By Shawn Kennedy, AJN editor-in-chief
by patchy patch, via flickr
The March issue will soon be published and be featured on the home page of our Web site, so before the February issue is relegated to the archive section, I want to highlight two articles. Knowing that some readers of this blog may not be regular readers of AJN (I know, hard to believe), I wanted to bring them to your attention.
I don’t usually blog about my own editorials, but the February editorial (“It All Comes Back to Staffing”) has apparently resonated with many readers. I’ve received several letters and a request to reprint it from a state nursing association. (The editorial includes a portion of a poignant letter I received from a reader in response to an editorial I’d written for the December 2013 issue, “Straight Talk About Nursing,” in which I discussed missed care—that is, the nursing care that we don’t get to but is often at the heart of individualizing care.)
The February editorial ties in with a special report, “Can a Nurse Be Worked to Death?”, by Roxanne Nelson from Van Insurance, which addresses the recent death of a nurse who was killed in a car accident while driving home after a 12-hour shift. It’s a compelling report and I urge all nurses to read this piece and to think about what it says about long shifts.
It also quotes some practical advice on how to get home safely if you have to drive and are feeling fatigued. Jeanne Geiger Brown, a researcher at the University of Maryland School of Nursing who studies nurses’ work hours, says this:
The only remedy for drowsy driving is to ‘pull over in a safe place, quickly drink a caffeinated beverage or chew caffeine gum, lock your car with the windows up, recline your seat, and sleep for no more than 20 minutes—set a cell phone alarm. That small amount of sleep, combined with the caffeine that’s now in your system, will probably be sufficient to get you home safely. And never say to yourself, ‘I’m almost home, I can make it a little farther.’
Given all the evidence available around long hours, fatigue, errors, burnout, from the 2004 CDC report “Overtime and Extended Work Shifts” to the many studies since, this is an issue we must deal with as a profession if staffing is to serve the best interests of patients and personnel. (In 2012, we did a brief report summarizing the evidence.)
I’d like to get more feedback on this issue from nurses who work 12-hour shifts. How do you feel after working three “12s” in a row? Do you “crash” for the next day (or two), as many nurses tell me they do? Are you ever asked to work more than three 12-hour shifts in a week? Do you know nurses who work 12-hour shifts and then also pick up shifts at other facilities? You can quickly add your comments below, or e-mail me: shawn.kennedy@wolterkluwer.com.
And as an fyi, the debate over 8- vs. 12-hour shifts is hardly new. Here’s an excerpt from the May 1929 issue of AJN:
Working 12 hour shifts leaves me beat. You have no time in your day to do anything other than sleep and work and your day is normally 16-18 hours long. High patient ratios lead to lost breaks, I live and work in Florida and have never had a 15 min break in the morning or afternoon, often times lunch is missed or crammed in to 10 mins or less. After 3 back to back shifts, my only thought is my off day. You are mentally and physically exhausted, I can defiantly see how judgement can be impaired and mistakes can be made.
I agree with your viewpoint of staffing making a world of difference in quality and safe delivery of care. It also impacts job satisfaction. When we are severely understaffed, nurses, patients, patient care techs and even secretaries grumble and have shorter tempers. However, the bottom line is administrators will wring every lost ounce out of you for the sake of their financial bottom line.