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Comparison of Nurse, System and Quality Patient Care Outcomes in 8-Hour and 12-Hour Shifts

Stone, Patricia W. PhD, RN*; Du, Yunling PhD; Cowell, Rhabia MS*; Amsterdam, Norma MA, RN; Helfrich, Thomas A. JD§; Linn, Robert W. JD§¶; Gladstein, Amy JD; Walsh, Mary MSN, RN; Mojica, Lorraine A. BSN, RNC**

doi: 10.1097/01.mlr.0000237180.72275.82
Original Articles

Background: Many nurses desire 12-hour shifts. However, there are concerns about implementation.

Objective: We sought to compare the effects of 8- and 12-hour shifts on nurse, system, and quality patient care outcomes.

Methods: We used a cross-sectional design with data collected from multiple sources in 2003–2004, including a nurse survey and administrative and patient records. We studied hospital nurses and patients in general adult wards, with outcomes including burnout, job satisfaction, scheduling satisfaction, preferences, intention to stay, and employee safety. System outcomes included recruitment and turnover, staffing, absenteeism, and related costs. A variety of quality patient care outcomes were measured from the 3 different types of data.

Results: Thirteen New York City hospitals participated; 805 surveys were examined from 99 nursing units (response rate 42%). Compared with nurses working 8-hour shifts, those working 12-hour shifts were on average more satisfied with their jobs, experienced less emotional exhaustion, 10 times more likely to be satisfied with schedules, 2 times as likely to perceive 12-hour schedules as important, and 58% less likely to report missing shifts; units with 12-hour shifts had lower vacancy rates and weeks to fill the position (all P values ≤0.05). There were no differences in patient outcomes.

Conclusions: Nurses working 12-hour shifts were more satisfied. There were no differences in quality outcomes. Flexibility and choice in shift length are important elements in a positive nurse work environment. This study represents an innovative attempt by a labor-management bargaining group to make an evidence-based decision. We encourage others to conduct similar studies.

From the *Columbia University School of Nursing, New York City, New York; †Department of Clinical Biostatistics, Albert Einstein College, New York City, New York; ‡1199SEIU National Health & Human Services Union, New York City, New York; §League of Voluntary Hospitals and Homes: ¶Linn & Green Consulting, Inc: New York City, New York; ∥Beth Israel Hospital, New York City, New York; and **SVCMC Saint John's Hospital Queens, Elmhurst, New York.

Supported by the 1199/SEIU League RN Planning and Placement Fund.

This study was conducted as a result of an agreement between the Registered Nurse Division of 1199 Service Employees International Union (SEIU), New York's Health and Human Service Union (RN Division of 1199), and the League of Voluntary Hospitals and Homes of New York (LVHH).

Reprints: Patricia W. Stone, Columbia University School of Nursing, 617 West 168th Street, New York, NY 10032. E-mail:

© 2006 Lippincott Williams & Wilkins, Inc.