The 12-hour shift is now the norm in the nursing profession. Although many nurses welcome a flexible schedule, is it good for the patients?
The Facebook post — uploaded in November 2014 — had been shared 636,912 by the afternoon of July 9, 2015.
And the momentum was still going. A few hours later, there were 2,500 more “shares,” and by July 10, another 11,151 people had shared the post, which attracted more than 5,000 comments. The hot topic?
Nurses and their long hours.
“I can make myself get up at 5 a.m. to make sure your mother had the medicine she needs,” reads the message posted on the NursingGuide.ph Facebook page. “I work all day to save the lives of strangers. I make my family wait for dinner until I know your family is taken care of. I make myself skip lunch so that I can make sure everything I did for your wife today is charted…”
It goes on, ending with: “Repost not only if you are a nurse or you love a nurse, but most importantly, repost this if you respect our work.”
Time was when the only “viral” aspects to nursing were the patients’ illnesses. But these days, the topic of nurses’ work hours and stress level has spread like measles on social media. Google “nurse bathroom breaks,” and you find social media posts and cartoons galore about nurses having to “hold their pee” for 10 or 12 hours. One cartoon shows a patient pointing to a restroom and asking, “What’s in that room?” and the hurried nurse replying, “I don’t know. I’ve never been in there.”
Are nurses really working on empty stomachs and full bladders? Is the hospital workplace becoming more grueling just as our millennial-influenced society is demanding greater “work-life balance?”
Interviews with nurses, nursing instructors, hospital officials and nursing organizations confirm that 12-hour work shifts have become the norm. A highly popular full-time schedule is 36 hours per week: three 12-hour shifts on and four days off. Froedtert Hospital has become known for its 7-70 schedule, in which nurses work 70 hours a week (seven 10-hour days in a row) and then take the next week off.
It does appear breaks are rare. But Brenda Bowers, chief nursing officer for the Milwaukee area’s extensive Wheaton Franciscan system, says it’s often the nurses themselves who are voluntarily skipping breaks.
“We know that’s a hot topic – it always has been in nursing,” says Bowers. “Nurses will say they’d rather just work through, so we have our charge nurses making rounds and ensuring that those breaks and lunches are being taken.”
At Aurora Health Care, another system with a large presence in southeastern Wisconsin, a 12-hour shift includes just 30 minutes for lunch. Other breaks are neither scheduled nor enforced, says Marie Willmann, a registered nurse at Aurora St. Luke’s Medical Center. (All nurses interviewed for this story are RNs who work, or have worked, in hospital settings.)
“You kind of take a five- or 10-minute break in between when you’re charting,” says Willmann. “But if I have stuff to get done, and I don’t need to take a break, I’m fine with it, I’ll keep going.”
Jessica Rotier, a clinical nursing instructor at the University of Wisconsin-Milwaukee’s College of Nursing, says her students, for a class project last semester, observed that nurses at Aurora Hartford Hospital “never took their breaks.” They concluded it was often by choice.
“I try to teach my seniors that you have to take your break to get some nutrition in your body so you can think better for the rest of your shift,” says Rotier. “Everywhere I go, management is trying to figure out how to get nurses to take their breaks. I just think it’s from nurses wanting to do for others before they do for themselves. I think it’s a choice we make, not forced on us.”
Willmann agrees. “I think if a nurse doesn’t get a break, it’s almost their fault,” she says. “I think maybe they’re mishandling their time-management. Nurses are very good at being martyrs as well. That’s where having a good charge nurse or manager there to say, ‘Hey, go take five minutes,’ helps a lot.”
So if nurses rarely take breaks, is it wise for so many of them to be working for 12 straight hours?
“I like the 12-hour day,” says Natalie McDonough, who works in the St. Luke’s surgical intensive care unit, “because I feel like I have more continuity of caring for my patients. If I’m exhausted at the end of the day, then I know I did a good job.”
“There is some data out there that a 12-hour shift is safer for patients, because only two nurses are taking care of them instead of three,” says Kim Litwack, associate dean for academic affairs at UWM’s College of Nursing. “There’s less chance for medication errors and a better chance of recognizing subtle changes in a patient’s status.
“Some are doing it by choice and some are not,” she says. “For me personally, I worked 12-hour days because it allowed me to go to school on the other days.”
