This issues cover story examines the pros and cons of the 12-hour shift. From increased schedule flexibility to sleep deprivation, nurses have long debated the costs and benefits of the longer shift. New York and New Jersey recruiters share how the availability of this schedule impacts recruitment, retention and bedside care in their hospitals.
Ronni Schultz, RN, MA, Clinical Recruiter, Brookhaven Memorial Hospital Medical Center, Patchogue, N.Y.Ronni Schultz, RN
Our decision to offer the 12-hour shift on most of our nursing units has impacted recruitment and retention efforts in a positive way. It may be a key deciding factor that affects a nurses decision to seek employment at our facility.
For the staff nurse, the 12-hour shift supports work-home balance issues, which affords the nurse more time off to attend to personal and family needs and to pursue educational opportunities. From the perspective of patient care, nurses express their satisfaction with having more time to organize and deliver personalized care, often leading to a less stressful day.
However, the reality is the 12-hour shift is not for everyone. Increasing numbers of nurses are expected to retire over the next 10 years. As our nursing staff mature in age, we find that a desire to work 10- or eight-hour shifts is more manageable and desired, said Kim K. Mendez, RN, EdD, ANP-C, vice president and CNO. Our focus will align with the demand. Flexible staffing can provide the opportunity to support retention of senior nurses and ensure that knowledge gained through experience at our organization remains at the point-of-care.
Our most valuable resource is talent. Aligning staff flexibility to meet patient care workflow is a win-win situation.
Nancy Miller, Nurse Recruiter, JFK Medical Center, Edison, N.J.Nancy Miller
The implementation of 12-hour shifts began a decade ago in the critical care units at JFK Medical Center in Edison, N.J. The 36-hour week was recognized as a retention tool by nurse managers who discovered they were losing skilled and experienced nurses to other facilities while also faced with a national nursing shortage at the same time.
The shorter, concentrated work schedule came as a positive option for nurses who were struggling to maintain a balance between family time and work hours. The 12-hour shifts provide needed flexibility and additional time for staff members to rest and focus on other professional issues, such as furthering their nursing education. A five-day, eight-hour work week often could not accommodate the type of time management a goal-oriented professional required.
Nurse managers report RNs begin the shift refreshed but sometimes the longer time frame leaves staff with little energy when the shift is over. Despite this downside, med/surg units were quick to follow the critical care units in adopting the 12-hour staffing schedule, and both nurses and the allied support group chose this flexible scheduling option.
Laurie Cariglio, Recruitment Manager, Patient Care Services, New York Hospital QueensLaurie Cariglio
Ive been recruiting RNs at New York Hospital Queens for the past 12 years. When I first came to the hospital, our RNs only worked 7.5 hours a shift. I was in need of ED nurses for our trauma I ED. Every time I received a call from an experienced ED nurse, his or her first question was Do you have 12-hour shifts? No one was interested in working for us if we didnt have 12-hour flex time.
Stephen Mills, president and CEO, and Michaelle Williams, RN, MA, CNAA, BC, senior vice president of patient care services, questioned me about our lack of recruitment for ED nurses. When I explained the lack of interest in our 7.5-hour shifts, they immediately worked out a contingency plan to create 12-hour flex shifts for the ED. Once 12-hour flex shifts went into effect my recruitment problems completely turned around and we were able to fill our vacancies. Twelve-hour shifts worked out so well, we implemented them into all our patient care service units.
Three days on, four days off helps RNs regenerate, especially the night shift staff. Changing to 12-hour flex time has definitely helped our hospital recruit and retain our nursing staff.
Rosemarie Moshier, Manager, Nurse Recruitment, Nyack (N.Y.) HospitalRosemarie Moshier
Although some of our units still operate on an eight-hour shift schedule, most of our units have been using 12-hour shifts for quite some time.
Its been a successful strategy here when nurses call me about a job at Nyack because 98% of the time they are interested in 12-hour shifts. Our nurses work every third weekend, so especially for the young RNs who have other family responsibilities, the work schedule at Nyack suits them professionally and personally.
There are still other nurses who prefer the eight-hour shifts, and we have that schedule available on some of our units, like the PACU, pain management and ambulatory surgery. Over the past year, we have changed our schedule for training and orienting new hires. We use the eight-hour model for the initial orientation time, then the nurses move into the 12-hour shifts once they have completed it. This change seems to have worked out well for everyone involved in the precepting and orientation of our new nurses.
