Can 12-hour work shifts contribute to burnout and compromise patient safety, and can shorter shifts mitigate these risks?

Impact of 12-Hour Work Shifts on Burnout and Patient Safety

12-hour work shifts significantly contribute to healthcare worker burnout and compromise patient safety, while shorter shifts can mitigate these risks by reducing fatigue and improving cognitive function. 1, 2

Relationship Between Long Shifts, Burnout, and Patient Safety

Evidence on 12-Hour Shifts and Burnout

• 12-hour shifts are associated with higher levels of burnout compared to shorter shifts (≤8 hours), including increased emotional exhaustion (adjusted OR=1.26), depersonalization (adjusted OR=1.21), and reduced personal accomplishment (adjusted OR=1.39) 2
• Healthcare workers often sacrifice self-care during long shifts, leading to increased fatigue and impaired coping, immunity, and cognitive function 1
• Burnout syndrome develops as a psychological response to long-term exposure to occupational stressors, particularly affecting professionals who work directly with patients 3

Impact on Patient Safety

• Fatigue from prolonged shifts negatively affects critical abilities including reaction time, hand-eye coordination, clerical accuracy, memory, and reasoning 1
• A meta-analysis found a clear relationship between high levels of burnout and worsening patient safety actions with a probability of superiority of 66.4% 4
• Healthcare workers with burnout are more likely to make medical errors and be subject to malpractice claims 3
• Studies have shown that prolonged wakefulness of 18 hours has a negative effect on human performance approximately equivalent to a blood alcohol concentration of 0.1% 1

Mitigating Strategies with Shorter Shifts

Benefits of Shorter Shifts

• Studies comparing 8-hour and 12-hour shifts among nurses demonstrated increased fatigue and safety concerns associated with the longer shifts 1
• Shorter shifts help maintain cognitive and psychomotor skills that cannot be consistently sustained by fatigued individuals 1
• Reducing shift length can help address the negative impacts on nurses' well-being, job satisfaction, and intention to leave their job 2

Organizational Recommendations

• Healthcare organizations should ensure compliance with mandated rest periods and adequate respite between day and night shifts 1
• Strict adherence to shift time limits, including sign-out times, is recommended to prevent fatigue-related errors 1
• If an emergency department group is large enough, scheduling single overnight shifts rather than consecutive ones may be preferable, as circadian rhythms take at least one week to adjust to an 8-hour phase change 1

Additional Strategies to Reduce Burnout and Improve Safety

Work Environment Modifications

• Balance heavy workloads through flexible work hours or rotating between high and low-stress environments 1
• Maintain appropriate staffing ratios to prevent excessive workload 1
• Provide adequate training and supplies for patient care to reduce stress 1
• Build trust in leadership through clear and consistent communication and support 1

Supporting Healthcare Worker Wellbeing

• Ensure adequate nutrition, hydration, and rest breaks during the workday 1
• Provide opportunities for staff physical fitness and mental health breaks 1
• Implement strategic napping as a fatigue countermeasure, especially after overnight shifts 1
• Offer mental health resources that are easily accessible, voluntary, and free of stigma 1

High-Risk Groups Requiring Special Attention

• Less-experienced workers and staff in training 1
• Those with direct patient contact, particularly ED and ICU bedside nurses 1
• Healthcare workers without strong social support at home 1
• Those with significant family and childcare needs 1

Implementation Challenges

• Many workers prefer 12-hour shifts despite the evidence of increased fatigue and safety concerns 1
• Circadian rhythm disruption is a biological reality that cannot be fully overridden by determination or professional commitment 1
• Balancing continuity of care with staff wellbeing requires thoughtful scheduling approaches 1

By implementing shorter shifts and supporting healthcare worker wellbeing, healthcare organizations can significantly reduce burnout and improve patient safety outcomes.