Long hours, nursing fatigue put patients at risk

A major nationwide study has found that the long hours worked by hospital staff nurses may have adverse effects on patient safety. By studying the work habits of 393 hospital staff nurses, researchers determined that nurses working more than 12.5 consecutive hours were three times more likely to make an error than nurses working shorter hours. Working overtime at the end of a shift also increased the risk of making an error, says Linda Scott, associate professor of nursing in the Kirkhof College of Nursing at the Grand Valley State University in Grand Rapids, MI, and one of the researchers.

The study was conducted by giving nurses logbooks to track hours worked, overtime, days off and sleep/wake patterns for 28 days.1 Participants were asked to describe errors or near errors that might have occurred during their work periods.

Participants reported 199 errors and 213 near errors during the data-gathering period. More than half of the errors (58%) involved medication administration; other errors included procedural errors (18%), charting errors (12%), and transcription errors (7%).

Researchers found that most hospital nurses no longer work eight-hour day, evening, or night shifts. Instead, they may be scheduled for 12-hour, 16-hour, or even 20-hour shifts. Even when working extended shifts (12.5 hours or more), they were rarely able to leave the hospital at the end of their scheduled shift. All participants reported working overtime at least once during the data-gathering period, and one-third of the nurses reported working overtime every day they worked, says Ann Rogers, PhD, RN, FAAN, associate professor of nursing at the University of Pennsylvania in Philadelphia and lead researcher.

"Both the use of extended shifts and overtime documented in this study pose significant threats to patient safety," Rogers says. "In fact, the routine use of 12-hour shifts should be curtailed and overtime — especially overtime associated with 12-hour shifts — should be eliminated."

The study was funded with a grant from the Agency for Healthcare Research and Quality in Maryland. Scott and Rogers are conducting a correlating study to research the work hours of critical care nurses.

Scott and Rogers are expected to speak before their respective state legislatures on nurse fatigue and patient safety. Scott also is working with the Michigan Nurses Association on patient safety legislation. "We need to educate nurses and hospitals about fatigue," Rogers says. "It’s a shared responsibility, and both parties are accountable. This is a national problem and will likely have a national effect."


1. Rogers AE, Hwant WT, Scott LD, et al. The working hours of hospital staff nurses and patient safety. Health Affairs 2004; 23:202-212.