Karen DeLorenzo, RN, BSN, CHCR, Director, Nursing Recruitment & Retention, Lutheran Medical Center, Brooklyn, N.Y.Karen DeLorenzo, RN
At Lutheran Medical Center, 90% of our RNs work 12-hour shifts, which enables them to balance work and home obligations. In addition, the flexibility of working 12-hour shifts gives nurses an opportunity to seek educational and professional advancement on their own time. For example, many of our RNs are enrolled in BSN and MSN programs, attending classes and conferences on their days off.
Twelve-hour shifts and individual unit scheduling provide flexibility for the nurse managers to create schedules that provide adequate staffing on the unit, while accommodating the needs of the nurses. From a recruitment standpoint, 12-hour shifts are most desirable in the workforce today. Nurses working eight-hour shifts often seek positions at hospitals that offer 12-hour shifts, sighting the need for more flexibility and time to fulfill personal responsibilities and commitments.
From a retention standpoint, a work schedule that meets nurses needs is one ingredient in the recipe for retaining nurses and increasing job satisfaction.
Kathryn McLay, RN, Senior Human Resource Business Partner, Raritan Bay Medical Center, Perth Amboy, N.J.Kathryn McLay, RN
In February 2009, staff at Raritan Bay Medical Center completed a nursing survey specific to 12-hour vs. eight-hour shifts. The survey was conducted because some of our newer nurses had left our facility for others that had positions with 12-hour shifts. Surprisingly, the difference between the 12-hour and the eight-hour shift preference was only 3%, which we attributed to the wide range of generations in our workforce.
The survey highlighted the nurses need for flexibility, and that a one-shift preference would not meet everyones needs. Joan Harewood, RN, DNP, CNO, charged managers with the challenge of providing scheduling flexibility while maintaining optimum staffing for quality patient care.
Managers went to their unit practice councils to seek a solution from staff, and each unit was responsible for coming up with a plan.
At RBMC today, we have a variety of shifts throughout the organization, and recruitment is enhanced since we offer options in scheduling. Even though the shift preference may not be available at a particular moment, it is still a benefit for those nurses who are willing and able to wait. It is all about flexibility.
Karen Hanson, Director of Talent Acquisition and Retention, Hackensack (N.J.) University Medical CenterKaren Hanson
As we know, job satisfaction comes from more than just the money we receive from our employers. Improving quality of life is something for which most nurses strive.
Offering 12-hour shifts is one way HUMC demonstrates to its employees that we are listening to them. Our nurses have told us they want more flexibility in their scheduling, and offering a variety of shift options is one way to respond to this need.
We have recently launched a campaign, A Healthier You, which focuses on improving the lifestyles of our employees. Working 12-hour shifts allows employees more time to devote to their families and other activities, giving them a healthier perspective on life. Our nurses are dedicated to their patients, and being able to provide better continuity of care with the 12-hour shifts improves job satisfaction, too.
We are able to recruit and retain great nurses because of all we offer to our employees. The 12-hour shift is just one of the ways we demonstrate how important our nurses are to us.
Susan Shevlin, RN, MA, MEd, Assistant Vice President of Talent Acquisition, North Shore-Long Island Jewish Health System, Manhasset, N.Y.Susan Shevlin, RN
What is critical when it comes to 12-hour shifts is the implementation. In an effort to keep staff from becoming exhausted, our organizations limit the number of 12-hour shifts worked in a row to just two.
In reading blogs of nurses who work 12-hour shifts, they report they have more time to complete their assignments as opposed to rushing to complete their assignment by the 3 oclock hour. When staff work 12-hour shifts, fewer handoffs occur. This is a beneficial aspect that affects quality outcomes; fewer handoffs reduce the error rate. It also has been reported that RNs who work 12-hour shifts have less absenteeism, are less emotionally exhausted and are more satisfied with their jobs than those working a traditional eight-hour shift. These results are all without negative effects on patient outcomes.
The new competitive edge as the nursing shortage begins to return in the upcoming years will be how flexible employers are in scheduling staff. In New York, the average age of a nurse is 47.3 years old. As our nurses age, the appeal of 12-hour shifts declines. Organizations will be looking for ways to keep experienced nurses in the workforce as long as possible.
The American Association of Colleges of Nursing reports that by 2015 all states will be experiencing some degree of a nursing shortage, and by 2020 the impact will be widespread. Units will need to have a mix of staff working 12-, eight- and four-hour shifts as employers grapple with ensuring there are adequate nurses to provide patient care. We will be challenged by having four different generations in the workforce all with different views on what work-life balance means to them. The challenge will be how to create that work-life balance for all.