A Systematic Review: 12-Hour Shifts for Nurses - Burden or Boon?

This report presents a systematic review of 12 peer-reviewed articles to assess the impact of 12-hour working shifts on nurses' health, performance, and job satisfaction. The study investigates the causes of the increasing prevalence of these shifts, their influence on working efficiency and well-being, and the effects of prolonged work durations on fatigue and work-life balance. The research employs a post-positivism approach and secondary study methods, using databases such as NCBI, ProQuest, Medline, CINAHL, and SCOPUS. Findings indicate that rotational shift work increases the risk of coronary heart diseases, occupational stress affects nursing efficacy, and prolonged work has a detrimental impact on physical health. Night shifts also negatively affect working efficiency and increase BMI levels. The conclusion highlights the negative consequences of long working hours and rotational duties on nurses' emotional well-being and working efficiency. The report includes an introduction, background, research questions, aim and objectives, rationale, search strategy, philosophical worldviews, research design, approach, and methods, followed by a discussion of evidence, findings, analysis, implications, limitations, and conclusion. The appendices include a PRISMA flow diagram.

8-12 HOURS SHIFT FOR NURSES A BURDEN OR A BOON

Abstract
Background: The prominent concerns in the nursing profession globally are burnout and lack of
job satisfaction. Overworking can pose a plethora of negative impact on the health and service
quality of the nursing practitioners. The studies on length of working shift in the United
Kingdom shed negligible light that reviews the contrasting evidence of cause and impacts that
arise due to overworking by nursing practitioners.
Aim: The aim of this study is to enumerate the impact of 12-hours working shift on the health,
performance and job satisfaction in nurses.
Methods: 12 peer-reviewed articles are chosen for the research study to be reviewed in a systematic
manner. The databases that are used in the present study are NCBI, ProQuest, Medline, CINAHL
and SCOPUS. The research design follows a secondary study method to review the peer-
reviewed articles. The researcher has taken a post-positivism approach to guide this study.
Results and Findings: Rotational shift work increases the tendency of developing coronary heart
diseases among nurses. Occupational stress has immense impact on nursing efficacy. 12 hour of
prolonged work has a detrimental impact on the physical health of nurses. Night shifts increase
BMI level of nurses and also negatively affect the working efficiency of nurses.
Conclusion: Long working hours has a detrimental impact on the health provider of nurses. 12
hours of working schedule and rotational duties have an immense negative impact on the
emotional well being of the nurses as well as their working efficiency.
Keywords: 12-hour shift, nurse burnout, nursing performance, exhaustion, and prolonged
working hours
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Table of Contents
Part 1 4
Introduction.............................................................................................................................. 4
Background.............................................................................................................................. 4
Research question................................................................................................................... 5
Aim and objectives................................................................................................................... 5
Rationale.................................................................................................................................. 5
Search strategy........................................................................................................................ 8
Philosophical worldviews......................................................................................................8
Research design...................................................................................................................9
Research approach.............................................................................................................. 9
Research method.....................................................................................................................9
Part 2 11
Discussion of evidence...........................................................................................................16
Findings.............................................................................................................................. 16
Analysis.............................................................................................................................. 23
Implications and limitations....................................................................................................25
Conclusion............................................................................................................................. 26
References 27
Appendices 32
Appendix A: PRISMA............................................................................................................. 32
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Part 1
Introduction
The topic of the research is to investigate the increasing hours in nursing care services. In
healthcare sector, the increasing working hours is a major issue among the nurses. Increased
working hours have influenced the nurses in both physical and mental manner. As well as, the
increased working hours have been increased job satisfaction among the nurses. In this concern,
the topic is selected to increase depth understanding about the issue of increased hours in nursing
services and causes of job dissatisfaction in nursing care (Sadati et al., 2016). It is observed that
the nurses are required to provide round-the-clock services within their health units that often
render their physical and mental well being. They are often required to work for prolonged
periods of time (11 to 12 hours) that affect their well being (Leung et al., 2016). Moreover,
several health impacts have also been evident due to prolonged working hours that overall
reduces their efficiency rate. The literature review will provide a detailed analysis of the impacts
of prolonged working periods on the health outcomes of nurses (Griffiths wt al., 2014).
Moreover, this literature will also detail about the impact of night shifts on increased prevalence
of fatigue and psychological well being of nurses (Wilkinson et al., 2017). Their working
patterns get altered and affected under the impact of tremendous work pressure due to shift
timings. Angina pectoris and myocardial infarction are often the common health outcomes of this
prolonged period of work and these will also be detailed in this current literature review. Overall,
12-hour working schedule results in a loss of work-life balance among nurses that overall affects
their nursing behaviours and working patterns.
Background
The prominent concerns in the nursing profession globally are burnout and lack of job
satisfaction. Both of these occurrences can be caused due to prolonged work hours that implant a
potential influence on safety and quality of care (Aiken et al., 2014). This is because; reduced job
satisfaction poses a contributing parameter that can be related to nurses that quit their profession
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due to demanding requirements (Castaneda and Scanlan, 2014). Job satisfaction leads to
decreased quality of the care services as the nurses cannot work intentionally at the workplace
that leads to lower quality of the services. In this concern, it is essential for the care organizations
to understand the issues among the nurses regarding the increased working hours at the
workplace. Zerwekh & Garneau (2017: 122) discovered that shift pattern is a critical factor to
recognise satisfaction among nurses. Provision of clinical services usually involves shift work
around 12 hours. This has become increasingly prominent for various nursing practitioners in
national hospitals around the United Kingdom (Karkar et al., 2015). This modification in
healthcare organisations is driven by the incorrect perceptions of managers to improve
efficiency. Improper perception has led to reduction in nursing staff per day. This can give rise to
less number of handovers and interruptions in service provision. Marek, Schaufeli & Maslach
(2017: 78) enumerate from the perspective of nurse, which can give rise to elevated shifts that
offer benefit potentials from the compression of working schedules. Nurses from lower socio-
economic backgrounds often opt for longer working hours owing to the fiscal remunerations that
they obtain in return. Wilkinson et al. (2017: 18-29) show two-fifth of nurses in the UK prefer
hour shifts in some cases as it can facilitate balance in personal and professional commitments.
Nevertheless, studies on length of working shift in the United Kingdom shed negligible light that
reviews the contrasting evidence of cause and impacts that arise due to overworking by nursing
practitioners.
Research question
