Shift work, and why 12 hours is not ideal

When I was a new nurse doing my year on medsurg the hospital I was working in starting “experimenting” with staff mix. And not for the better.

To set the scene, this was in late months of 2001, I had been a nurse for 4 months. I was a newbie, wet behind the ears, still afraid to confront doctors. Oh, how times have changed.

The first thing they did was go to ‘team’ nursing. I had an LPN, and 1.5 CNAs, and 20 patients, which was half the floor. I was expected to assess all the patients, give all the IV medications, and oversee the LPN and the CNAs. You know what is troubling in that set-up? One patient going south, and by that I mean coding, or falling, or pitching a fit and holding the other nurse who had the other half of the unit at knifepoint.

That really happened. The patient was psychotic and threatening to jump out of the window and threatened the nurse with the knife that had been in their bag from home. They wanted the window opened and they were not going to take no for an answer. Never mind that the unit was on the second floor of the hospital. Not a lethal distance. This is also when the hospital developed the code gray around threats from patients. Security and the police came, and the patient was disarmed and put back to bed in a room closer to the nurses’ station where there could be many people watching them. It was a tension filled evening. And charting happened until way after midnight because no charting got done during the crisis.

The point is that the entire evening was wrecked in terms of patient care. The LPNs and the CNAs had been medicating, and positioning patients, and getting them ready for bed; in other words, keeping them calm and unaware of what was going down in room 201. The other RN and I were trying to de-escalate the situation, struggling to assess our patients, making sure that all the orders were carried out. It was a mess. But funnily enough, not the shift that sank the new program, or not the only one. I had a patient who was a self-harmer for attention, a patient who had Munchausen’s. They were in their early twenties and had a self-reported history of cancer, a central line and they would pull blood from the central line and have “bloody emesis” to cause a ruckus and many phone calls to the doctor. This was witnessed and the patient referred to the local psychiatric hospital.

The RNs had been complaining for days about this new team nursing paradigm and several shifts that went sideways in a week was the impetus to change back to the normal workload of 1 RN for 10 patients. This is not the workload of nurses today, thank goodness.

And then administration glommed onto 12-hour shifts. Who doesn’t want two more days off a week? The units could be run with less staff. Think of the savinge!

This ended up happening. Two extra days off a week is not a gift. It is recovery time. Nursing is hard and physical work, not to mention the mental work.

However, this was not created with nurses in mind. It is, and has always been, about saving money by requiring less staff.