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12+ hour shifts heightens risk of burnout

Working such long shifts also linked to job dissatisfaction and intention to leave for nurses

Ingrid Torjesen

Friday, 11 September 2015

Working 12+ hour shifts is linked to a heightened risk of burnout, job dissatisfaction, and intention to leave among hospital nurses in 12 European countries, research published in the online journal BMJ Open has found.

The researchers surveyed 31 627 registered hospital nurses (response rate 62%), excluding those working in intensive or long term care units, in 488 hospitals in Belgium, England, Finland, Germany, Greece, Ireland, The Netherlands, Norway, Poland, Spain, Switzerland and Sweden, between 2009 and 2010. The survey included 118 questions, relating to the demands and experience of the job itself, the most recent shift worked, and personal details.

Burnout was assessed, using an internationally validated three-dimensional measure (MBI), and participants were asked directly about their levels of job satisfaction and intentions to leave.

The average age of the respondents was 38, and most were women. Almost two thirds worked in hi-tech and/or teaching hospitals. Over half (57%) worked in medical units, and the remainder in surgical units.

The most common shift length was 8 or fewer hours (50%); almost a third (31%) worked 8-10 hours; 4% worked 10 to less than 12 hours; and 14% worked 12-13 hours. Just 1% worked more than 13 hours.

But 12 hour+ shifts were more common in certain countries, with 39% of respondents in England, 79% in Ireland, and 99% in Poland, working this shift length. And more than one in four of the entire sample (27%) had worked overtime on their last shift.

Around one in four (27%) respondents reported high emotional exhaustion, while 10% said they experienced high depersonalisation and 17% low personal accomplishment – the three dimensions of burnout. Around one in four expressed dissatisfaction with their job; a similar proportion were equally dissatisfied with their work schedule flexibility, and a third said they planned to leave their current job.

The analysis of the responses showed that shift length of 12+ hours was associated with greater levels of burnout in all three dimensions; job dissatisfaction; working schedule dissatisfaction; and intention to leave. For example, job dissatisfaction rose to 40% among those clocking up shifts of 12+ hours compared with those working shifts of 8 hours or less, while the intention to leave rose to 31%.

Furthermore, working 8 hour shifts was associated with poorer job satisfaction, while working overtime was linked to unfavourable outcomes in all domains, irrespective of the actual additional hours worked.

The researchers said: “Current literature tends to report that 12 h shifts represent a way to retain nurses in hospital clinical practice because it is believed to be the preferred shift length and that nurses are more satisfied with their jobs: our results suggest the opposite.

“Therefore, our findings pose substantial questions for managers, most notably because job satisfaction is a consistent and robust predictor of remaining in a job.”

They add that employers need to be aware of the potential effects of burnout, which include a heightened risk of making a mistake, poorer quality of care, compromised wellbeing, and increased absenteeism and high staff turnover.

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