The research question is related to the issue discussed in the background. The impact of 12-hour
working shifts on the working capacity and health of nurses are to be discussed in this study with
the help of the below research questions:
1. What are the causes of rising prevalence of 12-hour working shifts in nursing?
2. How 12-hour working schedule is influencing to working efficiency and job satisfaction
in nurses?
3. What is cognitive and psycho-social well-being of nurses in healthcare organisations?
4. What are the effects of prolonged working durations on employment fatigue and work-
life balance among nurses within their healthcare units?
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Aim and objectives
Due to the increased demand of the nurses in care organizations, the care organizations have
been increased the working hours of the nurses at the workplace to fulfil the demand. This
strategy influenced the working practices of the nurses as the nurses are working with mental
stress as they cannot spend time for their personal life in desired manner. It has influenced their
routine activities in big manner (National Health Service, 2017). In this concern, the aim of this
research is to critically discuss and enumerate the impact of 12-hours working shift on the health,
performance and job satisfaction in nurses. The cause of research on this topic or the aim is that
it will be helpful in understanding the working strategies of the care organizations. This aim will
be attained through the accomplishment of below objectives:
1. To enumerate the causes that has given rise to prevalence in 12-hours working shifts
2. To understand the impact of 12-hour working schedule on working efficiency and job
satisfaction among nurses
3. To analyse cognitive and psycho-social well-being of nurses who work in 12-hour shifts
in various healthcare organisations
4. To evaluate the effect of prolonged working durations on employment fatigue and work-
life balance among nurses within their healthcare units
Rationale
Prolonged working hours, such as twelve hours or more have gained prominence in health care
centres. However this practice is rarely evaluated from the perspective of job satisfaction and
working efficiency. In addition to this, prominent reviews have shed little light on the influence
of extended hours on long-term physical and emotional impact on nurses. Manzano-García &
Ayala (2017: 0175352) survey nurses in four hospitals that show 70% of nursing practitioners
are satisfied with practice schedules at hospitals. Nevertheless, nursing practitioners that work
for more than twelve hours have increased in the past five years. However, 12-hour of prolonged
work has aggravated the mental and physical wellbeing of nurses. Schmidt et al. (2014: 42-46)
state nurses that work for ten continuous hours or longer are 25% more exposed to the risk of
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burnouts. This increment in likelihood can enable nurses to experience job dissatisfaction, which
in turn, can enable them to leave their jobs. Extended shifts can undermine the well-being of the
nurses that can result in elevated turnover levels and reduced efficiency rate.
Nursing leaders encourage organisational cultures, which respect the vacation and leave days of
nurses and enable prompt discharge at the shift end. As stated by Khamisa et al. (2015: 652-666),
policies that regulate working hours for nursing practitioners are usually similar for resident
doctors or physicians. Despite directives on cumulative hours of working in other sectors,
national policies for nursing work-hours are not updated in the United Kingdom (National Health
Service, 2017). Although several private healthcare organisations have prohibited overtime for
nursing staff, rarely a limit has been applied for voluntary hours of their overtime. Distinction
between mandatory and voluntary is also seen to be blurred in several. As commented by Jakel et
al., (611-616), about 48% of nurses have reported that they are pressured by their hierarchy to
work overtime voluntarily. Shortage in nursing staff, weak economic growth in the healthcare
system and personal financial needs often compel nurses to work even after their scheduled
working shift has ended.
Search strategy
Philosophical worldviews
Philosophical worldviews facilitate guiding a study in a specific pathway. According to Huber
(2017: 132), there are four philosophical paradigms that can guide a study, post-positivism,
constructivism, transformativism and pragmatism. Out of these four worldviews, the researcher
has taken a post-positivism approach to guide this study. Post-positivism follows objectivity by
recognizing the possible effects of biases, so that it is an effective philosophy of attaining the
objectives of the research study. In addition, the Post-positivists consider the human knowledge
is not based on a priori assessments from an objective individual. This philosophy has been
chosen to influence positive outcomes at the end of the study without disregarding the chances of
failure (Taylor and Medina, 2013). In this concern, it is an effective philosophical aspect of
attaining the research objectives in effective manner. As well as, the Post-positivism philosophy
is used in attaining observations of different scholars on the research issue.
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Research design
The research design follows a secondary study method to review the peer-reviewed articles. The
secondary review has resulted in an analytical method to justify the findings and related
observations (Van Bogaert et al. 2017: 5). These observations are drawn by prominent scholars
in the issue of nurse burnouts and lower service quality. In this concern, different journals,
articles and already published contents are used to collect relevant information. The researcher
can collect huge information in less time. Moreover, a secondary review is easier to implement
from the perspective of time and budget (Brakewood and Poldrack, 2013). So that, the secondary
research studies are used to accomplish the research objectives in more professional manner.
Research approach
Qualitative research study is conducted to attain the objectives of the research study. Due to the
present study being a systematic study, 12 peer reviewed articles have been chosen. The data
have been collected from these articles to review the issues that are caused by 12-hour working
shifts in nursing profession. As opined by Grove, Gray & Faan (2018: 331-338), collected data
can give rise to in-depth analysis of the key findings from reviewed studies. In addition, the
qualitative data are easier to understand the issue in better manner and attain the research
objectives in more realistic manner. Therefore, different relevant secondary resources are used to
support the arguments of 12 selected peer reviewed articles.
Research method
The method of this study has been implemented after a thorough search protocol. This section
analyses the method and strategy chosen to search for the articles that have been selected for the
review. As opined by Van Bogaert & Clarke (2018: 489), absence of an appropriate search
protocol can hinder the quality of the overall study. The segment of research method can be
signified by the strategies that have been used to collect, analyse and validate the data.
Search terms and equipments: The researcher identified key terms that can be related to the
issue discussed in the study. Keywords like “12-hour shift”, “nurse burnout”, “quality of care”,
“exhaustion”, and “prolonged working hours” are searched in various databases over the web.
Textbooks have also been used to enrich the study with conceptual paradigms related to
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workplace protocols and demands of the nursing profession. The databases that are used in the
present study are NCBI, ProQuest, Medline, CINAHL and SCOPUS. These repositories are
chosen due to their relevant and valid content. The search flowchart is prepared with the help of
the PRISMA collaborative tool.
Data collection: Data is collected by the application of inclusion and exclusion criteria. The
researcher favoured recently published (after 2014), peer reviewed journals that can shed a more
prominent light on 12-hour working shift. Grey literature is discarded due to lack of promising
evidence. Similarly, journal articles that can be accessed freely over the web are taken into
consideration. Exclusion criteria involve archived and obsolete information and the articles that
are published in languages other than English.
Data analysis: Data is analysed with the help of systematic study protocol. The key findings are
tabulated in a summary table. This helps to establish the main observation in light of benefits and
limitations of the research. As stated by Trotter-Mathison & Skovholt (2014: 293-311), critical
evaluation is essential for the findings to be linked to the discussed issue. In this study the
working time of 12-hour shifts are analysed from the perspectives of nurses. Critical evaluation
of multiple ideas and observations from the scholars has helped the study to reach its own
definite inference.
Ethical issues:
During the collection of secondary data several ethical issues such as patent issues and copyright
issues are found. In order to manage these issues, the data are collected from the authentic
