Implementation of 12-hour RN Shifts at Eastern State Hospital Dudley 1 Implementation of 12-hour RN Shifts at Eastern State Hospital
Introduction
Twelve-hour shifts are a common scheduling pattern for nurses on medical units, and have been
for several years. However, it has not been a common psychiatric nursing practice. The literature
notes many positives, both professionally and personally, for nurses working 12-hour shifts. The
flexibility of 12 hour shifts provides more time for nurses to spend with family, pursue another
career, engage in hobbies, and continue their formal education. Patients also benefit from the
longer shift because of increased patient continuity across the day and evening, as well as
increased time available for nurses to engage in therapeutic relationship building. The primary
argument against the use of 12-hour schedules is a possible decline in productivity after 8 hours
and the possibility of increased adverse actions regarding patients (such as medication errors)
from fatigue during the longer shift (Stimpfel, Sloane, & Aiken, 2012). It is my intention to
suggest a feasible 12-hour schedule that will benefit the hospital, our staff, and our patients.
Staff Recruitment/Retention and Job Satisfaction
The tendency of nurses to leave general hospitals has been widely researched. For example, a
third of nurses in England and Scotland and more than a fifth in the United States planned to
leave their job and that, across the whole international sample, 27–54% of nurses under 30 years
of age planned to leave within 12 months of data collection (Aiken, et al., 2001). This tendency
has been connected to different variables but a central variable is nurses' job satisfaction. Roche
and Duffield (2010) compared the job satisfaction of psychiatric nurses with that of general
hospital nurses. While the former reported better doctor–nurse working relations, the latter felt
more involved in the running of the hospital and that the hospital offered them more leadership
potential and a wider range of personal development options. Another factor that could make a
significant difference in the perception of job satisfaction between medical and psychiatric units
could be the general usage of 12-hour shifts in medical units in hospitals.
When staff work 12-hour shifts, fewer handoffs occur. This is a beneficial aspect that affects
quality outcomes as fewer handoffs reduce the error rate and decrease the propensity of “passing
the buck”. It also has been reported that RNs who work 12-hour shifts have less absenteeism, are
less emotionally exhausted and are more satisfied with their jobs than those working a traditional
eight-hour shift. In fact, 80% of nurses surveyed responded that they were “very satisfied” with
working 12-hour shifts opposed to 8-hour shift (Stimpfel, et al., 2012). Some reasons that nurses
seem to prefer 12-hour shifts over 8-hour shifts are less patient turnover, better work-life
balance, less commuting, and improved morale in general.
From a recruitment standpoint, 12-hour shifts are more desirable in the workforce today. Nurses
working eight-hour shifts often seek positions at hospitals that offer 12-hour shifts, citing the
need for more flexibility and time to fulfill personal responsibilities and commitments. From a
retention standpoint, a work schedule that meets nurse’s needs is one crucial factor for retaining
nurses and increasing job satisfaction. From the perspective of patient care, nurses express their
satisfaction with having more time to organize and deliver personalized care, often leading to a
less stressful day. Implementation of 12-hour RN Shifts at Eastern State Hospital Dudley 2 How does this apply to Eastern State Hospital?
As an employee at Eastern State Hospital, I am very concerned about the well-being of my
fellow co-workers and the patients under our care. For the safety of both patients and staff, we
must have adequate staffing to care for our patients. At this time, many nurses are questioning
whether or not they will remain at this facility if the state legislature refuses to fund our contract.
Without the pay increase that was provided to staff through emergency funding in the prior
year’s budget and the new hire incentive bonus, many staff would not have not came to work
here at all. There has been a tremendous influx of new staff, including an impressive number of
RNs, in the past year. Our facility has gone from being well under-staffed to almost fully staffed.
With the increased wages, we are finally competitive with other hospitals in the area. Our pay
may not be quite at the same level even with the temporary pay increase, but the other benefits
usually make up for the difference.
