Clinical Issue Article - Step 4
The working patterns of the Registered Nurse (RN) have caught the attention of researchers in the last 15 years. The mounting evidence illustrates a direct correlation between long working hours and poor patient outcomes as evidenced by an increase in patient errors, near sentinel events, and injuries to the nurse. The sentence outline is a clear and concise method of uniting the original study question of patient quality care outcomes directly affected by nursing hours worked and the major facts of the research evidence to support the conclusions and findings of the study.

I. Clinical Issue Chosen: PICO format
a. Problem/Population of Interest
i. Registered nurses care for patients in a variety of settings, including hospitals that require 24-hour nursing coverage. ii. Does an RN working eight- or 12-hour shift create potential hazard to patient safety?
b. Intervention of Interest
i. Nurses who work eight-hour shifts do not cause an increased risk to patient safety.
c. Comparison of Interest
i. Nurses who work 12-hour shifts may increase the risk of errors and may potentially negatively affect patient care.
d. Outcome
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II. Literature Search (Quantitative)
a. Extended work shifts may predispose nurses to make more errors.
i. Evidence supports that nurses working beyond a 12-hour shift may directly affect patient mortality rates and patient safety (Bae, 2012; Rogers et al., 2004). ii. Other studies expose evidence that supports there were no differences in nursing errors related to eight- or 12-hour shifts (Bae, 2012). iii. Rogers et al. (2004) provides evidence that supports that errors and near misses correlate to extended work hours.
b. Work/life balance is a key reason that nurses choose to work 12-hour shifts that may result in poorer health status (Estryn-Behar & Van der Heijden, 2012).
i. More females work 12-hour shifts than men, mostly for childcare reasons (Estryn-Behar & Van der Heijden, 2012). ii. Increasing satisfaction with schedule flexibility and number of days worked per week are noted as positives for those who choose to work 12-hour shifts (Stimpfel & Aiken, 2013). iii. Nurses working extended shifts experience more injuries, fatigue, and changes in cognitive functions compared to nurses who work eight-hour shifts (Estryn-Behar & Van der Heijden, 2012).
III. Literature Search (Qualitative)
a. Nurses believe the extended shift gives them the opportunity to provide better patient care.
i. Cardiology nurses can pace their patient care during 12-hour shifts although have more difficulty staying informed about discharge plans (Wooten, 2000). ii. Nursing students can provide holistic, family involved care during 12-hour nursing shifts (Resson & Fegan, 2009).
b. Working extended hours has negative effects on nurses’ health regardless of their preference to work more hours and have more days off.
i. Nurses working 12-hour shifts have approximately five and a half hours of sleep before returning to work (Fallis & Edwards, 2011). ii. Research suggests that limited sleep hours are a direct cause 30% more patient care errors and near sentinel events (Fallis & Edwards, 2011). There is a substantial amount of data from quantitative and qualitative studies supporting that patient and nurses suffer health and safety issues when the nurse is working over a 12-hour shift. Studies consistently report that the chance of error, omission, and sentinel events with the patient are 30% more likely to occur. This figure is consistent with nurses developing work related injuries and impaired cognitive ability. The responsibilities of the staff nurse are to observe, react, and reorganize plans of care to accommodate the changes in patient status. This function in the brain is affected by sleep deprivation. Data on nurses working 12-hour shifts report that the hours of sleep before returning to work is approximately five and a half hours. Normal circadian rhythms have eight hours cycles, thus leaving the 12-hour nurse not just sleepy but also fatigued. Despite the overwhelming amount of recent research on this subject that corroborates this data, nurses continue to choose to work 12-hour shifts for flexibility and lifestyle choices. Hospital administration likes 12-hour shifts because it takes one less staff nurse to man a 24- hour shift. Nurses and administrators would agree that patient safety is the number one concern, but no one wants to make the changes necessary for that to be a reality