sources and the content is written in own words. As well as, all secondary information is written
carefully with maintaining their authentic meaning and avoided illegal use or copyright issues in
the research study.
Conclusion
From the above discussion, it is analyzed that the there must be a systematic procedure to collect
relevant data about a specific research issue. A systematic process will enable the researchers to
collect the data in an effective manner. As well as, the researchers must have their proper focus
on selection of appropriate data collection method to collect relevant information from different
sources to improve reliability of the research outcomes.
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Part 2
Psychological and physiological well-being of nurses is found to be compromise in these cases.
Longer shifts create a cumulative adverse impact on nurses. Ball, Dall'ora & Griffiths (2015: 4-
12) assumed increase in shift length retain nurses due to their expressed preferences.
Nevertheless, the prolonged exposure to 12 hour shifts contributes to higher probability for
nursing resignations, lack of work satisfaction and negotiation in performance (Smith et al.,
1998). The influence of prolonged shifts in the UK can be explained by facilitation of fewer
working days of nurses in each week. Probable betterment through nursing performance can be
seen due to reduced shift overlaps between shifts and fewer handovers. However,
Ananthakrishnan et al., (2014: 1879-1886) argue 12 hour shifts give rise to increased burnouts in
nurses and reduction in performance. Hence, long shifts are found to impose both positive and
negative impacts on job satisfaction, performance or health of nurses.
Estryn-Béhar & Van der Heijden (2012: 4283-4290) use a multivariate appraisal of 25,924
nurses to deduce work schedule do not impose health and mental status of nurses as the choice of
working in longer shifts is available to nurses (Kalisch et al., 2010). Nurses, however, choose the
prolonged shifts due to lesser number of working hours and flexibility of working at the
workplace (Gillespie and Curzio, 1996). Hence, the choice of these nursing practitioners show
those socio-economic conditions of nurses play a significant role in their choice for working in
12 hour shifts. The working 12 hours shift is beneficial for the nurses in reducing travel costs and
getting more flexibility at the workplace (Knauth and Hornberger, 2003). The nurses can prefer
12 hour shifts over 7.5 hours because it means less travelling to and from work. Longer shifts
means the nurses don't have to travel as far because they are doing their hours on fewer days. As
an extra bonus, they have more free days at their disposal (Johnson et al., 2014)). In addition, the
12 hour work shifts help the hospitals to battle nursing shortages and save money. By working
longer hours, nurses cover longer shifts so hospitals don't have to hire more nurses (Ball et al.,
2015). Hence, nurses are often burdened with hectic working schedules. In order to reduce time
wasted in commute, nurses are provided with the choice of working longer shifts (Costa et al.,
2014). On the other hand, Selvi et al., (2007) depicted that 12 hour shifts can impose health
complications in the long run. Nurses working for longer hours show reduced performance and
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increase in errors due to fatigue. Exhaustion can impact a nurse's judgments and their
performance at work. One of the cons of working longer hours is there is an increased chance of
making mistakes
Johnson et al., (2014) stated that conflicting outcomes have been found in the study evaluating
the effect of both total and partial sleep deprivation (SD) on mood in healthy subjects and a few
variables have been analyzed as possible predictors (Donga et al., 2010). Partial sleep
deprivation occurs when a person sleeps too little for several days or weeks and the total sleep
deprivation means being kept awake for at least 24 hours (Basner et al., 2011). Both of the
situations may influence to mental health of the nurses and may lead to inappropriate care
services at the workplace. It is also examined that circadian preference modifies the effect of
sleep deprivation on mood changes in healthy subjects. The results recommend that the effect of
sleep deprivation on mood in normal subjects is related to circadian preferences (Costa et al.,
2014). The characteristics of morning or evening shift workers have significant impact on their
mood states. Therefore, adjusting the work schedule with the morning and evening
characteristics of the nurses may develop their mood alterations. In this concern, Phiri et al.,
(2014: 38) commented longer shift work increases the risk for disturbances in regular sleeping
patterns of the nurses. Burnouts are also commonly observed that poses a risk to the job
performance of nurses.
According to Ball et al., (2015: 23-41) the internal variations in shift length in NHS healthcare
centers has shown emergence of safety issues in nursing care. The literature review sheds light
on outcomes like error risks with possible impact on job performance and psychological state of
nurses. External validity in the study expresses prominence in job dissatisfaction and burnout in
nursing staff working in 12 hour shifts. A majority of the evidence show varying degrees of
negativity for nurses. No considerable impact on economic state of nurses is noted (Sarafis et al.,
2016). Nurses who work in 12-hour shifts suffer from multiple problems that are associated to a
disturbed body-clock. In this concern, Hayes et al. (2015: 3063-3076), stated that the disruption
in regular sleeping patterns imposes long lasting effect on health of the nurses, such as insomnia,
migraine and depression. Lack of adequate coping approaches can lead to chronic consequences
on physical and mental health, such as elevated gastrointestinal and cardiovascular problems.
Majority of nurses have accepted suffering from sleeping difficulties. As well as, Recio Saucedo
et al., (2018: 2248-2259) notes that 12 hour working shifts give rise to obesity due to prolonged
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sitting or lack of physical activities. Hence, it is essential to develop appropriate measures like
extended care for nurses to achieve a healthy work-life balance. In the words of Josten et al.,
(2003), 12 hour shift pattern generates issue for the nurses in both day and night shift. The nurses
with 12 hour pattern cannot work other responsibilities. The nurses cannot work in other
organizations like banks for additional income as they will extreme mental and physical
tiredness. They will not be able to perform another job in both day shift and night shifts. Thus,
12 hour working shift in nursing sector will generate issues in both night shift and day shift as
they will not be able to perform their job in proper manner due to physical and mental tiredness.
Eldevik et al., (2013: 13-25) used Bergen, Epworth and HAD scales to measure the prominence
of the health implications given above. Considerable positive link between insomnia and quick
returns is established. Health hazards relative to fatigue, such as fatigue and depression is also
noted by the researchers in nurses who are work in longer shifts. These health implications are
collectively termed as shift work disorder. Similar results have been found in multiple studies
that associate health hazards to quick returns to. On the other hand, Maslin-Prothero & Smith
(2015: 2715-2727) found strategies like 12 hour shifts originally aimed to reduce workload by
providing longer breaks to the nurses. Significant interaction between insomnia and quick shift
returns are found in retrospective of decline in nursing performance. It is also seen that 12 hour
shifts pose a greater threat for aged nurses or single mothers. Ample evidence from Dellefield et
al. (2015: 95-108) attest to this relationship among performance, sleep and errors. Quick returns
thus cause insufficient rest among nurses and increase their chances of making clinical mistakes.
In this concern, at least 16 hours are required for nurses as free time to obtain optimum sleep.
Josten et al., (2003) stated that working habits of nurses with 3 shifts a day to overlap 1 to 3
hours gap between shifts. These shifting systems give rise to an increased number of handovers
each day. Hence, in 24 hours, a significant time is lost in handovers and commute. Frequent
handovers can also cause information gaps that reduce efficiency of nurses giving rise to reduced
care quality, medication errors and delayed discharges (NHS, 2010). The 12 hour shifts reduces
the chances of communication errors by curtailing handovers. NHS has undertaken staff
consultation prior to implementation of the 12 hour shifts. Significant benefits of 12 hour
working shifts have been noted in economic stability of nurses. Since hospitals can now meet
service needs with lesser staffs, they offer higher pay scales to nurses who work for longer shifts.
As opined by Perry et al. (2016: 1088-1097), nursing staff prefer 12-hour work shifts as it
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enables them to spend more time in their personal sphere. In addition to this, less time is lost
