwanten (2007) indicate that the new graduate nurses may have not worked full-time in the past; given that graduate nurses begin their career with a full-time job can lead to exhaustion. It was discovered that shift work leads to desynchronisation of physiologically determined circadian rhythms which has a major psychobiology effect and it is commonly perceived the effects of shift work contribute to graduate nurses attrition rate. The NGNs often have a high level of stress due to disturbed sleeping patterns, as they find to adaption to shift work or rotating work hours difficult. Eventually, it leads to feelings of lack of job satisfaction, exhaustion and spending of less time with their friends and family, which can eventually could lead to burnout (West et al., 2007).

Within the recent years, hospitals and medical facilities have been experiencing nursing shortages that necessitate more nurses to be present to compensate for the care needed to be given. This requires nurses to be dealt with imperative extended work hours along with their normal shifts with no denial or excuse accepted. Working extra hours are accompanied with negative effects that have an impact on the nurse, coworkers, and patients. A major concern that occurs with overtime is that nurses become fatigued or burnout. Fatigue that is experienced is a result of sleep deprivation from working overtime that is associated with arduousness neurobehavioral functioning

Throughout the years there has been more attention directed towards healthcare worker fatigue. More specifically, fatigue associated among night-shift nurses. The Joint Commission has found that lack of sleep from night shifts has contributed to increased errors, leading to poor patient outcomes (Gardner, Dubeck, 2016).

Additionally, the study found that a high patient to nurse ratio resulted in greater emotional exhaustion and greater job dissatisfaction amongst nurses. Each additional patient per nurse was associated with a 23% increase in the likelihood of nurse burnout, and a 15% increase in the likelihood of job dissatisfaction. Moreover, 40% of hospital nurses have burnout levels exceeding the normal level for healthcare workers, and job dissatisfaction among hospital nurses is four times greater than the average for all US workers. 43% of nurses involved in this study that reported job dissatisfaction intended to leave their job within the upcoming year. (Aiken et al.)

As a result, overtime can compromise patients ' health or safety. Medical residents cited fatigue as a cause for their serious mistakes in four out of 10 cases (Boodman 2001), and two studies linked infection outbreaks at hospitals to overtime work (Arnow et al. 1982; and Russell et al. 1983). Indeed, the California Nurses Association reports that more nurses are refusing to work in hospitals with unsafe conditions, in which they include being forced to work unplanned overtime. The American Nurses Association (ANA), in a national survey of 7,300 of its members, found, disturbingly, that 56% of nurses believe that the time they have available for care for each patient has decreased, and 75% feel that the quality of patient care at their own facility has decreased in the last two years. The cited inadequate staffing as the chief reason.

When the hospitals and other health care facilities were adequately staffed with nurses, the facilities saved more money. When nurses are out for 7 to 8 days from work related injuries, temporary nurse from agencies would come in to fill their spot. This process cost the health care facilities even more money, because temporary nurse agencies are paid more than regular staff nurses. Also when nurses are required to work overtime to cover shifts, nurses reported feeling burned out from work related stress. Nurses working overtime, also reported feeling depressed and stressed from the demand placed on their jobs. As a result of this demand, nurses often would leave their place of employment after a year. This resulted in high overturn rates of nurses. Facilities would then spend more money on new hires and temporary nurses. When ratio of nurse to patient is low facilities spend more on covering for nurses out on leave and patient care

Patients in a hospital and/or healthcare facilities have to be cared for all day and all night, everyday of the week by nurses. The usual way to fulfill this need is to divide up the day into three 8-hour shifts. Different shifts have been put into place to help improve nurse satisfaction, decrease the nursing shortage and save the hospital money. The 24-hour day is made up of two 12-hour shifts; 12 hours in the day and 12 hours at night. There has been quite an ongoing debate over the years regarding this issue of nurses working over 8 hours in a single day. Many people, such as hospital nursing administrators, have reason to believe that working long hour shifts causes more errors in

