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NIOSH Training for Nurses on Shift Work and Long Work Hours

Injuries/Errors (Continued)

Patient Care Errors

  • Evidence is growing that long work hours are linked to patient care errors and dissatisfaction.27 Stimpfel et al.28 examined data from nurses, their hospitals, and their patients in four states. They found shifts greater than 13 hours were linked to patient dissatisfaction. Specifically, patients reported their nurses were not communicating well, their pain was not controlled, they did not get help as soon as they wanted, and they would not recommend the hospital. Nurses with shifts greater than 13 hours had over double the risk for burnout and job dissatisfaction.
  • Rogers et al.29 measured the working hours of nurses and their errors or near-errors during work. They found nurses had over 3 times the odds of making an error when working 12 or more hours, compared with 8.5-hour shifts.
  • Scott et al.30 reported the risk for patient care errors almost doubled when critical care nursing shifts lasted longer than 12.5 hours. The risk for struggling to stay awake at work increased by 50% when shifts exceeded 12.5 hours.
  • Trinkoff et al.31 reported hospitals with higher patient mortality rates had higher rates of nurses working long hours, lacking time away from work, working while sick, and having higher weekly work hour burdens. Staffing and hospital characteristics were controlled in the analysis, indicating these schedule features had an independent impact on patient outcomes.
  • Three studies of nurses found that working more than 40 hours per week was associated with increased risk for adverse patient outcomes, including errors and near misses, injury from falls, and nosocomial infections.29,30,32
Because of concern for patient safety, a 2004 Institute of Medicine report recommended that work hours for nurses be limited to 60 hours or less in a 7-day period, and no more than 12 hours in a 24-hour period.33 A 2014 systematic review of studies examining work hours for nurses concluded that working more than 40 hours a week was linked to adverse patient and nurse outcomes.27

Be aware that employers and workers have been penalized when a fatigue-related error led to a person’s death.34-36

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