If nurses are really 'at breaking point', they should stop working 12-hour shifts

Doing a full week's work in three days is not in patients' interests

5 October 2013

9:00 AM

5 October 2013

9:00 AM

Scarcely a month goes by, or so it seems, without one or other representative body of the medical profession complaining about how dangerously overworked and generally unappreciated its members are. The latest is the Royal College of Nursing — still smarting, perhaps, from the Francis report into the fatal negligence at Stafford Hospital — which found that nurses today are frequently stressed out and ‘forced to choose between the health of their patients and their own’. Forgive me, but they would say that, wouldn’t they?

The preamble notes that morale has deteriorated since a similar RCN survey eight years ago published under the same self-fulfilling title, At Breaking Point. What the survey failed to spell out, however — and would be equally hard to find in any recent consideration of nurses’ grievances — is that the worst of the long hours are self-imposed, and take the form of the 12-hour shift.

Some shifts are even longer. There are web forums where you find nurses talking about working up to 14 hours on the trot, – and not because their ‘bully’ of a boss has demanded unpaid overtime, but because this is their shift, and they like it. They choose to work like this.

According to the Nursing Times, almost half of all NHS nurses now work shifts of 12 hours or more. These long shifts began, like so much, in the United States in the 1970s, and soon made their inevitable advance over here. In the US, the new shift patterns reflected difficulties in staffing night shifts. Here, it was always a tool for efficiency — or, to put it another way, for reducing numbers. But it rapidly became that holy grail of management: an economy measure so popular that it became a recruitment draw.

For a profession that is still predominantly female, the 12-hour shift is a boon. It allows nurses to cram a full-time job, with full-time pay, into three days a week. They save on the cost of child care; they save, too, on the time and cost of commuting. It is the ultimate win-win. They gain valuable family days, without sacrificing the money they would lose by working part-time. Some take second jobs.

Surprisingly, these 12-hour days have attracted no opprobrium either from the guardians of the EU Working Time Directive, or from the trades unions. So long as the weekly tally of hours is not too high and statutory breaks are observed, this shift pattern seems to be fine with Brussels. The trade unions have nothing to say so long as their members are happy — which, mostly, they are.

But there is a conspicuous absentee from this discussion: the patient. And some dissonant voices admit that, just maybe, these long shifts have a downside: as nurses clock up the hours, they grow more tired, more irritable, and more prone to make mistakes. Could it be that 12-hour shifts are to blame, at least in part, for what many patients regard as the deterioration in nursing standards over the past 20 years?

Some say, as do the managers, that patients benefit from continuity of care. But this continuity is through the day, not the week, and if the choice is between continuity and competence, what choice is that? This is an arrangement in which nurses, their professional organisations and their managers are effectively colluding against the interests of patients.

How cheerful, observant and considerate would you be after ten hours on the job? I was a tourism volunteer in London this summer and can attest that even six hours on your feet tests your stamina and humour. No wonder nurses retreat to their computers and coffee rooms at every opportunity. No wonder they ignore patients’ bells. No wonder they may not be as compassionate as we would wish. They are ten hours into their 12-hour shift, with a two-hour drive to get home. Apparently no one thinks anything is wrong.

Well, one person may do. Last April, the Chief Nursing Officer asked NHS England to review the safety of 12-hour shifts. With several American studies finding that long nursing shifts jeopardise care and lead to mistakes, this research is overdue.

Whatever the outcome, though, it is clear that nurses will be dragged kicking and screaming from their long days and short weeks. We, the patients, will have to gear up for a bizarre new stand-off in which nurses at once complain of fatigue while fighting for their supposed right to work long hours. They are currently demanding minimum staffing levels on wards. We should demand maximum eight-hour shifts.

Got something to add? Join the discussion and comment below.

Mary Dejevsky has worked as a foreign correspondent all over the world. She now writes for the Independent.

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Show comments
  • Peter Brown

    My wife is a nurse. She prefers the long shifts because she works fewer days. She saves on travelling time and costs and avoids the rush hour. On night shifts they are able to have a brief sleep for 90 minutes.

    I doubt that anyone goes into nursing expecting a 9 to 5 experience. If that is what you want, work for the council.