Nurse staffing have an effect on a variety of areas within nursing. Quality of care is usually affected. Hospitals with low staffing tend to have higher incidence of poor patient outcomes. Martin, (2015) wrote an article on how insufficient nursing staff increases workload and job dissatisfaction, which in effect decreases total patient care over all. When nurse staffing is inadequate, the ability to practice ethically becomes questionable. Time worked, overtime, and total hours per week have significant effect on errors. When nurses works long hours, the more likely errors will be made. He also argued that inadequate staffing not only affects their patients but also their loved ones, future and current nursing staff, and the hospitals in which they are employed. An unrealistic workload may result in chronic fatigue, poor sleep patterns, and absenteeism thus affecting the patients they take care of.

Mandatory overtime is a major problem for RNs and health care in general. In consequence of unequal RN staffing, organizations have adopted mandatory overtime often as a cost savings factor. The purpose of this paper is to voice nurses concerns about the health influences of long-term overtime and the quality of care that they provide.

The 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. (Trossman, 2009). Working longer hours in a high stress area will always increase the error rate. Designating an adequate number of RN positions to ensure nurses work an appropriate schedule without overtime and that their workload allows for breaks. Managerial staff must work to develop specific policies about the length of work times based on the setting, patient and provider needs. Those policies should limit nurses from working more than 12.5 consecutive hours. Provide education for all care providers on the hazards and causes of fatigue. Continue to document unsafe staffing conditions and work with others to change the current work culture so that it recognizes the effects of fatigue on patient safety, as well as the nurse. (Berger, et al. 2006)

Limited attention has been paid to the hours worked by nurses, or the effects of these hours on patient safety (Rogers, 2008). Even though most nurses favor 12- hour shifts and overtime, it is associated with difficulties staying awake during times of duty, reduced sleep times, and triple the risk of making an error (Rogers, 2008). The most significant risk of making an error occurred when nurses were scheduled to work 12.5 hours or more.

For some nurses, mandatory overtime can be an advantage due to financial instability but mostly mandatory overtime can cause fatigue, burnout, injuries, errors, inadequate sleep and deficits in performance. According to research working long hours which consists more than 40 hours a week or over 12 hours a day leads to an increased medication errors and patient mortality. The probability of making medication errors increases tremendously when nurses work longer than 12.5 hours a day. During surveys regarding reasons of overtime, 60 % of nurses stated that overtime was obligatory as part of their job, 29 % of nurses stated that they volunteered and 41% of nurses stated that they were “on call hours” (Bae, 2012)

The first topic focused on in an article by Stimpfel et al. (2012) looked at the effect of longer shifts on nurses. Compared to the past, nurses are working twelve-hour shifts, instead of eight-hour shifts. The reason for these changes in shift lengths is for it to allow for nurses to have more flexibility in their schedules and to give them more time at home. This study revealed that the hours actually worked by nurses are unpredictable. Due to the fluctuations of patient needs and unanticipated staffing on the unit, leads to nurses having to work over their scheduled time (Stimpfel et al. 2012). This study also pointed out that there are no national policies for nurses that dictate the maximum number of hours a nurse can work. Nurses often end up working several hours over their shift because they feel forced into working those hours and thereby leading to burnout.

The many responsibilities burdened on nurses have a detrimental effect on them as it leads to long, tiresome shifts. The physical and emotional exhaustion that the

With the concern of work-related injuries associated with mandatory overtime, many research studies have been piloted to examine the impact of overtime on nursing. A particular study conducted with 655 registered nurses in the Philippines reveals significant results in regards to the effects of nurses working mandated overtime. Results show 65% of nurses involved in the study report working over 40 hours per week. Also, 83% report working mandatory or unexpected overtime at least once a month and 15% state working overtime more than seven times each month. Furthermore, 37% of the nurses have suffered an occupational injury and 41% acquired an occupational related illness within a year span (de Castro, Fujishiro, Rue, Taglog, Samaco-Paquiz, & Glee, 2010). Mandatory overtime increases staffing absences.