Although common today, 12-hour shifts are unthinkable to many retired nurses.
“I don’t think I’d like to be an RN now,” says Doris Sorvick, who worked from the 1950s to the early ’70s, including at St. Luke’s and Columbia hospitals, when eight-hour days were the norm. “On rare occasions, we’d work a second eight hours if someone was sick,” she says.
Elaine Guetz, who worked at the former Milwaukee County Hospital during the 1960s and ’70s, also remembers traditional shifts, starting at 7 a.m., 3 p.m. or 11 p.m. “There was no working from 7 to 7 for seven days and then having off for seven days, like they do now at Froedtert,” she says. “After you work eight hours, you’re tired, and it really isn’t such a good thing for the patients.”
Multiple legislative attempts have been made by Wisconsin Democrats to limit mandatory overtime for nurses, except in the case of unforeseen disasters. The legislation has always failed. “Even when Gov. Jim Doyle was in office, it never reached his desk,” says Candice Owley, president of the Wisconsin Federation of Nurses and Health Professionals, which continues to lobby for such laws.
Nurse unions have had little influence here. In the Milwaukee area, only the Zablocki VA Medical Center, St. Francis Hospital and the Milwaukee County Mental Health Complex are unionized, says Owley.
Owley notes that she constantly hears from nurses around the state who complain of being begged, if not forced, to work extra hours or days, no matter what their official schedule dictates.
“Without question, systems like Aurora and Froedtert have an enormous amount of money,” says Owley, “and so it’s always quite upsetting to see that they staff their facilities at such a narrow margin. The salaries are pretty reasonable. But the hours, the schedules, the ability to get time off with your family, and the workload that you have when you’re there is just daunting. It’s common to hear nurses crying at the end of their shift.
“It shouldn’t have to be that way,” she continues. “It’s not like we have hospitals that are going broke in this area – that’s just not the case.”
According to the 2014 RN Workforce Survey report, prepared by the Wisconsin Center for Nursing and state Department of Workforce Development, more than a third of currently employed registered nurses are 55 or older. Another 23 percent fall in the age range of 45-54.
The Great Recession appears to have caused a temporary glut of nurses, as older nurses postponed retirement and others picked up extra hours. But as the economy improves and retirements resume, a shortage of 20,000 nurses is predicted by 2035.
The incoming millennials, a generation known for demanding greater work-life balance and more say in their own careers, is already spurring changes in the nursing workplace.
In past years, nurses just accepted that they’d miss social gatherings.
“We agreed to work every other weekend,” says Guetz. “I know some nurses who never took a summer vacation with their families. I worked on days when there were weddings and I couldn’t go, but I sort of took it for granted that’s the way it was going to be. I didn’t expect to have off when I wanted off.”
Guetz recalls informal schedule swaps, such as Christian and Jewish nurses exchanging shifts to accommodate religious holidays.
But today, hospitals formally encourage such teamwork, and it’s as easy as the click of a mouse. Nurses choose their schedules by entering them into a computer program.
There’s an online platform for special requests and swapping shifts.
McDonough of Aurora St. Luke’s schedules her three 12-hour shifts “based on what I have planned in my life. If I have something I want to go to on a Tuesday, like a Brewers game, I’m going to work Monday, Wednesday and Thursday. If it’s something that happens after the schedule has come out, we have really great teamwork on the unit, and I can ask someone to cover my shift, and I’ll cover their shift.”
Another hospital trend is the “float nurse” option. These are staff nurses who float among units, as opposed to outsiders hired through temp agencies, explains Bowers of Wheaton Franciscan. Rotier, who formerly worked at ProHealth Care hospitals, says float nurses are likely to be on-call during their off days.
Amy Konet-Nagel chose to be a float nurse at St. Luke’s. She works four “eights” and one four-hour shift each week. At least some of those must be nights and weekends.
“It’s totally self-scheduled,” says Konet-Nagel. “We have a text line that the staffing office will send out if there’s an urgent need or a sick call. If you go into overtime, that would be covered. If you want to, you can call back.”
Konet-Nagel, who used to work Froedtert’s 7-70 schedule, adds, “I love working in the float pool because once I put in my schedule, I know what it is. That’s not always what you hear in nursing. It helps me with the work-life balance.”