    We do not pay nurses very much. We don’t have to – if we run short we just recruit some more from the Third World. My wife can only afford to be a nurse because I pay the bills.

    Mrs Dejevsky has no idea of how nurses live, and presumes to dictate their working hours. Not everyone gets to work from home sipping on a soya latte.

  • Treebrain

    Excellent article that once again makes clear that all the talk of ‘patient-centric’ medicine is just a smokescreen to allow the NHS to be run for the benefit for those who work there.

    Three, eight hour shifts should be mandatory.

    There is sound, scientific research that shows that working for more than eight hours causing a profound deterioration in physiological responses.

    This is precisely the reason that lorries are fitted with tachometers, to prevent drivers working excessive hours that cause them to be a danger to themselves and others.

    Who does the UK government and medical profession insist drivers hours are limited but those of nurses are not?

  • Why is a 12 hour shift so hard? I work offshore all around the world and the basic hours are 12 hours per day seven days a week for six weeks. In all weathers. When you first do it, it takes some getting used to but it’s not the end of the world. When I worked deep sea the trips were 6 months long. Typically a minimum day was 10 hours and if there was a problem more than a day. Seven days a week for six months in conditions that are more like a Mexican sweat box. Try it on a steam ship in the Persian Gulf.

    My point being that I hear all sorts of people moaning about long hours and how impossible it is. Nonsense. Most of this is folk losing the understanding what work is and getting soft.

    • vasgar

      because my friend is not yet another job!!!you treat human beings in need and suffering and you are responsible for their health and life, you don’t work in factory line sealing packages…it requires a different level of alertness and concentration than most of other jobs…not all jobs are the same…is it so hard to understand…if you were sick sometime and and need to admit to a hospital, you would understand…every chronic patient respects nurses, but most of you have visited a hospital flloor one or two times in your life for 10 minutes…you don’t have the right to judge, because you have not knowledge of the matter…

  • Teacher

    I agree with what you say but if nurses worked eight hour shifts every day they would need more money for child care or they would have to leave work when they had children. Would people be prepared to pay more for better nursing?

    None of the problems concerning tired or tetchy nurses seem to happen in private hospitals. Nurses there in my experience are cheerful, efficient and polite. Do they work twelve hour shifts? If so, what conclusions can we draw?

  • Margot

    This article is long, long overdue. Also worth looking at are the long distances many are taking to get to work. With a mainly female workforce many jobs are ‘second’ ones i.e. they are worked around the husband’s job which takes precedence when decisions about hours, where to live are taken. This applies in education as well. Both teachers at a local small primary school were both travelling over 60 miles each way every day across rural roads. They were never available for out of hours activities etc. The salaries made it worthwhile. Most nurses’ salaries make such travelling equally worth it. There should be some sort of contract clause limiting the distance anyone needs to travel to work. With large distances now common they are in no way fit to work a full day’s work as a nurse or teacher. There are already accidents occurring with dog-tired workers making these huge journeys each day. Recently and just locally, amongst others: a young teacher was killed en route to work – she had left at 6.30 to make the journey on a notoriously difficult road; a doctor killed one person, maimed another in a hurry to do his every day 50 mile trip across narrow country roads.

    • mikewaller

      Long travelling distances were thought to be one of the limits to growth that would hold back both development and house prices in cities like Oxford; this on the basis that they would not be able to recruit enough people to fulfill a whole range of functions necessary for city life. Instead it seems the candidates keep on coming forward on the basis that they will travel from where they can afford to live to where they can get work. The above shows the price some pay,

  • Eddie

    Some nurses are great – a good attitude, very helpful, compassionate and polite – but many are not. That has NOTHING to do with pay or work patterns – it is to do with culture and attitude.

    The union rep for nurses (RCN) has actualled stated ‘there is no such thing as a bad nurse, only a nurse who needs more training’. No, no and no again. There are bad nurses – rude, arrogant, stuck up, lazy, who think helping an elderly patient to go to the toilet is beneath them.

    And frankly, the pay is great. You need a very basic education to become a nurse and then aged 19 or 20 can be earning the national average wage.

