The Effects of

8-Hour vs. 12-Hour Shifts

on Medication Errors
Dan Liptak, Jamie Giambattista
Alyssa Blosser, Christopher Ross, Alyssa Zorzi

NURS 3749: Nursing Research

Dr. Patricia Hoyson & Dr. Mary Shortreed
Problem:
The reality that medical care provided by nurses can potentially harm
patients rather than help is a reality that healthcare systems worldwide
have been forced to come to terms with due to the recent upward trend in
the number of medication administration errors (MAEs) reported.

Reason for this trend???

Working longer hours...
...with lack
of adequate
rest
periods...
… resulting in overall
fatigue / burnout.
 Significance:
Safely administering the proper medication to a patient is one of the most
crucial nursing responsibilities.

● Key to successfully executing a plan that decreases the frequency of

reported MAEs is understanding the contributing factors involved
(total hours worked within one shift, level of fatigue, etc.)
Purpose of Literature Review/Variables:
We wanted to explore the research previously published to look at
frequency of medication administration errors (MAEs) reported during
8-hour hospital shifts vs. 12-hour hospital shifts.

● We intend to find a significant correlation between our variables:

8-hour and 12-hour shifts, and reported MAEs.

Variables: 8-hour nursing shift

12-hour nursing shift
medication administration errors for each group
 Research Question:
Is there a difference in the
number of medication errors
that occur on an 8-hour shift
versus a 12-hour shift
within an acute hospital setting?
P- nurses within an acute hospital setting (working 8 hour shifts or 12
hour shifts)
I- medication errors that occur during these selected shifts
C- comparing of the total medication errors that occur (during the 8 hour
shift to the total errors during the 12 hour shift)
O- rate of occurrence of total medication errors that produce an adverse
outcome
T- 8 hour shift vs 12 hour shift
 Overview of Literature:
● Effects of fatigue and shift duration on medication administration errors
● Overall effects of longer shifts
● Joint Commission / Effects of increased medication errors on the patient
● International Exploration

● Conclusion
Fatigue
● the majority of medication errors occurred in the month of
January, with November being second in that regard.
● During the week, the most errors occurred on Friday or
Wednesday with the least amount of errors occurring on a
Saturday (Madegowda et al., 2007, p.177)
● The majority of the medication errors reported were on the
second shift during which some nurses had up to fifteen
patients.
Something to Consider...
● A nurse’s fatigue and sleepiness are considered
subjective data, so some nurses might not have reported
if they had difficulty staying awake or if they briefly fell
asleep, which would in turn reduce the fatigue and
tiredness of the nurses
● Many medication errors are not reported if they do not
cause harm to the patient, and that most errors reported
are at the perception of the nurse
Shift Duration
- a combination of 224 errors and 350 near
errors made throughout this study period
with most of the errors from medication
administration (Scott et al., 2006, p.34).
-The longer the work duration, the more
likely an error or near error will occur.
-Of the scheduled eight, eight to twelve, and
twelve or more hour shifts scheduled, 5,201
or 86% of shifts were overtime and 236 or 4%
of the shifts were mandatory overtime
(Scott et al., 2006, p.33).
Health Effects of Longer Shifts
•Increased rates of chronic illness such as diabetes, cardiovascular
disease, and hypertension, especially among shift workers
•Increased rates of gastrointestinal, minor psychiatric, and sleep disorders
•Higher levels of fatigue, accidents, injuries
•Greater susceptibility to fatigue with increased age
Health Effects of Longer Shifts: Sleep
•Potentially more difficult work/life balance such as when working
consecutive 12s or working hours after a double
•Shifts greater than 8 hours linked to lower quality of sleep
•Increased rates of insomnia, especially in shift workers
•2012 study found that mean sleep duration between 12 hour shifts was
5.5 hours
•2007 study concluded that each additional hour in a shift is correlated to
a half hour less of sleep
•Increased prevalence of microsleeps
Joint Commission:
The Joint Commission addresses worker fatigue and puts it into 3
categories:
● Organization/Management issues
● Overtime requirements
● Personal challenges
Ends of the Spectrum:
Patients have a higher chance of:
● Infection
● Not recommending a hospital for care

Nurses have a higher chance of:

● Burnout
● Dissatisfaction
● Intent to leave
International Exploration
Area of interest: Middle East

- Iran, Israel, Saudi, Bahrain, Egypt, Jordan, Qatar, United Arab Emirates,
Palestine and Lebanon
Middle East
Importance of the Middle Eastern region
- Home to 300 million people
- Plentiful natural resources- century long conflict over oil. Ottoman empire vs.
Allies WWI.
- Massive geopolitical importance- current proxy wars, US
intervention/occupation/foreign aid.
Middle East Findings
- In total, 11 studies on medication administration errors were examined.

