Objective: Extended work schedules—those that vary from the standard eight hours per day, 35 to 40 hours per week—are common in nursing and contribute to problems with nursing recruitment and retention, in addition to compromising patient safety and the health and well-being of nurses. This study describes the nature and prevalence of such schedules across nursing settings.
Methods: Quantitative survey data collected as part of the Nurses Worklife and Health Study were analyzed. The sample consisted of 2,273 RNs. Demographic data, information about respondents’ primary jobs (position, workplace, and specialty), and specific work schedule variables were analyzed, including data on off-shifts, breaks, overtime and on-call requirements, time off between shifts, and how often respondents worked more than 13 hours per day and on scheduled days off and vacation days. Respondents were also asked about activities outside of work, commuting time, and other nonnursing activities and chores.
Results: More than a quarter of the sample reported that they typically worked 12 or more hours per day, as did more than half of hospital staff nurses and more than a third of those with more than one job. A third of the total sample worked more than 40 hours per week, and more than a third worked six or more days in a row at least once in the preceding six months. Nearly a quarter rotated shifts.
Almost one-quarter of nurses with more than one job worked 50 or more hours per week, and they were more likely to work many days consecutively, without sufficient rest between shifts, and during scheduled time off. Single parents were as likely as those with more than one job to work 13 to 15 hours per day, 50 to 60 hours or more per week, and many days consecutively. Seventeen percent of all nurses worked mandatory overtime, as did almost a quarter of the single parents. Nearly 40% of the total sample and more than 40% of hospital staff nurses had jobs with on-call requirements.
Conclusions: The proportion of nurses who reported working schedules that exceed the recommendations of the Institute of Medicine should raise industry-wide concerns about fatigue and health risks to nurses as well as the safety of patients in their care.
Data collected as part of the Nurses Worklife and Health Study were analyzed to determine the extent to which nurses worked extended schedules. Among other findings, the researchers found that more than a quarter of nurses reported that they typically worked 12 or more hours per day.
Alison Trinkoff is a professor, Jeanne Geiger-Brown is an assistant professor, Barbara Brady is a project director, and Jane Lipscomb is a professor, all at the University of Maryland School of Nursing in Baltimore. In addition, Trinkoff and Geiger-Brown are members and Lipscomb is director of the Work and Health Research Center, also at the University of Maryland School of Nursing. Carles Muntaner is chairperson of psychiatry and addictions nursing research at the Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Contact author: Alison Trinkoff, firstname.lastname@example.org. This research was funded by the National Institute for Occupational Safety and Health, grant number R01 OH007554. The authors of this article have no significant ties, financial or otherwise, to any company that might have an interest in the publication of this educational activity.