while commuting. Nurses need to come for work thrice a week with their total working hours
amounting to 36 hours (Josten et al., 2003).
Hublin et al. (2010: 315-323) present a population-based research to assess interaction between
shift-work and three distinct outcomes, mortality, incident hypertension, and disability
retirement. The researchers use models of Cox proportional hazards to retrieve hazard ratios for
each of the specified outcomes against type of working shifts. It is seen that cardiovascular
complications is a common cause of death in people who are associated to nursing professions.
Disability retirements and medicated hypertension cases are also higher in nurses who have
opted for longer working shifts. Multiple incidents have shed light on the issue of cardiovascular
complications in resident nurses. The results of Nea et al. (2015: 143-166) argue direct
interaction between cardiovascular diseases and shift-work is not considerable significant in
young nurses. This gives rise to the possibility of age bias in the older records. In addition to this,
Pappas et al. (2015: 8-73) state lack of increment in mortality risks in recent times can cater to
the fact that improper working condition play a major role in the observations. Hence, working
shift in the present times cannot be linked directly to cardiovascular mortality. However, nurses
must opt for rotational shifts and access employee health benefits to maintain their work-life
balance.
Matheson, O'brien & Reid (2014: 3309-3320) uses a narrative review of literature to gauge the
changes in working conditions and time in hospitals. Researchers used databases to obtain
information relative to shift work in hospitals and their psychosocial and physiological health
effects on nurses. However, it is hard to conclude management approaches of nurses in
accordance to their shift works due to an absence of primary study. A majority of nurses
undertake their shifts for prolonged (12 hours) time due to increased pay scales (Sarafis et al.,
2016). In addition to this, 12 hour shifts enable nurses to opt for studies or working other shifts.
As stated by Leung et al. (2016: 1178), the changing conditions of hospital shifts have given rise
to prominence in errors for nurses who are accustomed to conventional approaches of working.
The concept of prolonged shifts has undergone a rapid change to fit to the needs of nurses. Keers
et al. (2015: 12-34) comment this rapid change can impose adverse effects along with positive
results. This is why, it is essential to maintain a sustainable approach towards the working shits
in order to successfully balance personal and professional life.
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Nursing care include prolong working shifts that is further strengthened by global evidence in the
healthcare sector. Ball et al. (2017: 26) collected the data from a questionnaire survey that
included 31 nurses from 46 English hospitals. This is a portion of RN4CAST study that analysed
the data in a descriptive manner that involves percentages, frequencies and net scores derived
from shift length. This includes working beyond shift hours or other work related stress (Han et
al., 2014). The multi-tiered regression has concluded statistical relation between nurse measures
and shift length. Self-reported care quality is found higher among nurses who work less than 8
hours. The present study shows that working in a prolonged shift can reduce the critical thinking
and decision making of the nursing practitioners. Ball et al. (2017: 26) state 74% of nurses work
day shift whereas 26% work in night shifts. Undone or inappropriate care scores vary by the
length of the shift. The observations are found to be similar to the studies of Jakel et al. (611-
616), that show highest insufficiency is exhibited in nurses who work for 12 hours or more. The
chances of incapable care quality are found higher by 1.64 times for nurses who worked less than
12 hours.
Extreme work pressure and stress have a devastating impact on nursing efficiency. This cross-
sectional study has performed an experiment on about 246 nurses in both private and public units
in order to understand impact of stress and wo0rk pressure on nursing performance. Working for
more than 12 hours triggers stress and pressure among these nurses. It has been observed that
about 128 nurses suffered from mental trauma and this affected their rate of performance. They
were unable to provide full attention and care to their jobs due to extreme pressure and stress.
Survey results have shown that nurses working for more than 12 hours have an immense impact
on nursing performance. Most of the nurses faced with emotional and physical stress and this
further affected their quality of life. Farquhar (2017:127-132) opined that service receivers are
significant stressors and affect the emotional well being of these nurses. The findings of the
research study also suggested that occupational stress have a negative impact on these nurses.
They are unable to perform their duty and are forced to work for a prolonged time. This also
impacted their mental state and hampered their rate of performance.
In acute care hospitals, nursing workload has an immense impact on the professional behaviour
exhibited by registered nurses. Furthermore, it has been observed that rotating shift works impact
the physical well being of the nurses. High prevalence of coronary heart disease has been evident
among nurses working in rotating shifts (Chen et al., 2014). This cohort study was conducted on
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189,158 women nurses and it was observed that majority of these registered nurses suffered from
coronary heart diseases. Longer duration of rotational shifts affected the health profile of these
registered nurses. Recio-Saucedo et al. (2018:2248-2259) opined that nurses working for
prolonged periods of time were affected the most. They could not provide effective treatments
and care due to their own health-related complications. High incidence of nonfatal myocardial
infarction along with angina pectoris has been evident among these registered nurses on working
for prolonged period of time. Furthermore, waning risk has also been observed among nurses
after cessation of shift work. Therefore, it can be said that nurses should not be allowed to work
for prolonged periods of time in order to prevent any harmful impact on their health (McGettrick
and O’Neill, 2006).
Night shift among registered nurses has been associated with increased body weight. Cross-
sectional study on 744 nurses and midwives was carried out in order to understand the impact of
night shifts on their health. Anthropometric measurements were carried out to estimate their BMI
level and it was observed that majority of the nurses suffered from high BMI rate. Around 83%
of nurses resigned for their night duties due to ill-health. High prevalence of obesity was
predominant among nurses working during night shifts. This cross-sectional study has shown
effective results in anthropometric measurements. It was observed that working during night
shifts have an immense health-related impact on the physical well being of these nurses (Attarchi
et al., 2014). Furthermore, it has also been observed that in this case, almost majority of the
nurses wished to resign from their works due to high health-related complications manifested
due to working in night shifts. Abdominal obesity is a common outcome among these nurses.
Chances of developing breast cancer and abdominal adiposity were higher among nurses
working in night shifts as compared with other nurses working in normal shifts (Harris et al.,
2015). Therefore, it can be said that nurses should control their working for prolonged periods of
time in order to ensure their proper physical and mental well being.
Eldevik et al., (2013) stated that adverse working conditions are contributing factors behind
occurrence of obesity. It has been observed that physical inactivity and working for prolonged
periods of time are subjected to stress and this overall affects their mental stability. This cross-
sectional study was performed on 394 nurses in order to evaluate adverse working conditions on
their physical health. It was observed that about 31% of nurses were overweight while about
18% of nurses were found to be extremely obese. Occupational factors greatly attribute to
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adverse health conditions among nurses. They are often forced to work for prolonged periods of
time and this impact their health profile. Along with this, Ball et al., (2015) stated that physical
workload was not related to a high occurrence of obesity. Inadequate physical activity and
working for higher periods of time have been linked to a high prevalence of obesity. It has been
observed that nurses could not get time to perform any sort of aerobic exercises and this affected
their physical health. They often need to deal with long working hours this affects their mental
state (Clendon and Gibbons, 2015). These registered nurses should be allowed to take breaks in
their working premises. They should not be overloaded with work pressure as this impacts their
mental health.
Discussion of evidence
Findings
Serial
no.
Included studies Country Aims Design:
Sample:
Data
collection:
Data
analysis
method:
Key findings
Page 16 of 37

