Types of Nursing Shifts

Registered Nurses Work

Related to Patient Care
Alicia Leone, Lisa Palmer, Tori McCormick, Alyssa
Streb, and Kristy Vrona
 Effects of Types of
Nursing Shifts
When you are down a team member it is noticeable

Health of patients and nurses

In patient care regarding; medication errors and

safety, how does the type of shift with respect to
length and time affect these factors over the patient’s
length of stay in a critical care setting?
Patient Safety
 Patient Safety
Types of Shifts influence how the patient receives care

Day shift vs. evening/night shift

Lack of physical and human resources

Resulting in patient care errors

 Patient Safety
Rotating/night shifts

sleep deprivation

sleep is a biological need

patient care errors increase with evening/night

shifts

sleep deprived person cannot reliably stay

focused
Medication Errors
 What is a medication
error?
A medication error is any preventable event that may
cause or lead to inappropriate medication use or patient
harm while the medication is in the control of the health
care professional, patient, or consumer.

Medication errors still continue to happen even though

there are guidelines to follow during the medication
process of prescription, transcription, dispensing or
administration.
Nurses are the final check point of making sure that a
medication is going to be delivered safely, so they will
receive the final blame even though there are multiple
members of the health care team involved such as
pharmacists and physicians.
 What causes medication
errors?
During my research, I found a report by the Institute of Medicine (IOM), which indicated 44,000-98,000
people die each year in hospitals due to medical errors and these are some of the causes:

Fatigue

Long work hours

Incorrect drug calculations

Failure to follow protocol

Lack of knowledge

Time pressure

Staffing levels

Inexperience

Inadequate equipment
 Different Research
Studies
While I was doing my research, I found four different studies that
were done to determine if nurses being tired and having an
increased workload contributed to medication errors.

Rodgers and colleagues who examined work patterns of staff

nurses in hospitals determined if a relationship existed between
the number of hours worked and the frequency of errors. Their
findings revealed not only the number of hours worked per week
had a significant effect on errors, but also the likelihood of making
an error was three times higher when nurses worked 12.5 hours
or more in a shift. More than half of the errors involved medication
administration.
 Different Research
Studies
I then looked at different research studies that were done to determine what a nurse
specifically perceives as the cause of so many medication errors and here were the
findings:

Fatigue and exhaustion

Failure to follow the five rights of medication administration

Confusion with drugs with similar names or similar packaging

Length of shift

Excessive daytime sleepiness

Distractions

Confusion regarding infusion devices

 Different Research
Studies
The last research study I looked at was done to determine
the number of reported errors, types and severity of errors,
and units on which errors occurred during three nursing
shifts in one hospital.

The results were decreased staffing puts higher demands

on available staff, which in turn may lead to increased
workload; increased workload may lead subsequently to
increased fatigue. Both increased workload and fatigue
affect nurses’ ability to focus on tasks such as medication
administration.
If nurses are too tired to perform at the best of their
ability and they have too much work on their shoulders
or they are constantly interrupted during a shift, there
is a higher chance that they will not follow the
standard medication administration protocol.

The nurses role is a big part of the medication

administration process and it needs to be taken
seriously because this is a real and frightening event
in health care today.
Fatigue
 Fatigue
Is a growing concern as a registered nurse

Routine shifts are 12 hours and sometimes may be longer

Increased fatigue related to working 12 hour shifts may lead to injuries

such as

Needlestick injuries

Higher medical cost per injury than

those who worked 8 hour shifts

Car accidents
 Shift length
An evidence-based practice Rosswaum and Larabee
(1999) model was used in one study

An extensive review of the literature revealed 35

studies related to nurse fatigue and shift length

The literature review indicated shift length is

associated with nurse fatigue and is a growing
concern in the US with the routine shift length of 12
hours
 Sleep duration
A set of analyses were done to assess sleep duration on consecutive
shifts (Geiger-brown et al 2014)

The mean sleep duration for nurses between two

consecutive day shifts was 6.79 hours

The mean sleep duration between two consecutive

night shifts was much less, - 5.68 hours

Only 20% of participants slept at least 6 hours

45% of nurses reported a high level of sleepiness

 Insufficient sleep
insufficient sleep has been associated with cognitive problems, mood
alterations, reduced job performance, reduced motivation, increased safety
risks, and physiological changes.