With the looming possibility that our current contract may not be funded for another year, it is
crucial to find some incentive to encourage our current staff to remain. We owe it to both our
staff and the patients in the mileu to maintain a safe and therapeutic environment. The
possibility of going to 12-hours shifts has been one incentive that seems to have the most staff
support. Both licensed and unlicensed staff have indicated an interest in this type of schedule.
Specifically, as a staff member of 1 North 1, we feel that our unit would be one of the best to
implement the idea of a 12-hour schedule.
As the admission unit for the adult psychiatric units, our floor handles some of the most unstable
patients in the hospital. We have direct admissions from the emergency room, hospitals across
the state, and even local jails. Our job is to quickly assess and build rapport with these highly
unstable patients to get them some much needed help. However, it is difficult to build a level of
trust when staff is frequently changing throughout the day. Our patients are already struggling
with many trust issues due to their mental illness and/or past traumas in their life. Our patients
need consistency and trust in their caregivers almost as much as they need the medication that we
provide them.
Scheduling
Twelve-hour shifts could offer a variety of scheduling options. Currently, there are 4 day shift
RNs, 4 evening shift RNs, and 2 night shift RNs on this unit. There is currently one full time RN
working a weekend only shift between days and evenings and one full time night shift RN
position open. In total, that represents the possibility of 12 staff. In speaking with my fellow coworkers, most of them have been agreeable to the option of a 12-hour shift. Two nurses have
stated that they would prefer to stay on 8 hour shifts. Of the two nurses that stated the they
would prefer to remain on 8 hour shifts, one works during the morning and one works in the
evening.
As such, I would like to propose the following schedule. For the two nurses wishing to remain
on 8 hour schedules, they could work Monday through Friday with their currently scheduled
times (6:40 am to 3:10 pm and 2:40 pm to 11:10 pm respectively). The remaining ten nurses
would be in a revolving Pittman schedule (6:40 am to 7:10 pm and 6:40 pm to 7:10 am). A total Implementation of 12-hour RN Shifts at Eastern State Hospital Dudley 3 of 6 nurses would be allocated to 12-hour day shift positions and a total of 4 nurses would be
allocated to 12-hour night shift positions. The schedule would allow for 2 teams of schedules,
both day and night. Team 1 would work 48 hours one week and 36 hours the following week.
Suggested days would be to work Monday/Tuesday/Friday/Saturday for the first week and
Sunday/Wednesday/Thursday on the following week. Team 2 would work the opposite schedule
of 36 hours one week and 48 hours the following week. Suggested days would be
Sunday/Wednesday/Thursday in the first week and Monday/Tuesday/Friday/Saturday for the
second week. The schedule would repeat after 2 weeks.
This schedule would meet the current stipulation in our union contract that all RNs must be
provided the opportunity to have at least one weekend day off during the week. This schedule
would allow RNs to have every other weekend as a 3-day weekend and thus increase perceived
satisfaction with work schedule. This schedule also ensures that all RNs on a 12 hour schedule
would have reduced fatigue as they are not scheduled to work more than 2-3 days at any given
time. Staffing would not be negatively impacted as there would be 4 RNs working from 6:40 am
to 7:10 pm, 3 RNs working from 7:10 pm to 11:10 pm, and 2 RNs working from 11:10 pm until
7:10 am during the week, Monday through Friday. On the weekends, Saturday and Sunday, there
would be 3 RNs available from 6:40 am to 7:10 and 2 RNs available between 6:40 pm to 7:10
am. These staffing numbers do not include LPNs who also share in the nursing responsibilities.
Cost-Benefit Analysis
The shift to 12-hour shifts would not only result in increased perception of job satisfaction, but it
would also be a more cost effective option. Consider this. If fully staffed, our floor would
include a minimum of 12 full time RNs. Not taking into consideration the individual pay of each
nurse, that equates to 480 work hours to be paid in one week. Under the proposed schedule,
between offering two nurses to retain their 8-hour schedules and placing everyone else on a 12
hour Pittman schedule, labor costs would be decreased to 472 work hours during the week
(including scheduled overtime). If the average salary for RNs was $36 an hour (not including
shift differential), that would equate to $288 per week or $14, 976 annually.