1. Ball, J., Day, T.,
Murrells, T.,
Dall’Ora, C.,
Rafferty, A. M.,
Griffiths, P., &
Maben, J. (2017).
Cross-sectional
examination of
the association
between shift
length and
hospital nurses
job satisfaction
and nurse
reported quality
measures. BMC
nursing, 16(1),
26.
UK To access the
impact of shift
work on job
dissatisfaction
among nurses
Design:
Cross-
sectional
study
Sample: 31
NHS hospital
trusts
Data
collection:
Questionnair
e
Data
analysis:
Descriptive
analysis
Prolonged shift
works cause job
dissatisfaction
among nurses
2. Ball, J., Maben,
J., Murrells, T.,
Day, T., &
Griffiths, P.
(2015). 12-hour
shifts:
Prevalence,
UK To understand
and identify the
prevalence of
12-hour shift
working in
hospital
premises and
Design:
Cross-
sectional
study
Sample: A
total 75
research
The RCN
employment
survey has
revealed
information that
12-hour shift
work has an
Page 17 of 37

views and
impact.
their impact on
nursing well
being.
articles were
selected out
of which
only 49
articles were
included in
this research
study.
Data
collection:
Systematic
analysis
Data
analysis:
Descriptive
analysis
immense impact
on the nursing
performance and
their well being.
Contemporary
data have also
revealed that
working patterns
of nurses change
under the impact
of prolonged
nursing time.
3. Ball, J., Dall'ora,
C., & Griffiths,
P. (2015). The
12-hour shift:
friend or foe?.
Nursing Times,
111(6):12–4.
UK To understand
the impact of
12-hour shift
work on
creating job
dissatisfaction
and high
turnover rate
among nurses
Design:
Evidence-
based
research
Sample: A
total 488
hospitals
were
included out
From the
evidences, it has
been observed
that three 12-
hour shifting
working duties
might favour
some of the
nurses however,
Page 18 of 37

