12-hour shifts: an ethical dilemma for the nurse executive

Flexible work hours, including 12-hour shifts, have become a common scheduling option for nurses. The author explores whether 12-hour shifts are an ethical scheduling option for nurses because recent research suggests that 12-hour shifts are a potential hazard to patients. A multistep model for ethical decision making, reflecting the concept of procedural justice, is used to examine this issue.

Workplace stress in nursing: a literature review

BACKGROUND

Stress perception is highly subjective, and so the complexity of nursing practice may result in variation between nurses in their identification of sources of stress, especially when the workplace and roles of nurses are changing, as is currently occurring in the United Kingdom health service. This could have implications for measures being introduced to address problems of stress in nursing.

AIMS

To identify nurses' perceptions of workplace stress, consider the potential effectiveness of initiatives to reduce distress, and identify directions for future research.

METHOD

A literature search from January 1985 to April 2003 was conducted using the key words nursing, stress, distress, stress management, job satisfaction, staff turnover and coping to identify research on sources of stress in adult and child care nursing. Recent (post-1997) United Kingdom Department of Health documents and literature about the views of practitioners was also consulted.

FINDINGS

Workload, leadership/management style, professional conflict and emotional cost of caring have been the main sources of distress for nurses for many years, but there is disagreement as to the magnitude of their impact. Lack of reward and shiftworking may also now be displacing some of the other issues in order of ranking. Organizational interventions are targeted at most but not all of these sources, and their effectiveness is likely to be limited, at least in the short to medium term. Individuals must be supported better, but this is hindered by lack of understanding of how sources of stress vary between different practice areas, lack of predictive power of assessment tools, and a lack of understanding of how personal and workplace factors interact.

CONCLUSIONS

Stress intervention measures should focus on stress prevention for individuals as well as tackling organizational issues. Achieving this will require further comparative studies, and new tools to evaluate the intensity of individual distress.

Twelve-hour shift on ITU: a nursing evaluation

This paper describes the introduction and subsequent evaluation of a 12-h shift system in a large ITU in the northeast of UK. To date, only a small number of studies has evaluated nurses working the 12-h shifts in critical care areas. To evaluate the level of staff satisfaction, data were collected by means of a questionnaire involving 41 nurses, at 3 months following the introduction of the 12-h shifts. The responses from the evaluation advocated the continuation of 12-h shifts with alternative shift patterns for nurses who felt dissatisfied with the current system. Twelve-hour shifts can be seen as a flexible system for nurses working in intensive care and may assist with staff satisfaction and improving nurse recruitment and retention.

Evaluation of 12-hour shifts on a cardiology nursing development unit

The first part of this two-part article discussed the implementation of 12-hours shifts using a locally devised nursing development unit (NDU) framework (Vol 9(19): 2095-9). This article, the second part, discusses the results of a survey to evaluate the 12-hour shifts, the problems encountered during the implementation of 12-hours shifts, the solutions and the NDU framework as described in the first part of the article. A qualitative design to the postal survey was chosen with the resulting data being subjected to a content analysis. Data triangulation compared survey results with incident reports and sickness records. The limitations of the survey included having the change agent analysing the data, the sampling method and being unable to pilot the questionnaire. The results indicated an improvement in the quality of patient care, although this is difficult to measure, a pacing of workload throughout the day, and tiredness during, after and at the end of a stretch of shifts. Other results centred on staff morale, social life, student nurses' experience and night shifts. The solutions to identified problems included the employment of two twilight nurses to help the night staff during the busy early evening period. As a requirement of the NDU framework, standards were produced from the survey results, as this would allow subsequent audit of the 12-hour shift system. The recommendations from this survey included the dissemination of results both locally and nationally to expand the body of nursing knowledge and to promote practice based on the best available evidence.

Implementing 12-hour shifts on a cardiology nursing development unit

This article, the first of two parts, discusses the implementation of 12-hour shifts using a locally devised nursing development unit (NDU) framework. A literature review and force-field analysis were undertaken to plan, implement and evaluate the introduction of the 12-hour system. The literature review identified five broad categories: effect on care delivery; nurse education; cost-effectiveness; impact on staff; and implementation strategies. It also ascertained that the most successful methods of implementation were those that gained the cooperation of staff. The force-field analysis identified the restraining forces (e.g. tiredness, the European Working Time Directive and staff views) and therefore allowed the change agent to concentrate his limited time on combating these restraining forces. The second part of this series will examine the evaluation and audit of the 12-hour shift system.