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Nurses’ communication and driving skills suffer after 12‑hour night shifts

Lois James standing next to a hospital bed with a nursing manikin inside a simulation lab.
Lois James in the WSU College of Nursing’s simulation lab.

SPOKANE, Wash. –  Working consecutive 12-hour night shifts impairs a nurse’s communication skills and driving abilities, a three-year study by researchers at Washington State University found. 

The study was intended to look at the safety of 12-hour shifts, which are typical for hospital nurses, said lead author Lois James, associate professor and assistant dean of research at the WSU College of Nursing. 

“With nursing there’s very little monitoring and no regulations at the federal level in terms of safe work hours and consecutive shifts, compared to physicians who have had regulations of some type since the 1980s,” James said. 

The study involved 94 registered nurses who work in direct patient care in 12-hour shifts at hospitals in Spokane, Washington. Half worked consecutive 12-hour day shifts, and half worked consecutive 12-hour night shifts. Nurses were tested after three consecutive shifts, and again after three consecutive days off. 

Testing was conducted in the WSU College of Nursing’s simulation lab, where nurses were evaluated on specific patient-care skills, such as IV insertion and medication administration, and quality of patient care such as assessment, communication, and clinical judgment. Their driving skills were tested in a simulator in the WSU Sleep and Performance Research Center. 

The study sought to answer two questions, James said: does working consecutive 12-hour shifts affect nurse or patient safety? And, are there differences between safety among nurses working day and night shifts? 

The study found that night-shift nurses got less sleep and were more fatigued by the end of their back-to-back shifts than were the day-shift nurses. Even so, on average nurses were able to maintain safe, competent patient care. 

Nurses working night shifts, however, experienced a decline in the quality of communication between nurse and patient. 

“Some would say that’s not critical for patient outcomes,” James said. “I would argue that the therapeutic relationship is just as important as patient safety. If a patient doesn’t feel like they’re being heard, being respected, they are less likely to return to the hospital and less likely to be compliant with their treatment requirements.” 

Another finding of the study was that nurses are less safe driving home after working back-to-back 12-hour night shifts than their day-shift counterparts. 

By hour 10 of their second and third shifts, night-shift nurses’ predicted cognitive effectiveness had dropped to a point equivalent with a blood alcohol content of 0.08 – legally drunk. Some nurses scored even lower on predicted cognitive effectiveness, making them high risk for accident, error and injury. Day-shift nurses didn’t experience those extreme declines in predicted cognitive effectiveness. 

“There’s definitely a question mark over whether nurses are safe driving home from night shifts,” James said. 

Data collection for the study concluded before the COVID-19 pandemic, and participants were asked to not work any overtime while the study was under way. 

 James said the overall goal of the study was to add to the body of evidence surrounding 12-hour work shifts for nurses. 

“The safety of physicians has been on peoples’ minds for a very long time, compared to the safety of nurses, which seems to be secondary,” she said. “We’ve shown there is risk for nurses working 12-hour night shifts, and employers need to monitor their work hours; hospitals can’t just work nurses into the ground.” 

The findings from the study have been published in the International Journal of Nursing Studies, with future papers expected. 

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