within their
premises
of which
about 31,627
registered
nurses
participated
in this
research
study.
Data
collection
methods:
Survey
Data
analysis:
Thematic
analysis
this affect their
psychological
well being.
Prolonged
working duties
might also affect
nursing retention
within their
hospitals.
4. Eldevik, M. F.,
Flo, E., Moen, B.
E., Pallesen, S.,
& Bjorvatn, B.
(2013).
Insomnia,
excessive
sleepiness,
excessive fatigue,
UK To assess
whether less
than 11-hour
working
patterns
contributes in
sleepiness,
anxiety and
depression
Design:
Cross-
sectional
study
Sample:
About 5400
registered
nurses were
selected for
Shift working
duties have a
negative impact
on the health
impact of nurses
thereby affecting
their working
patterns. It has
been observed
Page 19 of 37

anxiety,
depression and
shift work
disorder in
nurses having
less than 11
hours in-between
shifts. PloS one,
8(8), e70882.
among nurses
during their
course of
working
this study.
Data
collection
methods:
Survey
Data
analysis:
Descriptive
analysis
that most of the
nurses feel their
nursing pattern
get affected
under the
influence of
prolonged
working hours.
5. Evidence, N. H.
S. (2010).
Moving to 12-
hour shift
patterns: to
increase
continuity and
reduce costs.
Basingstoke and
North Hampshire
NHS Foundation
Trust.
UK To reduce the
total number of
shifting
overlaps
among nurses
and increasing
their continuity
through their
working day.
Design: Case
study
Sample: The
study was
conducted
within health
wards
Data
collection
methods:
Quality
research
Data
analysis:
Case study
analysis
Moving from 12-
hour shift
patterns improve
the quality and
productivity of
nurses thereby
improving their
performance
rate.
Page 20 of 37

6. Hublin, C.,
Partinen, M.,
Koskenvuo, K.,
Silventoinen, K.,
Koskenvuo, M.,
& Kaprio, J.
(2010). Shift-
work and
cardiovascular
disease: a
population-based
22-year follow-
up study.
European
journal of
epidemiology,
25(5), 315-323.
UK To understand
the impact of
shit works on
the
cardiovascular
health
provision of
nurses
Design:
Cohort study
Sample:
20,142
nurses were
included in
this study out
of them,
76.9%
worked
during
daytime
while 9.5%
were shift
workers.
Data
collection
methods:
Survey
Data
analysis:
Descriptive
analysis
No association
has been found
between
cardiovascular
morbidity and
shot works
among nurses.
Based on the
findings,
cardiovascular
health is not
dependent on the
working patterns
of nurses.
7.
Vetter, C.,
Devore, E. E.,
Wegrzyn, L. R.,
Massa, J.,
Speizer, F. E.,
UK To analyse the
impact of
Design:
Cohort study
Rotational shift
work increases
Page 21 of 37