- Medication admin. Error rate ranged from 9.4 - 80%

- Possible explanation: incongruent definitions and methods used for data collection
- Mostly incorrect dose errors.
- Errors were confirmed through patient interviews.
Wow is rig
h
Mr. Wilso t,
- “Hey, we think someone gave you the wrong med dose. Sorry.”
- Most MEs (50%) occurred during extended work hours and on night shift n.
- “Extended hours” is a somewhat
- Overall lack of pharmacological knowledge of physicians and nurses contributed to this problem
Wrapping it up...
The findings from the literature yield a correlation between nurses working
twelve or more hour shifts and having a greater risk of making an error or
near error in regards to medication administration.
● 12 hour shifts were found to be more favorable among staff; however,
working more than 8 consecutive hours can increase, and in some
cases double, the probability of making a medication error.
● One study found fatigue and medication errors to have some relation
whereas another study found no correlation between decreased
vigilance and an increase in medication administration errors.
Anything Missing? Recommendations??
Missing from the literature:
● No findings of the effects of working an 8-hour shift alone with
increased medication administration errors.

Recommendations:
● One recommendation is to allow nurses to make their own schedules
that best suit them to increase worker satisfaction and also patient
safety. This could be a variety of 4, 8, and 12 hour shifts, whichever
better fit that specific nurse’s schedule.
● Adjust nurse-patient ratios to prevent burnout, fatigue, and lack of
motivation. (maybe by increasing the number of nurses to patients or
by using more non-professional staff such as aides, unit clerks, etc.)
 References:
Alemu, W., Belachew, T., & Yimam, I. (2017). Medication administration errors and contributing factors: A
cross sectional study in two public hospitals in Southern Ethiopia. International Journal of Africa Nursing Sciences, 7,
68-74. Doi:10.1016/j.ijans.2017.09.001

Alsulami, Z., Conroy, S., & Choonara, I. (2013, April). Medication errors in the Middle East Countries: A
Systematic Review of the Literature. Retrieved March 20, 2018, from https://www.ncbi.nlm.nih.gov/
pmc/articles/PMC3621991/

Bellebaum, K. (2008). The relationship between nurses’ work hours, fatigue, and occurrence of medication
administration errors (Dissertation). Retrieved from OhioLink Nursing Research database. (Accession No.
109850803)

Clendon, J. (2015). 12 h shifts and rates of error among nurses: A systematic review. International Journal
of Nursing Studies. 52(7), pages-pages. doi:http://dx.doi.org/10.1016/j.ijnurstu.2015.03.011
Ferris, J., BSN (n.d.). Nursing Fatigue: An Evidence-Based Practice Review For Oncology Nurses. Evidence-Based
Practice. Retrieved March 20, 2018.

Madegowda, B., Hill, P., & Anderson, M. (2007). Medication errors in a rural hospital. Medsurg Nursing,
16(3), 175-80. Retrieved from https://search-proquest-com.proxy.ohiolink.edu:9100/docview/
230528420?accountid=12953
 References:
Olds, D., & Clarke, S. (2010). The effect of work hours on adverse events and errors in health care.
Journal of Safety Research, 41(2), 153-162. doi:10.1016/j.jsr.2010.02.002

Rosenberg, K. (2014). The Joint Commission Addresses Health Care Worker Fatigue. AJN, American
Journal of Nursing,114(7), 17. doi:10.1097/01.naj.0000451665.31008.61

Scott, L., Rogers, A., Hwang, W., & Zhang, Y. (2006). Effects of critical care nurses’ work hours on
vigilance and patients’ safety. American Journal of Critical Care, 15(1), 30-37. Retrieved from
https://search-proquest-com.proxy.ohiolink.edu:9100/docview/227910762?accountid=12953

Stimpfel, A. (2011). The impact of hospital staff nurse shift length on nurse and patient outcomes.
University of Pennsylvania, ProQuest Dissertations Publishing,1-2. Retrieved April 12, 2018, from
https://search-proquest-com.proxy.ohiolink.edu.9100/nahs/docview/893661022/
previewPDF/4E8C49DEF83248B4PQ/21?accountid=12953.