RCN2020 debate: Unpredictable shifts

10 Nov 2020 20:00 - 21:00

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Should the RCN commission a full review on the effects of unpredictable shifts patterns on the nursing workforce and the impact on patient safety.

Proposed by the RCN UK Safety Representatives’ Committee 

The body’s internal circadian biological clock, which is controlled by a part of the brain in the hypothalamus, regulates the timing of periods of sleepiness and wakefulness throughout the day. As levels of tolerance to any disruption to the body clock or circadian rhythms vary from person to person, so some individuals adjust better to shift working. Yet as shift work is a major part of nursing, and with a 2019 RCN survey of the nursing workforce finding that 51% of our members work shifts, this is an important area requiring insight and understanding of the relative benefits and risks to individuals, employers and the wider community[1].


The RCN guidance document on the occupational health and safety of shift work in the nursing workforce A Shift in the Right Direction[2] reviewed the available research. It stated that the disruptive effects of shift working on the natural sleep cycle are a substantial risk factor for fatigue and that poorly managed shift work, particularly night-shift work can have a negative impact on mental health, the cardiovascular system, gastrointestinal system and reproductive health. It also points out that working shift patterns allows little time for social interaction and support out of the workplace, and that strain on personal relationships is on the increase. The document looked at, in particular, the growing use of 12-hour shifts and twilight shifts. Subsequent research by Dall’Ora et al (2015) shows that registered nurses working shifts of 12 hours or longer were more likely to report dissatisfaction with their job and with schedule flexibility, intention to leave their current job and to experience burnout.[3]

This research also shows that the drive towards increased use of shifts of 12 hours or longer is largely associated by managers’ perceptions of greater efficiencies associated with the need for fewer handovers and fewer interruptions to clinical care. From the individual perspective, longer shifts can offer benefits of a compressed working week and increased flexibility.

Literature reviews published in the International Journal of Nursing Studies sought to identify the key factors impeding or enhancing recovery from fatigue in shift-working nurses[4] [5]. These reviews highlight the complicated nature of shift work and how different aspects, including shift length and working patterns are interlinked in impacting on employee wellbeing, performance and fatigue. They point to the impact not only of the length or timing of shifts as causing stress and job dissatisfaction, but also the impact of unpredictable patterns of work which can cause harm to individuals and their work-life balance[6]. Predictable patterns can enable individuals to adapt better to shift and unsocial hours working.

The COVID-19 health crisis has highlighted the need for increased knowledge about how to schedule work during periods of high workload amid dealing with staffing pressures while allowing for recovery and minimising fatigue. There is an acute need to understand how scheduling can be done in the most efficient way while avoiding risk to employee health and wellbeing. In particular, there is some evidence that increased control over shift patterns lead to decreased absenteeism compared to traditional scheduling systems.[7]

The need to understand scheduling and the importance of control of work scheduling is also vital against the growing use of technology by health and care organisations, and particularly the development and use of e-rostering. For example, the NHS Long Term Plan for England contains the commitment that ‘by 2021, NHS Improvement will support NHS trusts and foundation trusts to deploy electronic rosters or e-job plans’. As health and care organisations across all sectors in the UK develop new technologies, it is the roster and the accompanying principles and guidance that support their use that will become increasingly important for nursing staff in the achievement of work-life balance, fatigue recovery and the avoidance of burnout. Such guidance and principles are important in ensuring that patterns of work and rotas are agreed in advance with the input of all the team, that employees benefit from planned and predictable patterns of working time and that they feel in control of their working hours.


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[1]  Royal College of Nursing (2019) Employment survey 2019. Available at: rcn.org.uk/professional-development/publications/pub-007927 (Accessed 9 October 2020).

[2] Royal College of Nursing (2012) A shift in the right direction: RCN guidance on the occupational health and safety of shift work in the nursing workforce. London: RCN.

[3] Dall'Ora C, Griffiths P, Ball J, Simon M and Aiken L H (2015) Association of 12 h shifts and nurses’ job satisfaction, burnout and intention to leave: findings from a cross-sectional study of 12 European countries, BMJ Open, 5(9). doi: 10.1136/bmjopen-2015-008331.

[4]  Dall’Ora C and Dahlgren A (2020) Shift work in nursing: closing the knowledge gaps and advancing innovation in practice, International Journal of Nursing Studies. doi.org/10.1016/j.ijnurstu.2020.103743.

[5] Gifkins J, Johnston A, Loudoun R and Troth A (2020) Fatigue and recovery in shiftworking nurses: a scoping literature review, International Journal of Nursing Studies. doi.org/10.1016/j.ijnurstu.2020.103710.

[6] NHS (2019) The NHS Long Term Plan. Available at: www.longtermplan.nhs.uk (Accessed 9 October 2020).

[7] Gifikins J et al ibid


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