Long hours, shift work still plague nurses

Working long hours and short staffing have been identified as two problems for nurses for some time

When you work long hours, whether voluntarily or out of staff number necessity, you are not functioning at your best. Short staffing results in fatigue, burnout and dissatisfaction with your job.

When you’re fatigued and overwhelmed with responsibilities — and you see no changes are coming — patients are at a higher risk for injury or compromised care.

Shift work is a norm of nursing practice. In the past, nurses worked various shifts and many alternated shifts from day to night and back to day, all in a span of a week or two. When the nursing shortage began, more flexible hours were adopted. As you may know, 75% of hospital nurses now work 12-hour shifts.

Twelve-hour shifts are beneficial for many reasons, but one drawback may be an increase in fatigue and less sleep, especially when hours are added to the shift or other stressors compound. For instance, a nurse may be asked to attend meetings after quitting time or he or she may have few breaks or meals during the shift.

A study conducted by the Pennsylvania Patient Safety Reporting System showed working a 12-hour shift or working overtime was related to having trouble staying awake during the shift, reduced sleep times and nearly three times the risk of making an error. The study also indicated the “most significant” error risk seen was when the nurses worked 12.5 hours or longer (See Rachael Zimlich, “Reconsidering The 12-Hour Shift For Nurses” 2014, Healthcare Traveler at.

The most common medication errors identified in the Pennsylvania study due to nurse fatigue were wrong doses, dose omission and extra doses.

nurse sitting on floor, stressed nurse

Connection to ratios

Inadequate staffing is a major deterrent to your role of ensuring a patient’s safety and well-being. Many studies analyzing nurse-patient ratios overwhelmingly indicate that having more qualified and competent RNs on duty leads to the better patient outcomes and lower rates of patient deaths and decubitus ulcers.

In addition to the potential effects on patient care long work hours, lack of sleep and short staffing also adversely affect nurses’ health. Obesity, diabetes, depression and cardiovascular disease are a few of the potential risks of a lack of adequate sleep.

It is vital for nurses to change these age-old working conditions. Doing so is necessary not only for patients but also for nurses. If a patient injury occurs due to a nurse’s fatigue or anxiety or short-staffing, the nurse’s potential liability is at stake.

Here are some ways nurses can make decrease these risks:

• Advocate for changes in your workplace through your CNO and other available avenues (e.g., union membership, community education).

• Become an active member of your professional associations (e.g., ANA, specialty nursing associations) and participate in their respective legislative initiatives to eradicate these issues.

• Recognize the signs and symptoms you experience due to fatigue and lack of sleep and make necessary changes (e.g., say no to extra shifts, seek medical attention, get adequate rest/sleep).

• Support and respect your fellow nursing staff members.

• Be mindful and focused when providing patient care.


Nancy Brent’s posts are designed for educational purposes only and are not to be taken as specific legal or other advice. Individuals who need advice on a specific incident or work situation should contact a nurse attorney or attorney in their state. Visit The American Association of Nurse Attorneys website to search its attorney referral database by state.

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About the Author:

Nancy J. Brent, MS, JD, RN
Our legal information columnist Nancy J. Brent, MS, JD, RN, concentrates her solo law practice in health law and legal representation, consultation, and education for healthcare professionals, school of nursing faculty and healthcare delivery facilities. Brent has conducted many seminars on legal issues and has published extensively in the area of law and nursing practice. She brings more than 30 years of experience to her role of legal information columnist. Her posts are designed for educational purposes only and are not to be taken as specific legal or other advice. Individuals who need advice on a specific incident or work situation should contact a nurse attorney or attorney in their state. 


  1. Avatar
    REHEMA MAHIMBO April 18, 2017 at 7:44 am - Reply

    I am a Tanzanian Registered nurse, I am very happy to see you as a Lawyer in Nursing Practice.
    I request to learn more from you.Is it possible for you to share with you in case of any challenges facing Nurses?
    Thanks in advance.
    Rehema Mahimbo

    • Sallie Jimenez
      Sallie Jimenez April 21, 2017 at 1:21 pm - Reply

      Hello Rehema,

      Questions for Nancy Brent, MS, JD, RN, can be sent to [email protected].

      Thank you for your interest.

  2. Avatar
    A. Steele July 30, 2017 at 4:49 am - Reply

    The information discussed in this article is accurate. Nursing has become stressful due to the lack of adequate staffing. Not only is there inadequate staffing of nurses, but CNAs as well, this is causing nurses to fill double positions, (CNA and the Nurses).

  3. Avatar
    FIHPR August 31, 2017 at 2:35 pm - Reply

    Greatly enjoyed this article :), keep up the great authorship and I’ll keep coming back for more.
    Will be sharing this wifh my instagram followers and I’m
    sure they’ll love it as well!

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