NIOSH Training for Nurses on Shift Work and Long Work Hours

Extended Shifts (Continued)

Extended shifts require special consideration for a nurse’s needs because of the many hours worked consecutively. You can promote a culture of safety by creating unit norms that nurses take reasonable breaks, leave work on time, and come to work rested.

Knauth and Hornberger¹² recommended the following conditions be met for using extended shifts. Consider whether these conditions are met on your unit if 12-hour shifts are being used.

• ‘Nature of the work and workload should be suitable. Extended shifts may be difficult in jobs with heavy physical demands, dangerous work, fast paced demands, or high stress.’ It is important to realize that nurses acclimate to demanding and stressful settings and may not report feeling stressed. However, chronic stress may lead to physiological changes that make them more susceptible to disease in the long term.
• ‘Shift system is designed to minimize fatigue.’
• ‘Adequate arrangements are in place to cover absentees.’
• ‘Overtime will not be added.’ Shift overruns on extended-hour shifts are common for nurses, but severely reduce the opportunity for sleep, and could lead to drowsy driving.
• ‘Toxic exposure is limited.’ Healthcare workers may be exposed to a variety of toxins: disinfectants and cleaning products, sterilizing agents, anesthetic gases, hazardous drugs and chemicals, and pathogens.²⁰
• ‘Complete recovery after work is possible.’ If a nurse feels unrecovered from the previous work shift when reporting for the next one, the risk of fatigue increases.