    And don’t tell me that all nurses need degrees. Yes I know – I have proof read many essays done for such courses. But really, the nurses union (them again) pressed for nurses to have degrees so they could argue that nurses were as professional as doctors so needed more pay, fewer hours, more perks etc.
    The old system was better – have nurses learn under sisters (charge nurses). They do NOT need degrees at all.

    The unions are a major problem here – they defend all nurses no matter what.
    What I have seen and experienced is that some nurses are unfit to wear the uniform and should be sacked immediately (maybe 15% of them, and mostly lazy British girls too, not foreigners). The rest – and doctors too – should be forced by law to work weekends, It is an utter scandal that death rates rocket in hospitals at weekends – would we put up with that in the airline industry? 3 or 5 times the average death rate of passengers at weekends?

    Time to start thinking about patients which the NHS is there to serve, and to stop listening to the lobbyists for lazy and unfit nurses.

    • Mike Barnes

      It’s the 21st Century, everybody needs a degree!

      • Eddie

        What I say is true and fair. When you have learnt to read – to the level of the very hungry caterpillar at lest – please get back to me, Mike Nurse.
        A lot of nurses are an utter disgrace and should be sacked – and indeed prosecuted for hastening the death of so many poor patients.

    • Michael Barnes

      Please go to university or learn how to use Google..! The ‘national average wage’ as you call it is around £26K in this country. Degree courses are minimum three years so a nurse would be at least 21yrs old when graduating. Charge nurses(senior male nurses) remain too few in the system; that is a fault of our entire culture(and education system) as well as the RCN.

      Most hospital doctors already work weekends, that has always been the case at junior level. Historically consultants were not seen outside 9-5 but increasingly they are much more visible outside office hours. Whilst drivers and pilots hours are seriously restricted, hospital doctors often work bizarre hours well outside the EWTD. The issue at weekends is more to do with the fact that the rest of the hospital shuts down on Friday pm meaning that tests, procedures, clinics, operating theatre lists and discharges are heavily restricted.

      In the UK basic nursing care is mostly supposed to be done by relatively untrained ‘health care assistants’ because the more technical aspects of health care which would be done by junior doctors have been taken on by nurses.

      Even in some European countries a larger proportion of basic care is still provided by the family(usually women) whilst a patient is in hospital. Because of our more fractured, atomised society a large proportion of Britons struggle with the idea and practicalities of feeding and/or nursing their own close relatives whether that is at home or in hospital. You have made some interesting and valid points but unfortunately you are still struggling with the very basics, like many nurses…..

      • Eddie

        Yes I know that every country has its own system – I lived in Greece once, and there relatives were expected to feed their relatives. But then, all the doctors and nurses smoked in the wards and corridors there too!
        Have you ever been in a hospital at weekends? Hardly anyone about – no wonder the death rate is much higher at weekends.
        And a nurse earns a very good salary – especially in places like the north, Wales and Scotland where property in cheaper than south-east England. Where else can a girl of lower academic ability earn £26k in her early 20s?
        In fact, I think they earn too much for too little – the RCN defends all nurses and makes it very hard to sack the bad ones, or even to criticise them.
        I have been through the NHS complaints process and still bear the scars on my back. The managers, surgeons, doctors and nurses regularly lie and engage in cover ups to protect their own.

        • Michael Barnes

          Eddie, most of us agree with what you are saying but you need to research the facts to boost your argument. Registered nurses(with degrees) start at 21,176 per annum. Clearly not all of them are in their ‘early 20s’..! Many will have come from another career, started training after having a family or have come back after a career break. Some work part-time in order to look after relatives; not always children but elderly or disabled family members. Most staff nurses do not in fact work long hours but then rarely do most public sector employees. That is a fact of long term government legislation and union power. Health care assistants(HCAs), unregistered nurses are less well paid although the money is very good for the level of training and education. The dilemma that most countries have is that if you pay peanuts for HCAs you will generally get drivel or they will simply work in the supermarket with better conditions! There is a fight to make hospitals more 24/7 style but this will be fought tooth and nail by many different groups and their unions… It is extremely costly to make ‘non-medical’ and supporting medical staff work out of hours so even if HMG were to pay the senior doctors more or just force them to do extra time they would be seriously restricted by lack of supporting staff. This would be money and effort being needlessly wasted. Naturally improvements in technology are already helping free up time and expertise however the NHS is very slow to take up modern technologies and has a terrible track record of waste in this field. Fragmentation of the NHS and concentration on only ‘core’ emergency treatments may be the only way to drive up standards overall but that is a very controversial step which few politicians and clinical staff want to take…. Keep reading!

