Letter to the Editor by Parast to the topics “Patient Safety: Who Guards the Patient? and “Nurse Safety: Have We Addressed the Risks?”

Patient Safety: Who Guards the Patient?

April 5, 2011

Response by Nazli Parast to the topics 'Patient Safety: Who Guards the Patient?" (September 30, 2003) and 'Nurse Safety: Have We Addressed the Risks?' (September 30, 2004).

Dear Editor:

I am writing in support of 8-hour shifts for the benefit of nurses, patients, and support staff.   Here in Ontario, Canada, each hospital, in conjunction with the nursing staff, develops its own policies regarding shift length. Some hospitals have a combination of 8-hour shifts and 12-hour shifts while others have only 12-hour shifts.

I believe it is time for the nursing profession to take the research seriously and protect their patients and themselves. Numerous research reports have identified the negative impact of 12-hour shifts (Berberich, 2011; Borges & Fischer, 2003; Brogmus & Maynard, 2006; Hutto & Davis, 1989; Kalisch, Begeny, & Anderson, 2008; Lorenz, 2008; Reid, Robinson, & Todd, 1993; Rogers, Hwang, Scott, Aiken, & Dinges, 2004; Scott, Rogers, Hwang, & Zhang, 2006).

Systematic reviews have reported that patient care errors increase when nurses work 12-hour shifts (Berberich, 2011; Geiger-Brown & Trinkoff, 2010).  According to recent studies, patients' deaths are significantly higher when nurses work 12-hour shifts (Lothschuetz Montgomery, & Geiger-Brown, 2010; Trinkoff et al., 2011). In addition, the quality of care provided to patients is greatly lessened (Borges & Fischer, 2003).

According to Health Canada, nurses are ranked third highest for job injury rates (Minister of Health, 2009). The rate of injury increases significantly during night shifts (Brogmus & Maynard, 2006). Twelve-hour shifts have been shown to cause fatigue which may result in needlestick injuries and musculoskeletal injuries, as well as drowsy driving, sleep deprivation, and ill-health consequences (Geiger-Brown & Trinkoff, 2010). Rogers et al. (2004) have shown that the number of sick-days increases when employees work 12-hour shifts. Without healthy workers, hospitals cannot provide quality care (Purdy et al., 2010).

It is crucial that we apply now what the research tells us to do. How much more proof do we need? It is time to protect nurses and patients alike - today!

Nazli Parast
Fourth year Nursing Student
University of Ottawa/Algonquin College
Ottawa, Ontario, Canada


Berberich, S. (2011, January 13). Nurses' long work hours, scheduling can increase patient mortality. UMB News. Retrieved January 31, 2011 from www.oea.umaryland.edu/communications/

Borges, F. N., & Fischer, F. M. (2003). Twelve-hour night shifts of healthcare workers: A risk to the patients? Chronobiology International, 20(2), 351-360.

Brogmus, G., & Maynard, W. (2006). Safer shift work through more effective scheduling. Occupational Health & Safety (Waco, Tex.), 75(12), 16.

Geiger-Brown, J., & Trinkoff, A. M. (2010). Is it time to pull the plug on 12-hour shifts?: Part 1. The evidence. The Journal of Nursing Administration, 40(3), 100-102. doi:10.1097/NNA.0b013e3181d0414e

Hutto, C.B., & Davis, L.L. (1989). 12-hour shifts: panacea or problem? Nursing Management, 20(8):56A, 56D, 56F passim.

Kalisch, B. J., Begeny, S., & Anderson, C. (2008). The effect of consistent nursing shifts on teamwork and continuity of care. The Journal of Nursing Administration, 38(3), 132-137. doi:10.1097/01.NNA.0000310721.28042.0b

Lorenz, S. G. (2008). 12-hour shifts: An ethical dilemma for the nurse executive. The Journal of Nursing Administration, 38(6), 297-301. doi:10.1097/01.NNA.0000312785.03341.80

Lothschuetz Montgomery, K., & Geiger-Brown, J. (2010). Is it time to pull the plug on 12-hour shifts?: Part 2. Barriers to change and executive leadership strategies. The Journal of Nursing Administration, 40(4), 147-149. doi:10.1097/NNA.0b013e3181d40e63

Minister of Health (2009, September 2). Environmental scan on workplace health in Canada. Retrieved January 31, 2011 from www.healthcanada.gc.ca/workplacehealth

Purdy, N., Spence Laschinger, H. K., Finegan, J., Kerr, M., & Olivera, F. (2010). Effects of work environments on nurse and patient outcomes. Journal of Nursing Management, 18(8), 901-913. doi:10.1111/j.1365-2834.2010.01172.x; 10.1111/j.1365-2834.2010.01172.x

Reid, N., Robinson, G., & Todd, C. (1993). The quantity of nursing care on wards working 8- and 12-hour shifts. International Journal of Nursing Studies, 30(5), 403-413.

Rogers, A. E., Hwang, W. T., Scott, L. D., Aiken, L. H., & Dinges, D. F. (2004). The working hours of hospital staff nurses and patient safety. Health Affairs (Project Hope), 23(4), 202-212.

Scott, L. D., Rogers, A. E., Hwang, W. T., & Zhang, Y. (2006). Effects of critical care nurses' work hours on vigilance and patients' safety. American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses, 15(1), 30-37.

Trinkoff, A. M., Johantgen, M., Storr, C. L., Gurses, A. P., Liang, Y., & Han, K. (2011). Nurses' work schedule characteristics, nurse staffing, and patient mortality. Nursing Research, 60(1), 1-8. doi:10.1097/NNR.0b013e3181fff15d