Kawachi, I., ... &
Schernhammer,
E. S. (2016).
Association
between rotating
night shift work
and risk of
coronary heart
disease among
women. Jama,
315(16), 1726-
1734.
rotational shift
on prevalence
of coronary
heart diseases
Sample:
189,158
women
nurses
Data
collection-
Questionnair
e
Data
analysis:
Statistical
interpretation
the tendency of
developing
coronary heart
diseases among
nurses.
8.
Sarafis, P.,
Rousaki, E.,
Tsounis, A.,
Malliarou, M.,
Lahana, L.,
Bamidis, P., ... &
Papastavrou, E.
(2016). The
impact of
occupational
stress on nurses’
caring
behaviours and
their health
related quality of
life. BMC
UK To understand
the impact of
occupational
stress on
nursing
efficiency
Design:
Cross-
sectional
study
Sample: 246
nurses
Data
collection:
survey
Data
analysis:
statistical
interpretation
Occupational
stress have
immense impact
on nursing
efficacy
Page 22 of 37

nursing, 15(1),
56.
9. Matheson, A.,
O'brien, L., &
Reid, J. A.
(2014). The
impact of
shiftwork on
health: a
literature review.
Journal of
Clinical Nursing,
23(23-24), 3309-
3320.
UK To find out and
analyse the
impact of shift
work on the
health
outcomes of
nurses
Design:
Narrative
literature
review
Sample: 118
research
studies were
included in
this research
study.
Data
collection
methods:
Systematic
review
Data
analysis:
Thematic
analysis
Shift works have
mostly impacted
the physiological
and
psychological
well being of
nurses. These
nurses find it
difficult to
perform with
high efficiency
within their
working
environment.
10. Estryn-Béhar,
M., & Van der
Heijden, B. I.
UK To critically
evaluate the
impact of
Design:
NEXT study
Sample:
Extended or
prolonged
working hours
Page 23 of 37

(2012). Effects of
extended work
shifts on
employee
fatigue, health,
satisfaction,
work/family
balance, and
patient safety.
Work,
41(Supplement
1), 4283-4290.
extended shift
work on health
satisfaction as
well as fatigue
among nurses
25,924
European
nurses were
included in
this study
Data
collection
methods:
Survey
Data
analysis:
multivariate
analysis
have a
detrimental
impact on
nursing well
being and their
performance
rate. They feel
extreme fatigue
and remain
dissatisfied that
overall impacted
their working
patterns.
11.
Nam, S., & Lee,
S. J. (2016).
Occupational
factors associated
with obesity and
leisure-time
physical activity
among nurses: A
cross sectional
study.
International
journal of
nursing studies,
57, 60-69.
To understand
the impact of
an adverse
working
condition on
health profile
of nurses
Design-
Cross-
sectional
study
Sample: 394
nurses
Data
Collection:
Survey
Data
analysis:
SPSS
Night shift have
negative impact
on health
structure of
nurses
Page 24 of 37

12.
Peplonska, B.,
Bukowska, A.
and Sobala, W.,
2015.
Association of
rotating night
shift work with
BMI and
abdominal
obesity among
nurses and
midwives. PloS
one, 10(7),
p.e0133761.
UK To understand
the impact of
night shifts on
BMI level
Design:
Cross-
sectional
study
Sample: 744
nurses
Data
collection:
Survey
Data
analysis:
Statistical
representatio
n
Night shifts
increase BMI
level of nurses.
Table 1: Journal summary
(Source: Created by the researcher)
Analysis
Prolonged working hours and their impact on job satisfaction and work-family balance
among nurses
Estryn-Béhar, M., & Van der Heijden (2012:4283-4290) commented that employee satisfaction
is dependent on their retention within working premises. Therefore, in case nurses are
dissatisfied with their working duties and patterns then it will adversely impact their retention
Page 25 of 37

rates. High level of nurses’ turnover rate has been observed among most of the healthcare clinics
in UK. Most of them have reported regarding prolonged working hours and shift works. They are
not allowed to take sufficient rest within their shift timings and this aggravated their health.
Dellefield et al. (2015:95-108) argued that a high incidence of cardiovascular mobility rates also
has been observed among these nurses working for shift works. However, Farquhar (2017:127-
132) argued that shift timings have no relation to cardiovascular health outcomes.
In addition, Hublin et al. (2010:315-323) opined that prolonged working schedules impact the
mental stability and well being of nurses. They feel extremely fatigued in their working premises
and this impacts their physical health. They become agitated and depressed due to inability to
work with high efficiency which is reflected in their personal life (Nolan, 2016). They fail to
maintain an effective balance between their works and family that affects their mental state.
Furthermore, it has also been observed that most of these registered nurses prefer to choose night
shifts or 12-hour shifts for reducing their home conflicts. However, these prolonged working
duties result in burnout of nurses thereby affecting their working patterns. Matheson, O'brien &
Reid (2014:3309-3320) added that in extended working environments, employee health safety
and their job satisfaction are given less importance which again impacts their mental stability.
Influence of prolonged working duties and night shifts on physical and mental well being of
nurses
Moreover, Pappas et al. (2015:73-78) opined that nurses prefer night shifts so that they could
work at their home during their daytime. Therefore, this further affects their physical well being.
Perry et al. (2016:1088-1097) opined that night shifts affects the sleep-wake cycle thereby
influencing their circadian rhythms. Furthermore, a night shift also increases the risks of
developing breast cancer among nurses. It has been observed that night shifts increase the
tendency of nurses getting obese. This would further contribute to diabetes and cardiovascular
illness. High incidence of myocardial infarction has been evident among nurses working during
night shifts. Phiri et al. (2014:38) added that prolonged working duties make the nurses fatigue
that impacts their physical health. Higher incidence of angina pectoris has also been evident
within nurses working for shift timings. Apart from physical health, Recio‐Saucedo et al.
(2018:2248-2259) stated that a high level of depression and anxiety has been evident among
nurses working for a prolonged period of time. Moreover, they are more prone to workplace
injury that overall impact their physical health. Therefore, psycho-social impact is quite evident
Page 26 of 37

