Working longer hours is associated with higher levels of burnout, patient dissatisfaction and safety issues among hospital nurses, study results suggest.

Patient dissatisfaction was significantly higher among patients of nurses who worked shifts of 13 hours or more.

Those who worked 10 hours or more were 2.5 times more likely to experience job dissatisfaction and intention to leave than those who worked shorter shifts, Amy Witkoski Stimpfel, PhD, RN, a research fellow at the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing, in Philadelphia and colleagues reported in Health Affairs.

Continue Reading

“Extended shifts undermine nurses’ well-being, may result in expensive job turnover, and can negatively affect patient care,” the researchers wrote. “Policies regulating work hours for nurses, similar to those set for resident physicians, may be warranted.”

Twelve-hour shifts are growing increasingly popular among nurses because of the flexibility it offers, but nurses may also end up putting in unexpected overtime, which may have unintended implications for patients and hospitals.

Does working longer shifts negatively influence your performance on the job?

Stimpfel and colleagues analyzed data from 22,275 nurses in the Multi-State Nursing Care and Patient Study who worked at 577 hospitals in four states. It included only nurses working on medical or surgical units and in intensive care, and excluded those in long-term care, outpatient services or the operating room because of differences in shift patter

Patient satisfaction estimates were determined using data from the Hospital Consumer Assessment of Healthcare Providers and Systems survey, conducted from 2006 to 2007, during the same time period as the nurse’s survey.

The nurses survey covered shifts ranging in length from 8 to 9 hours, to 10 to 11 hours, to 12 to 13 hours and  greater than 13 hours. About two-thirds of nurses worked 12 to 13 hour shifts.

The researchers found the proportion of nurses reporting burnout and intention to leave the job was similar among those working 8 to 9 hour shifts and those working 12 to 13 hour shifts, but was higher among those working 10 to 11 hours and more than 13 hours.

Video: Long Shifts Lead to Nurse Burnout and
Dissatisfied Patients

A relationship between shift length and patient satisfaction was also identified, with higher patient satisfaction reported with shorter shifts.

“Nurses underestimate the impact of working long shifts because the idea of working three days a week instead of five seems appealing,” the researchers wrote.

However, reimbursement changes scheduled to start next year related to achievement of national benchmarks on two global measures of care may prompt hospitals to trend away from 12-hour nursing shifts because of the poor outcomes associated with longer shifts.

“Nurse working conditions, including shift lengths, is one area related to these benchmarks that we believe is readily amenable to change,” the researchers wrote. Policy changes could include restrictions on shift length and voluntary overtime.


  1. Health Affairs. 2012; 31: 2501-2509.