        • Hannah

          I don’t care how unintellegent you will percieve this reply. You sir, are f*cking ignorant and also a sexist pig. Don’t act like you know what it is to be a nurse unless you are one.

        • Lisha

          I think Michael makes very valid points and obviously knows what he is talking about. Hospitals seem dead at the weekend because there are less doctors, kitchen staff, porters, IV nurses, ward clarks etc. On my ward, the amount of nurses everyday NEVER CHANGES, it’s everyone else that leaves so take your blame elsewhere. Nurses run the hospital, we take the brunt of patient’s and relatives complaints about the NHS as a whole – I understand their plight but there is absolutely nothing I can do about it. Start with Cameron and the cuts and there is your answer. I work on a very busy, very big acute surgical ward with very sick patients and my day is mentally and physically challenging. Yes, you can be a nurse with a ‘lowly academic ability’ but you won’t be a good nurse without intelligence. I had a degree before nursing and i am an intelligent woman and it really annoys me when doctors, the press, the public, assume that i’m stupid or i’m a failed doctor. I’m a nurse because i stand by my patient even when they are shouting and spitting at me, even when they have done some heinous crimes and even when they personally target me. I also stand by my patient when they are dying, when they are too weak and too frail to go to the toilet on their own or when they are too sick to sit themselves up. I earn every cent of my money and my patients often notice that i work incredibly hard and i have an incredible amount of work and responsibility during my day.

          You have obviously had a bad experience, but DO NOT tarnish us all with the same brush. The nurses I work with are fantastic and so am I.

        • vasgar

          so: 1) ”of lower academic ability”…what exactly do you mean??is it a disrespectful arrogant comment??is it not a university school??what about the nature of nursing??do you thinh that it is a job just a s every other job??like a bank or office clerk who sits and presses keys on keyboard PC, sipping coffee?? it has long shifts, risk of infectious diseases, musculoskeletal and nervous fatigue (e.g lumbar pain, need to transfer or carry heavy load ), you have to work standing for long hours without rest, need to come in touch or handle bodily fluids, urine, faeces, it involves emotional stress, grief etc…it is a job with SPECIAL demands and a HAZARDOUS job, …GIVEN THE OVERALL NATURE AND DEMANDS OF THE NURSING JOB I THINK IT IS AN UNDERPAID JOB!!I THINK that you don’t have respect for the nursing job, because you don’t have respect for human life and health…people nowadays respect a general who orders bomboing of innocent people more than a nurse that takes care of your elder parent…that is the fall of modern society…that is why youngsters disgused by the modern values and self-centred people who do not consider the difficulties of others and think that their needs is the center of the world, flee west to join isis…

    • Rocksy

      I couldn’t agree more. Well Put!
      Almost all my experience of nurses as a patient, as a visitor and on both sides of the Atlantic is of petty tyrants of minimal intelligence.

      • TLC

        I have a first class science degree and recently a first class nursing degree. I found the nursing degree to be FAR harder. I think it would be easier to become a doctor but I wish to spend time looking after patients and for this reason I have no ambitions to move up the nursing ladder and become more office based.
        I work full time as a nurse and the 12 hr shifts although murder on my feet and legs are much better than the previous late-early 8hr shift pattern. This is because a late early can mean you only get 5 hours sleep and you also need an extra 40 minutes or more to hand over 34 patients at early afternoon shift changeover. Every minute counts and I frequently go home late. Patients and their relatives are always exclaiming that I have dealt with what has been a frustrating day for them with a very caring attitude.
        I prefer not to be thanked as I dont like the limelight, I get great satisfaction from raising a smile on the face of a patient who may be poorly or who may have dementia and are not aware of who I am.
        A great deal of knowledge is needed for me to safely care for patients with pressure sores, respiratory diseases, cardiac problems etc who are on IV fluids, antibiotics, morphine and hundreds of other medications. Picking up prescription errors made by doctors that could endanger the patients health is a daily occurence.
        Doctors on my ward go to the experienced nurses for advice on many things.

