Are 12 Hour Tours Fueling the Nursing Shortage?

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

This is a blog I never thought I would write. For decades despite safety evidence to the contrary, we have embedded 12-hour tours deeply into nursing cultures in acute care settings. Nurse leaders have told me that to discuss revising 12-hour tours in nursing was like a “third rail in politics” considered to be highly charged” and “untouchable.” The research has been consistent in noting that 12-hour tours often extend into 13 + hour tours, leading to nursing fatigue, burnout, lowered job satisfaction, and patient safety issues.

So during the last two decades in many healthcare settings, there has been little choice for nurses. You either work a 12-hour tour or transfer to an ambulatory setting. The 12-hour tour has become a self-imposed work rule. Using other scheduling patterns is considered inconvenient and might result in a need for more staff. This self-imposed work rule worked in most healthcare settings in a pre-COVID environment. But no longer, I would contend that the lack of flexibility in scheduling is tying our hands as we confront one of the most significant nursing shortages in history.

Over the past four months, countless frontline nurse leaders have shared stories such as the following with me:

I lost an experienced nurse today to retirement – she wanted to cut back to either a six, eight, or ten-hour tour. She is exhausted and is having trouble getting out of bed in the morning. Sadly, I had no options and was told that I could not offer a staffing alternative. She took early retirement instead. This did not have to happen. The vacancy she left still sits unfilled and probably will for the long term. I still feel bad that my hands were tied on this. I think we are very short-sighted in nursing.
Two of my millennial intensive care unit nurses who just had babies approached me and asked if they could job-share a position on my unit. Both feel overwhelmed with the demands of parenting, working full-time 12-hour shifts, and COVID. They offered to work the same schedule and split their shift. I asked my director, who talked with the CNO and HR. The answer was no. I lost both of these nurses and can’t fill their positions. Neither one is working in nursing right now.
A single mom nurse on my unit asked me if she could cut back to an 8-hour tour. She can’t find childcare to cover a 12-hour tour. I was told that I could not accommodate an 8-hour tour scheduling request and that others would want it if I gave it to her. She resigned and found an 8-hour tour position. The vacancy she left remains unfilled.
A young Generation Z nurse who is stressed and anxious told me that she is not sleeping after her 12-hour tours. She is overwhelmed with the work and wants a 10-hour tour. I was told that 10-hour tours are not in our labor contract, so the answer was no. She stayed another two months but then left, telling me that she was not sure she would ever work in nursing again.

I believe it is time to rethink nurse scheduling completely. Taking care of COVID patients for 12-13 hours a day has made it painfully clear just how exhausting these long shifts can be. Nurse leaders have shared that we have lost nurses both new and seasoned to inflexible thinking and self-imposed work rules. There are many aspects of this COVID experience that nurse leaders have no control over, but here is one that we clearly do.

Read to Lead

Geiger-Brown, J. & Trinkoff, M. (2010). Is it time to pull the plug on 12-hour tours: Part 1? The evidence. Journal of Nursing Administration, 40 (3) 100-102.

Jones-Berry, S. (2019). 12-hour shifts: they may offer nurses a work-life balance, but are they worth the risk to safety? Nursing Standard.

Montgomery, K.L. & Geiger-Brown, J. (2010). Is it time to pull the plug on 12-hour tours: Barriers to change and effective leadership strategies? Journal of Nursing Administration. 4(40), 147-149.

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, 31(11), 2501-2509.

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