I’ve been following a LinkedIn ANA thread about 12-hour shifts and it’s received a great many comments. Without counting, I’d say most responders to the thread are opposed to 12-hour shifts, or at least recognize the associated health problems. These shifts are typically done 3-4 times per week, consecutively. And therein lies the rub.
Here’s my story about working 12-hour shifts and how it became deadly.
Not long out of nursing school in the 1990s I took a job at a large teaching hospital in the US. It was my first hospital job after graduating from Northeastern University’s BSN program and like all new grads I was eager to get going and excited about this first job. I was hired to work on an ICU step-down floor rotating days and nights. Two weeks of days followed by two weeks of nights, three shifts one week and four shifts the next (consecutively) – this lead to four hours of overtime every pay period and I don’t recall if we were given OT.
I knew going into it that I was definitely not a night shift person but I thought I could “tough it out”. Many nurses love working the night shift. Reasons cited for liking 12-hour shifts on the LinkedIn thread were more time with family or for other pursuits, less commuting time (with less gas consumption), and better continuity of care for patients. But the negative reasons cited for 12-hour shifts carried the most weight. They included extreme fatigue (mimicking alcohol intoxication) leading to drowsy driving with resultant car accidents involving injury and death, over-scheduling with lack of down time for rest, higher infection rates, more job-related accidents (e.g., needle sticks and back injuries), mental illness, and hypertension – not an inclusive list.
The first couple of weeks I worked day shift. It was exciting. We all had pagers that hung from our scrub pants waistband that (in the beginning) made me feel like a VIP. We wore faded blue hospital scrubs with the hospital’s logo stamped on each side of the tops and bottoms. With my ID on a lanyard around my neck displaying a happy new employee smile, my black Littmann stethoscope from nursing school draped over my shoulders, hemostats with attached roll of paper tape clamped to the bottom hem of my shirt, a pocketful of alcohol swabs, and miscellaneous extra IV parts and syringes in my pockets — I felt like a champion saver of lives.
But our patients were really sick and “crashing” all the time. Codes were routine and I quickly learned how to do chest compressions. Ten years ago, or less, these patients would have remained in ICU. They were recovering from gunshots, horrific car accidents, suicide attempts, burns, and many surgeries that didn’t go as planned. We also took medical ICU overflow. We had it all. It was like a chronic emergency room. Some patients were there for months because they couldn’t recover; they were stuck somewhere between life and death. The hospital’s ethics committee was a frequent visitor.
I was learning at a frantic pace and it didn’t take long before the job stress started to mount, especially when I had to transition from days to nights. I remember walking in the hallways at 3am and the walls and the floor would be moving around like a strange hallucination. We had drop-down wall desks in the corridors called “wallabies” and I recall standing there on fatigued legs, leaning against the little gray makeshift shelf, head in my hand, trying to stay awake to recall details that needed documenting on the nursing flow sheet (“What were those vital signs…? What did his abdomen feel like…? What was that heart rhythm again…?). I could have fallen asleep standing up. Then like an alarm clock my pager would start beeping. I’d swiftly close the “wallabee” and off I went. We were constantly running in all directions.
I remember what it felt like trying to give report to the next nurse inheriting my patients at 7am, the one I swear I just spoke with a few hours ago. I tried to give a good report but I was barely awake. Walking outside into the parking lot, passing all the freshly rested bodies walking towards the hospital, I felt like a zombie. Getting into my car I’d pop a Benedryl in hopes that it would facilitate a faster nod-off when I hit the bed. Driving in the eastbound lane headed home the sun was blindingly bright. Gosh, looking back now, what a recipe for a car accident that was! I used black-out curtains in my bedroom to help mimic nighttime, hoping to trick my exhausted brain into thinking it was really 11pm. I slept poorly and “morning” always came far too soon. When I got back to the unit 12 hours later it felt like I’d never been gone.
One memorable day I came onto the unit ready to start work. I swiped my badge through the time clock at the precise moment allowed by HR and walked into the nurse’s station to see everyone looking grim. I was informed that one of our nurse colleagues wouldn’t be there that day. She had hanged herself the night before and was dead. While some of our nursing staff had become pretty tight, she had kept to herself. I recall she was friendly but somewhat withdrawn.
When I think back on this nurses’ death I don’t recall there being any sort of staff “debriefing” as should have happened. We had to go straight back to work, suppressing our recollections of her face and voice as we hurried through our work.
Clearly we missed something during that time. One doesn’t spend half their waking life with another person, side by side, and not notice something. But we didn’t, or didn’t take the time to check in with her, probably because we were too busy and too exhausted. Did any of us feel guilty for not helping her? I don’t think we thought about that either. It got stuffed down with the rest of the raw emotion that all nurses experience on every shift. We witness life, suffering, death, and dying all day long. That’s just what we do.
Physical stress leads to mental stress and we all know this to be true. As nurses we get so caught up in caring for other people that we neglect ourselves. We care for our patients, their family members, our own families, then maybe, if we have the energy, we might add a little oxygen to our own tanks. The nurse colleague we we lost that week did not get the care she needed and deserved, and I am so sorry for that. I apologize to her and to her family.
Hospitals have an obligation to help nurses care for themselves because they know we aren’t good at it –and I believe perhaps they take advantage of that. Some facilities are stepping up to the plate and are putting measures in place to help mitigate negative effects. But the 12-hour shift probably isn’t going away anytime soon. Meanwhile, I believe no nurse should be required to work more than two 12’s in a row and no more than three of these per week.
Nurses, take the time to check in with your colleagues. Speak up to your management regarding concerns you might have about staff safety. Don’t be a robot by doing everything you’re told to do – stand up for yourselves and your coworkers if you see something unjust. We aren’t dispensable just because there are so many of us. We’re all human beings.