Running Head: EFFECTS OF 8 VS.

12-HOUR SHIFT ON MEDICATION ERRORS

Is there a difference in the number of medication errors that occur on an 8-hour shift versus a 12-

hour shift within an acute hospital setting?

Daniel Liptak, Jamie Giambattista, Alyssa Blosser, Christopher Ross, Alyssa Zorzi

April 16, 2018

NURS 3947: Nursing Research

Dr. Patricia Hoyson & Dr. Mary Shortreed

Abstract
EFFECTS OF 8 VS. 12-HOUR SHIFTS ON MEDICATION ERRORS !1

Safely administering the proper medication to a patient is one of the most crucial nursing

responsibilities. The purpose of this research was to look at medication administration errors

(MAEs), and the differences in reported MAEs from nurses working an 8-hour hospital shift

versus a 12-hour shift. Found within the literature reviews and studies previously published was

a correlation between medication errors and longer work hours. One study published found that

working more than an 8-hour shift nearly doubled the occurrence of nurses reporting wrong

medications or doses administered. Within these studies, many articles also reported a significant

increase in MAEs with the more hours of overtime worked. The previously published research

in relation to this topic have shown that working more than 8-hour shifts within an acute-setting

hospital puts the nurse at a disadvantage with accuracy related to medication administration

errors, overall jeopardizing patient safety.

Chris: international med errors

Alyssa: fatigue, shift duration, med errors

Dan: job satisfaction and remedy

EFFECTS OF 8 VS. 12-HOUR SHIFTS ON MEDICATION ERRORS !2

Health Effects

The health effects of working longer than traditional eight hour shifts have been studied

for years. As eight hour shifts are being replaced by twelve hour shifts with increasing frequency

for cost effectiveness, continuity of care, and staffing reasons, more studies are being conducted

to look into the health effects therein. With increased duration of shifts beyond the traditional

eight hour shift, there are increased rates of chronic illness such as diabetes, cardiovascular

disease, and hypertension with increased prevalence of gastrointestinal, minor psychiatric, and

sleep disorders as well. (Simone, 2009, p. 498). As with many illnesses acute or chronic, older

populations are affected often at greater rates and at greater severity than those of younger age.

Research has deduced that due to normal physiological processes that occur with aging, older

workers and especially older shift workers experience the most health effects of anyone from

working extended shifts (Simone, 2009, p. 498). With age, a person may become less resilient to

stress, fatigue, and disease and more rapidly progress through the steps of general adaptation

syndrome (Rogers, 2014, p. 156). In a 2015 study done by the National Council of State Boards

of Nursing, 50% of the 78,700 who responded to the randomized survey were age fifty and older.

With a considerable amount of nurses contributing to an aging workforce, one may wonder the

extent to which the nursing workforce is successfully able to cope with longer shift durations.

Although advancing age may correspond with reduced resilience to fatigue and exhaustion, no

age group is or ever will be immune. As continuous hours worked have been found to be

inversely proportional to productivity, safe medication administration, and patient satisfaction, an

overall conclusion is drawn that with increasing shift durations and consequential worker fatigue,

patient experiences and outcomes become less favorable (Simone, 2009, p. 498). Perhaps the
EFFECTS OF 8 VS. 12-HOUR SHIFTS ON MEDICATION ERRORS !3

greatest concern of worker fatigue is inability to concentrate or think clearly. One manifestation

of this is unsafe or even erroneous medication administration.

Remedy

Patient safety is and should be the goal of nursing care regardless of setting. There are

numerous variables affecting safety, and one is the level of fatigue in nursing staff. As lengthy

shifts are correlated to unsafe or inappropriate medication administration, solutions need to be

put in place to either reduce shift duration or increase the amount of rest staff can get during or

between shifts, especially consecutively. In example, promoting higher levels of wakefulness and

worker mood can be achieved by increasing the incoming amount of natural light incoming to a

unit or artificial light in off shifts including afternoons and nights. Furthermore, staffing matrixes

that are more appropriate for patient acuity should be implemented with input from nurses on

safe and adequate patient ratios. Better patient outcomes and experiences can be achieved

through better nurse to patient ratios and/or increased use of non-professional help such as nurse

aides, unit secretaries, or other miscellaneous clinical support staff (Hodgson, 2016, p. 142).

Allowing nurses greater control over their work and life balance can be accomplished by offering

numerous shift durations when scheduling; in this case, an employee can schedule four, eight,

ten, or twelve hour shifts to fit their life better thereby allowing for more rest. Although this

would make for a more complex schedule, it would eliminate the problem of 100% of nursing

staff in strictly twelve hour shift units from being occupied with handoff during changes of shift,

as not all nurses would be changing shift at the exact same time. Despite the increase in

medication errors with extended shifts, longer than eight hour shifts are associated with both pros
EFFECTS OF 8 VS. 12-HOUR SHIFTS ON MEDICATION ERRORS !4

and cons, and steps can be taken to counteract worker fatigue and stress where twelve hour shifts

are implemented.
EFFECTS OF 8 VS. 12-HOUR SHIFTS ON MEDICATION ERRORS !5

Bellebaum, K. (2008). THE RELATIONSHIP BETWEEN NURSES’ WORK HOURS,

FATIGUE, AND OCCURRENCE OF MEDICATION ADMINISTRATION ERRORS.

(Dissertation). Retrieved from OhioLink Nursing Research database. (Accession No.

109850803)

Clendon, J. (2015). 12 h shifts and rates of error among nurses: A systematic review.

International Journal of Nursing Studies. 52(7). doi: http://dx.doi.org/10.1016/j.ijnurstu.2015.03.011

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3608421/

https://search-proquest-com.proxy.ohiolink.edu:9100/nahs/docview/219378334/

A41A9A95EB3B466DPQ/2?accountid=12953

https://www.physiology.org/doi/pdf/10.1152/physiol.00017.2014