    • vasgar

      again you don’t say a word about the nature of the nursing profession and the hazardous environment in which a nurse has to work…or the mental and emotional efoort that is needed….a nurse treats patients, she doesn’t work in an assembly line…i have high respect for the working class, but i think copying with human suffering an death is a litttle bit different, don’t you??? your comment below : they earn too much for too little!!!!”… so a human being’s life, health and well being is something trivila for you…and you did not tell us…what’s your job????

    • sar

      I personally do not know any nurse who has a basic education. I will assume you are not a nurse. Nor have I worked with a lazy nurse, how insulting of you to make this statement.

      Also where I work we have doctors all weekend and nights, as well as the same number of nurses and health care assistants.

      As a nurse my assessment of a patient ensures timely interventions and it is I who informs doctors on a deteriorating patient.

      And to say we get paid enough, really! I go without breaks and lunch, often leaving late to ensure I give a accurate and safe handover.

      Do you realise we nurses spend our entire shift with our patients and very often our skills save lives.

      Also, if I worked just 3 days out of 7 would be a dream, try 3 long days followed by a long night. 1 sleep day 1 day off then 4 long night’s, 1 sleep day, 2 days off then 4 long days, 1 day off. Try no month ever having a pattern of shift, imagine feeling jet lagged most of the time.

      Try turning 6 full care patients 2 hourly to prevent pressure ulcers, 2 productive tracheostomies requiring regular suctioning, TPN, epidural infusions, morphine PCAs, stoma and vac dressings, 4 of your patients with multiple IVIs, septic patient requiring hourly observations who is delirious and has become violent.

      That is a normal day where I work on a level 1 unit, can you really say I’m uneducated?

  • MilkandTwoSugarz

    My mother has been a nurse all of her working life. In the past she had been working around 10 hours everyday – with at least one or two days a week being 8am to 10pm. She is now a care home manager for the elderly. She now literally works 7 days a week from 9am to midnight just to keep a roof over our heads.

  • Jackthesmilingblack

    “If nurses are really ‘at breaking point’, they should stop working 12-hour shifts”
    That`s about as sensitive as telling a hunger striker, “If you don`t like the food you don`t have to eat it.”
    Jack, the only Brit in the village

    • Toby Esterházy

      Are you a Leftie all along? If so, why don’t you go back to the New Statesman?

  • Awakeup2U

    An excellent, well overdue article. Ms Dejevsky has great insight into the world of nursing/caring. Nurses do certainly, personally choose these long shifts and the patients do suffer because of that choice. Somewhere, someday I like to believe that the patient will come first and I thought Mr Cameron was “onto” starting the ball rolling. Nursing is a well paid, secure job but nurses are never satisfied – they want the public to pay each and every way. They choose the shifts and then cry overworked to the public. Furthermore, some nurses go to 2nd. jobs after those long shifts (usually at aged care facilities) Imagine how mentally capable they are after those hours ! (but maybe they don’t feel they need to be so mentally alert to look after the aged patients). Nursing needs a shakeup.

    • Charlotte Maddison

      Rubbish….ill informed rubbish

  • Paul

    “There are web forums where you find nurses talking about working up to 14 hours on the trot, – and not because their ‘bully’ of a boss has demanded unpaid overtime, but because this is their shift, and they like it. They choose to work like this.”

    Can you please provide citations for this?

    I personally know no nurses who choose their working hours in this manner. The shift patterns are dictated by individual NHS trusts, not individual nurses.

    This is sloppy journalism, looking to scapegoat an abstract group of individuals linked only by their profession. At least consider lobbying the policy makers who implement and have the power to influence these decisions.

  • Barbara

    One extra day off per week is all nurses have, let them have it. The staffing ratio of 1 nurse for 8 patients is what put patients at risk, not long shifts.

