Scarcely a month goes by, or so it seems, without one or other representative body of the medical profession complaining about how dangerously overworked and generally unappreciated its members are. The latest is the Royal College of Nursing — still smarting, perhaps, from the Francis report into the fatal negligence at Stafford Hospital — which found that nurses today are frequently stressed out and ‘forced to choose between the health of their patients and their own’. Forgive me, but they would say that, wouldn’t they?
The preamble notes that morale has deteriorated since a similar RCN survey eight years ago published under the same self-fulfilling title, At Breaking Point. What the survey failed to spell out, however — and would be equally hard to find in any recent consideration of nurses’ grievances — is that the worst of the long hours are self-imposed, and take the form of the 12-hour shift.
Some shifts are even longer. There are web forums where you find nurses talking about working up to 14 hours on the trot, – and not because their ‘bully’ of a boss has demanded unpaid overtime, but because this is their shift, and they like it. They choose to work like this.
According to the Nursing Times, almost half of all NHS nurses now work shifts of 12 hours or more. These long shifts began, like so much, in the United States in the 1970s, and soon made their inevitable advance over here. In the US, the new shift patterns reflected difficulties in staffing night shifts. Here, it was always a tool for efficiency — or, to put it another way, for reducing numbers. But it rapidly became that holy grail of management: an economy measure so popular that it became a recruitment draw.
For a profession that is still predominantly female, the 12-hour shift is a boon. It allows nurses to cram a full-time job, with full-time pay, into three days a week. They save on the cost of child care; they save, too, on the time and cost of commuting. It is the ultimate win-win. They gain valuable family days, without sacrificing the money they would lose by working part-time. Some take second jobs.
Surprisingly, these 12-hour days have attracted no opprobrium either from the guardians of the EU Working Time Directive, or from the trades unions. So long as the weekly tally of hours is not too high and statutory breaks are observed, this shift pattern seems to be fine with Brussels. The trade unions have nothing to say so long as their members are happy — which, mostly, they are.
But there is a conspicuous absentee from this discussion: the patient. And some dissonant voices admit that, just maybe, these long shifts have a downside: as nurses clock up the hours, they grow more tired, more irritable, and more prone to make mistakes. Could it be that 12-hour shifts are to blame, at least in part, for what many patients regard as the deterioration in nursing standards over the past 20 years?
Some say, as do the managers, that patients benefit from continuity of care. But this continuity is through the day, not the week, and if the choice is between continuity and competence, what choice is that? This is an arrangement in which nurses, their professional organisations and their managers are effectively colluding against the interests of patients.
How cheerful, observant and considerate would you be after ten hours on the job? I was a tourism volunteer in London this summer and can attest that even six hours on your feet tests your stamina and humour. No wonder nurses retreat to their computers and coffee rooms at every opportunity. No wonder they ignore patients’ bells. No wonder they may not be as compassionate as we would wish. They are ten hours into their 12-hour shift, with a two-hour drive to get home. Apparently no one thinks anything is wrong.
Well, one person may do. Last April, the Chief Nursing Officer asked NHS England to review the safety of 12-hour shifts. With several American studies finding that long nursing shifts jeopardise care and lead to mistakes, this research is overdue.
Whatever the outcome, though, it is clear that nurses will be dragged kicking and screaming from their long days and short weeks. We, the patients, will have to gear up for a bizarre new stand-off in which nurses at once complain of fatigue while fighting for their supposed right to work long hours. They are currently demanding minimum staffing levels on wards. We should demand maximum eight-hour shifts.
Mary Dejevsky has worked as a foreign correspondent all over the world. She now writes for the Independent.