Nurses who work at least 12 hours on a single shift face a greater risk of making errors that can injure themselves or their patients, research shows.

New Zealand nursing researchers Dr Jill Clendon and Dr Veronique Gibbons, who published their systematic review of research evidence in the International Journal of Nursing Studies last year, found six studies, comprising 60,780 nurses or 89 per cent of the review’s total sample size, revealed a significant rise in error rates among nurses working more than 12 hours on a single shift in acute care hospital settings.

One study reported higher rates of care left undone than nurses working up to eight hours, another study found the likelihood of making an error was three times higher while a third study found the risk was almost double.

Another study found nurses were more likely to suffer a needlestick injury, a separate study found nurses working more than 13 hours are far more likely to report frequent central line-associated bloodstream infections, while the sixth study found patients’ pain was less likely to be controlled.

Out of the 13 studies examined, four found higher rates of error in shifts of up to eight hours while three found no difference between the number of shift hours worked.

While 12 hour shifts are common and offer flexible working hours for nurses, the researchers said their review shows 12 hour shifts result in an adverse impact on patient and nurse outcomes.

“The (12 hour shift) approach has proven popular, with many proponents citing good quality time off work, ease of travel to work, improved relationships with patients, and better family time as benefits,” they state.

“However, there is significant debate in the literature regarding the disadvantages of 12 hour or longer shifts with some authors claiming extended shifts cause increased fatigue, greater risk of errors, greater risk of injury to self, and negative physiological outcomes, others claiming no difference in patient outcomes, and yet others attributing greater risk of error to poor scheduling practices rather than length of shift.”

Dr Clendon, a New Zealand Nurses Organisation (NZNO) nursing policy advisor, and Dr Gibbons said hospitals and units now using 12 hour shift systems should review the scheduling practice because of the potential negative impact on nurse and patient outcomes.

They suggest health providers consider reducing shifts to eight or 10 hours in length or revise scheduling patterns to enable nurses to have significant rest periods, such as two hour breaks, during 12 hour shifts.

“Although other factors may influence the relationship between shift length and rates of error, it is clear from the findings of this review that an association between working 12 h (hours) or longer on a single shift in an acute care setting and increased rates of error among nurses remains.”

Further research is needed to consider factors that may mitigate the risk of error in areas where 12 hour shifts are often scheduled, they added.

“For example, longer breaks that include a component of required sleep during night shift may be useful for addressing issues of fatigue that may be a contributing factor to error, however this may not be appropriate during daytime shifts, although longer breaks may be appropriate.”