  • Hannah

    I am almost a qualified mental health nurse, and having worked in both adult and mental health settings I can assure you that the 12 hour shift is not ‘loved’ by all nurses as you have so rudely put across in this article. Nurses also do not wish for wards to be understaffed – that is just rediculous. There is a highly ignorant presumed bias within this article which appears to point the finger at 12 hour shifts being the root cause of staff burnout and lack of appropriate care. Whilst they may be a minor contributor, I can assure you there are many other factors – including the top-down culture in the NHS making it very common practice for it to be unnaceptable for staff to take any breaks (particularly in 8 hour shifts) essentially meaning that within a 5 day week which equates to 2.5 hours of unpaid work per week. The lack of breaks, demotivating factors, lack of staff, lack of budget, lack of ability for you to provide the level of care you want to provide all contribute also. Also, nurses do not ‘hide’ in nursing stations for the fun of it, unfortunately there is a large amount of paperwork imposed on nurses which we have little control over.

    I find this whole article so rediculously offensive. Don’t get me wrong, I want only the best possible standards for those within my care and I am highly highly passionate about my carrer choice. But this whole patronising view of nurses not being selfless enough and being persecuted for taking any interested in themselves or their rights is condecending and patronising.

  • Dawn Brennan

    In our Trust, we have to work two 13 hour shifts per week. We do not get a choice. I’ve no doubt in my mind it is because it helps the Trust save money. Most of my colleagues would prefer not to have to work 13 hour shifts.

  • Charlotte Maddison

    In most case nurses work in excess of the paid 8 hour shift, therefore it would seem reasonable and fair to change to a paid longer shift.

    • Awakeup2U

      rubbish – they do not

  • Nursey

    Not all nurses want to do 8 hour shifts but can be/are coerced by managers and colleagues to do 12 hours shifts

  • vasgar

    the self-centered arrogant commentors want a better care without paying for the quality they want and of course at the expense of other hard working people. most of them would not stand a month handling the emotional and physical stress, the night shifts, handling bodily fluids etc…i bet htey turn their head away when venipunctured…but they can share their ignorance and inhumanity with us…they represent the infamous ”public opinion”…learn to care for your fellow humans or if you can not (and i bet you can’t) stop underestimate the intelligence of those who care…if someone wanted to make money and be lazy, he would be a banker not a nurse…

  • John

    I agree with Peter. I work in a Hospital. I’m not a Nurse, I’m admin, but the article is wrong about so many points. Absolutely awful journalism. Completely misses the real points… perhaps so far as intentionally demonising nurses.

  • Alexander White

    Mary, you are an ignorant troll, just out for comments. You should be ashamed of yourself. You clearly could never comprehend the hard work that goes into training to be a nurse or a doctor or other healthcare professional and the continued hard work every working day. The hardest work you have to do is thinking up the most insulting title possible for your article. The papers you write for should be ashamed of themselves for printing this drivel.

  • Carolyn Black

    Think you need to get your facts straight before you publish inaccurate articles like this. You’ll find now that most NHS Trusts are now making it mandatory for new staff to work long days. You need to do your research. Call yourself a journalist!

  • Al

    You assume a nurse only works three twelve hour days a week. I regularly work four, sometimes five twelve hour shifts a week and no, it is not by choice. I have been on nights for almost 9 weeks now and it isn’t by choice either. 6 hours on your feet may test your stamina but I feel fine after a 12 hour day, its when you do too many in a row when the tiredness can kick in. I don’t have time for my one hour break let a lone coffee breaks and unfortunately a lot of my time is taken up with paper work that forces me to spend large parts of my day in the office. The problem isn’t just the hours, its the lack of staff among other things. You have simplified a problem that is complex and it is evident you don’t really know what you’re talking about. I invite you to spend a twelve hour shift on the ward I work in, a busy London acute mental health ward, It would be interesting to see how you manage.

    • goodsoldier

      Why don’t you have a choice?

  • Mr B J Mann

    “So long as the weekly tally of hours is not too high and statutory breaks are observed,”

    How often do they actually manage to take their breaks (the traditional ones as opposed to the academic PC and Clipboard degree qualified nurse)?!