Twelve-hour shifts have been a mainstay of nursing schedules since they began as a staffing strategy in the 1970s, but debate continues about their effect on nurses' health and ability to safely care for patients.

Studies have examined both aspects of the issue. Regarding staffing, researchers have found that a majority of nurses and hospital administrators prefer 12-hour shifts as a means to achieve continuity of care, ease of scheduling, and for nurses, work-life balance. Regarding patient care quality, research has shown an association between longer consecutive shifts and more clinical errors.

A recent study from Washington State University aimed to test the latter. The research team recruited 94 RNs working consecutive 12-hour shifts to examine the cumulative effect of shift work-related changes on sustained attention, cognitive effectiveness, and subjective sleepiness. Participants were evaluated in two 20-minute simulated care situations by other RNs trained to assess performance. Nurses working day and night shifts were randomized across fatigued and rested conditions, defined respectively as having worked three consecutive 12-hour shifts or having three consecutive days off.

Results, which were published in the November 2021 International Journal of Nursing Studies, showed that day and night nurses performed well in clinical simulation activities regardless of fatigue, but small differences in communication skills were found, with night nurses having slightly worse skills than day nurses. Changes in sleepiness did not significantly affect performance. The authors noted, however, that participants, especially night nurses, were slower, had more attention lapses, and felt sleepier, which could translate into patient care errors that the simulations were unable to capture. They also noted large individual differences in cognitive effectiveness, which could inform future research on organizational interventions to mitigate risk to patients.-Gail M. Pfeifer, MA, RN