among nurses working for prolonged periods of time. Therefore, it can be said that night shifts or
a prolonged period of working hours have an overall impact on the mental and physical well
being of the nurses.
Impact of shift timings and prolonged working hours on working patterns of nurses
Most of the nurses have complained regarding their inability to work efficiently within their
working premises. In this concern, Aiken et al. (2014:1824-1830) commented that nurses feel de-
motivated due to extensive work pressure and this affects their working patterns and efficiency.
These healthcare practitioners often find it difficult to concentrate and deliver work with high
efficiency. Furthermore, it has also been observed that most of the hospital premises do not
provide sufficient break time in between shifts. This further aggravates their condition and makes
them more vulnerable. They are unable to produce work with high diligence and this further
affects their mental and physical wellbeing. Along with this, Gu et al., (2015:241-252)
commented that nurses should be capable of providing medications and care properly. However,
their own health gets affected that reduce their efficiency within their premises. Furthermore, it
has also been observed among many nurses that they suffer from insomnia under the impact of
prolonged working hours. Thus, it can be said that prolonged working duties do not accelerate
working efficiency, however, reduces their performance rate.
Solutions to reduce the stress of nurses from 8-12 working hours:
The stress among the nurses can be reduced through recruitment of more nurses to manage the
care practices in proper manner. Recruitment of new nurses will be helpful in dividing the care
practices among more nurses and reduce the working hours of nurses. In addition, the stress of
nurses can be reduced with the increased working hours through proper intervals of 2-3 hours
between two shifts. During this period, the nurses can get relax and feel better for further
practices. The care organizations can use provide relaxation of one hour for the nurses after each
4 fours to reduce their stress from the additional practices in at the workplace. In addition, the
care organizations can provide additional monetary benefits well as non-monetary benefits such
as living facilities for the nurses with family in care organization of nearby the organization to
motivate the nurses to perform more with the organization (Magnago et al., 2012). These
practices will be helpful in managing the stress of nurses from 8-12 working hours. As well as,
the flexible working hours can also be considered by the care organizations to manage the issue
Page 27 of 37

of stress among the nurses at the workplace. These efforts will be helpful for care organizations
in reducing stress of the nurses from 8-12 working hours.
Suggestions in regards to the psychological and physiological issues among the nurses:
Patient-centered care is a current descriptor given to the way in which care should be planned
and delivered. This moves health care beyond repairing the abnormal physiology, biochemistry
or anatomy and deals holistically with the whole patient. It recognizes what the patient feels,
how they engage and participate in decisions about their care and the values that underpin the
management of the health care system. The involvement of patients in healthcare is both a matter
of government policy, and an important part of quality improvement. Involvement occurs at
many levels – from citizens’ juries to patient participation groups (Farkas, 2017). One important
arena is the face-to-face consultation with a clinician and second is that the health professionals
are increasingly encouraged to involve patients in treatment decisions, recognizing patients as
experts with a unique knowledge of their own health and their preferences for treatments, health
states, and outcomes. In addition, there must be proper focus of the nurses on social and
psychological need of the patients to develop a healthy environment for the patients. As well as,
the care nurses must make efforts to reduce the noise in patient wards and have social interaction
with the patients to reduce stress and improves recovery outcomes from psychological and
psychological issues in care services (BMA Science & Education, 2011).
Implications and limitations
One of the major limitations faced by the researcher is shortage of time. In limited interval of
time, the author needs to acquire all the resources and conclude on the mentioned topic. In
addition to this, budget constraint is another potent limitation of this study. Due to inadequate
budget, various authentic research journals could not be assessed. However, despite these
limitations, the researcher has tried to use information and draw effective conclusion. In addition,
the research study only covers the information related to overtime of nurses and its influence on
their working practices. In this regard, the research outcomes cannot be used for any other field
of healthcare. The research study is based on secondary, which is reducing the reliability of the
research outcomes.
Page 28 of 37

Conclusion
Prolonged period of working hours has a detrimental impact on the health provider of nurses. 12
hours of working schedule and rotational duties have an immense negative impact on the
emotional well being of the nurses. Shift works increase the prevalence of coronary heart
diseases. High occurrence of myocardial infarction and angina pectoris has been evident among
nurses on working for more than 12 hours daily. Job dissatisfaction is another major concern of
these nurses for working prolonged periods of time. Therefore, these nurses need to take a break
in order to ensure proper physical and mental well being. Furthermore, extreme job
dissatisfaction has also been another contributing factor behind high mortality rate. Hence,
hospital authorities need to ensure that their nurses are not allowed to work for prolonged periods
of time in order to assure their health security. It s also analyzed that the characteristics of
morning or evening shift workers have considerable impact on mood states of the workers.
Therefore, the care organizations can improve the mental states of the nurses by adjusting the
work schedule with the morning and evening characteristics of the nurses.
Page 29 of 37

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Websites
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Appendices
Appendix A: PRISMA
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(Source: http://prisma.thetacollaborative.ca/generator)
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