Sleep deprivation may also cause

Accidental death type 2 diabetes

Memory problems heart disease

Hallucinations weight gain

High blood pressure

Weakened immune system

 Fatigue
The Occupational Safety and Health Administration
(2013) cautions people against working more than 8
hour shifts as longer shifts may result in reduced
alertness
Effects on Nursing Staff
 Effects on Nursing Staff
Mental and physical behavior

Inadequate amounts of sleep

Poor sleep cycles

Disorders related to lack of sleep

Obesity

Inflammatory bowel disease

Arterial hypertension

Cancer
 Regulation of Sleep
Circadian Pacemaker

Environmental Factors

Light

Social factors

Adjustments vs. Training

Effects of Rotating Shifts
Effects of Rotating Shifts
rotating shift is a day shift, evening shift, and night shift in some kind
of rotation.

Rotating shifts have been proven to have serious effects on the

health of the nurses working them.

These effects include: cardiovascular disease, lung cancer, obesity,

poor sleep quality resulting in fatigue, irritability, and increased risk
of injury.

There are also harmful effects on brain function including memory,

processing speed, decreased mental focus, and overall mental
power.
Effects of Rotating Shifts
One cause of these negative effects from rotating shifts is the fact
that people have a natural biological rhythm that is how the body
operates in a 24hr period.

Biological rhythms control human behavior and performance, sleep-

wake control, digestion, secretion of adrenaline, body temperature,
blood pressure, pulse and other vital signs”

Working rotating shifts does not allow the body to maintain a

consistent biological rhythm.

The inconsistency of rotating shifts can take toll on the nurse

working them
Effects of Rotating Shifts

With the biological rhythm being out of sync with the body
due to rotating shifts, chronic fatigue is a major side
effect.

According to ” Ferri, P., Guadi, M., Marcheselli, L.,

Balduzzi, S., Magnani, D., & Di Lorenzo, R. chronic
fatigue reported statistically significantly higher in the
group of rotating shift workers compared to other nurses.
 Brought to Light
Safety is most important in every profession

Contributing factors

Sleep habits

Length of shift

Type of shift

Implementing plan for change

Innovation

Trial and error

Determination
Allen, A. H., Park, J. E., Adhami, N., Sirounis, D., Tholin, H., Dodek, P., Rogers, A., Ayas, N. (2014). Impact of Work Schedules on Sleep
Duration of Critical Care Nurses. American Journal of Critical Care, 23(4), 290-295. doi:10.4037/ajcc2014876

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 References
Hewitt, P. (2010). Nurses’ Perceptions of the Causes of Medication Errors: An Integrative Literature Review. MEDSURG NURSING, 19(3),
159-167.

Lin, P., Chen, C., Pan, S., Chen, Y., Pan, C., Hung, H., & Wu, M. (2015, May 08). The association between rotating shift work and increased
occupational stress in nurses. Retrieved March 30, 2017, 308-312. from https://www.jstage.jst.go.jp/article/joh/advpub/0/advpub_13-0284-
OA/_article.

Majid, S., Masoudi, I., Moghadamnia, M., Sharif, M., & Barzegar, M. (2014). A Survey of Physical, Psychological, and Social Health Indices in
Shift Working Nurses. Retrieved March 29, 2017, from http://ijhr.iums.ac.ir/article_7655_84b89a61f45745e0af6a8ccd7dcb06af.pdf

Martin, D. M. (2015). Nurse Fatigue and Shift Length: A Pilot Study. American Journal of Critical Care, 33(4), 81-87.

Stanojevic, C., Simic, S., Milutinovic, D., (2016). Health Effects of Sleep Deprivation on Nurses Working Shifts.183-188

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