Shared governance” — the latest workplace buzzword — is now a roar at Aurora and other hospitals. Each nursing unit elects a council, which meets regularly with hospital officials to discuss patient care, air complaints and suggest changes.
“It’s the ownership,” says Konet-Nagel. “I don’t feel that someone in a boardroom who’s never touched a patient is making all the decisions.”
Bowers agrees: “Here at Wheaton Franciscan Health Care, we do focus on a shared-governance theme. The nursing voice is very important.”
Nursing instructor Patti Fischer encourages nurses entering the field to advocate for a say in workplace conditions and in patient care, even as she warns them that patient needs and hospital budgets can mean unavoidable overtime and stress. As a clinical professor for final-semester seniors at UWM, Fischer emphasizes management skills, noting that many RNs quickly progress into leadership positions as shift managers or charge nurses.
“I wore that budget hat for 15 years,” Fischer says. “Everything is team-oriented and outcome-driven. I teach students about finance, hospital systems, quality improvement, safety and ethical issues around patient care. My goal is, when my students get out in the world and they have a concern, they know the channels to take, in a constructive way.”
Kay Nolan is a Milwaukee-area freelance writer. Write to her at firstname.lastname@example.org.
Nightingales Take Wing
Travel nurses hit the road to fill a need and see the country.
➻ Patients at area hospitals usually know the names of the nurses assigned to their care. Nurses introduce themselves, wear ID tags, and often write their names on erasable white boards in patients’ rooms.
But patients might not know that sometimes, their nurses are from other cities or states, having arrived by plane or car after being summoned to ease a temporary staffing shortage.
Travel nurses, as they are called, work through agencies that vouch for their credentials.
Thousands of nurses make this their career. The pay is good and the agency provides benefits. Hospitals use travel nurses to fill staffing gaps without adding new hires, who would qualify for benefits like health insurance.
“Some travel nurses are young, single people who crave change,” says Kristie Christopherson, a senior recruiter for Nurses PRN, an Appleton-based travel nurse agency whose clients include several Milwaukee hospitals. “Or you might have an older nurse whose grown kids live in other states, and she’d like to work in those places for a few months to spend time with them and get paid to do it.
“It’s a win-win,” she continues. “Hospitals pay a little bit more to have somebody come in for shorter stints of time. The benefit for the travel nurses is, they make more money and they get to see the rest of the country.”
Specialties that tend to be especially in-demand are labor and delivery, as well as operating room nurses and those in intensive care units.
Typical travel contracts last around 13 weeks, but they can be shorter or longer. Some assignments lead to permanent jobs. Nurses PRN pays its travelers $30 to $50 an hour, plus an allowance to help offset travel costs. The agency helps find housing, and offers health and dental insurance options.
Some staff nurses grumble that traveling nurses are unfamiliar with a hospital’s procedures, and that they need too much direction and supervision. But Christopherson says traveling nurses typically bring considerable experience and are practiced in getting along with diverse patients, as well as physicians of all specialties and personalities. “They can have the experience of 50 hospitals,” she says.
“They’re considered part of the hospital staff when they are there,” adds Christopherson. “They still have to go through orientation just like any other nurse, and they still have to follow all of the same guidelines and rules.”
Candice Owley, president of the Wisconsin Federation of Nurses and Health Professionals, says frequent use of travel nurses may indicate a hospital is staffing its floors too thinly.
“What tends to happen is, as soon as nurses start leaving an area, like an ICU or emergency department or something, the hospital turns around and says, ‘Oh my, we have no nurses, we have to bring in travelers,’” says Owley. She notes that sometimes, hospitals end up offering bonuses to bring back the nurses they’ve lost and to retain the rest. “If they’d just listen to the nurses who are providing the care, they can tell you when the patient load is too high to be handled safely and when they’re working too many hours.”
Brenda Bowers, chief nursing officer at Wheaton Franciscan Health Care, says her hospital system tries minimizing its use of travel nurses, preferring to tap an internal “float pool” of staff nurses.
Still, Kim Litwack, associate dean for academic affairs at the University of Wisconsin-Milwaukee’s College of Nursing, says the practice remains widespread. “We call it locum tenens,” she says. “Physicians do it, too. Some love it, but you have to be able to be thrown into different situations.”