Hospital wide, implementation of 12 hour shifts would increase overall perception of job
satisfaction. Staff who are satisfied with their work will continue to work here. By increasing
staff retention, the hospital could significantly reduce operating costs as there would not be the
need to train new staff monthly. I do not currently have the means of calculating the cost for the
hospital, but my orientation class had well over 30 employees in it. Considering new employee
orientations have been occurring monthly for the past year, the costs of paying these new
employees who are not involved in direct patient care (or whatever their job title may entitle) for
at least 1 month must be substantial. In addition, there is a significant cost associated with
covering those open positions either with staff working overtime or as on-call.
Implementation and Timeline
To provide a more accurate view of how 12-hour shifts will benefit the hospital, staff, and
patients; it is recommended that this project should last for a minimum of 90 days. The initial
trial will be implemented on this unit and can be instituted on other units after a successful trial. Implementation of 12-hour RN Shifts at Eastern State Hospital Dudley 4 After the initial 90 day trial period, staff can be anonymously surveyed to determine satisfaction
with the 12-hour shifts. Patient outcomes can be evaluated through evaluation of any changes in
the frequency of medication errors, incidents of seclusion/restraint, or any other adverse actions
that could be in direct or indirect correlation to a change in shifts.
Conclusion
The implementation of 12-hour shifts for RNs would be beneficial for both patients and staff. It
promotes continuity in care and decreases the chance of miscommunication during shift changes.
The implementation of 12-hour shifts would also increase perceived job satisfaction for currently
employed staff and would encourage the recruitment of new staff as needed. If 12-hour shifts
were implemented for RNs on this floor only, it would result in savings of almost $15,000
annually for the hospital. If instituted hospital-wide, the savings would be more than substantial.
Overall, the implantation of 12-hour shift is what is best for our patients, our staff, and the
hospital.
Identification of Key Stakeholders
For this project, I identified multiple key stakeholders. The first stakeholder that I approached
was Lana S. Lana is the RN3, or permanent charge nurse, for my shift and unit. Lana served as
a mentor for this proposal and helped identify areas to emphasize in the proposal. I also spoke
with Melissa S, a RN3 from a different unit and shift, who spear-heads the local branch of SEIU
1199NW, the union representing RNs at Eastern State Hospital. I discussed some of the biggest
concerns of the RNs at Eastern State and further discussed the possibility of alternate 12-hour
scheduling on a smaller scale if this proposal was rejected. After working with both Lana and
Melissa, I compiled this presentation and presented it to Barb K. Barb is a RN4 and the director
of the Adult Psychiatric Units. I also briefly discussed the idea, but did not formerly present it,
to Jayme, the interim Chief Nursing Officer. While Barb was receptive to the idea, she stated
that it would not be a good time to implement it now. Jayme was not as receptive to the idea.
She stated that she was more focused on taking care of the “low-lying fruit”, an investigation
from the Department of Health following a patient elopement and a multi-system failure that did
not recognize the escape for almost 2 hours. Implementation of 12-hour RN Shifts at Eastern State Hospital Dudley 5 References
Aiken, L., Clarke, S., Sloane, D., Sochalski, J., Busse, R., Clarke, H., et al. (2001). Nurses'
reports on hospital care in five countries. Health Affairs, 20 (3) (2001), pp. 43–53.
Roche, M. A. & Duffield C. M. (2010). A comparison of the nursing practice environment in
mental health and medical-surgical settings. Journal of Nursing Scholarship, 42 (2)
(2010), pp. 195–206.
Stimpfel, A. W., Sloane, D. M., & Aiken, L. H. (2012). The longer the shifts for hospital nurses,
the higher the levels of burnout and patient dissatisfaction. Health Affairs (Project Hope),
31(11), 2501–2509.

Attachments:

• 1505130963-Leadership Experience Project.docx