The shift dilemma: How long should a "standard" shift be in nursing?

Introduction

Have you ever wondered what is the optimal way to work through an inpatient nursing shift?
Is it an 8-hour shift? 12-hour shift? Something in between? When I was a bedside nurse, I worked 8, 12, and even 16-hour shifts, and every time either option had its benefits and disadvantages. I look back, and I can’t vote for any ultimate structure. One day 12 hours fits me, and the other it’s too long and exhausting. One week I have five 8-hour shifts and less time with friends and family and so on..not to mention the 16-hour shift which sometimes would just go on, and on, and on. 

In the U.S., the 12-hour shift model has become the norm, gaining momentum in the late 20th century due to healthcare staffing challenges and the need for consistent patient care. While the traditional 8-hour shift is still in use, around 65% of nurses now work 12-hour shifts, Ejebu O-Z, Dall’Ora C, Griffiths P (2021).

‍
This article will unpack (objectively) the pros and cons of traditional 8-hour and 12-hour shifts, as well as the potential benefits and challenges of flexible shift patterns.

The 8-Hour Shift

8-hour shifts have been the traditional backbone of nursing schedules. They offer a structured routine that many find stable in maintaining a steady work-life balance. Nurses working these shorter shifts often report feeling less fatigued, which naturally contributes to a higher level of attentiveness and reduced risk of errors during patient care. However, 8-hour shifts are not without challenges, such as increased handovers (and mistakes) and potential cumulative fatigue over a five-day workweek.

Why yes?

This is, to be honest, probably my favorite structure, it is relatively limited in the hours, it allows to change the environment more frequently, and in general allows a bit more flexibility within the 24-hour time. What else is there?

• Probably a Better Work-Life Balance: nurses working 8-hour shifts often experience a better balance between their work and personal lives. The shorter shifts provide more consistent breaks and time off, which can reduce burnout. Research by Battle and Temblett (2018) found that nurses on 8-hour shifts showed lower levels of emotional exhaustion and depersonalization compared to those on longer shifts​.
• Lower Risk of Burnout: The shorter shift structure helps prevent the prolonged strain often seen with longer shifts, making it easier to recover and maintain mental well-being. Research by Dall'Ora et al. (2023) found that nurses working 8-hour shifts report lower rates of emotional exhaustion, with 49% experiencing burnout compared to 70% of nurses on 12-hour shifts.
• A Lower Risk of Fatigue: shorter shifts help mitigate the physical and mental fatigue that can build up over longer periods, reducing the risk of errors in patient care​.

Why not?

• Potential Increased Handover Risks: one significant downside is the increased frequency of handovers, which can lead to communication lapses and disrupt the continuity of patient care—a critical concern in intensive care settings​.
• More Workdays Required: nurses on 8-hour shifts typically work five days a week, which can contribute to increased stress and less time for recovery, especially in high-pressure environments like the ICU​.
• Rest and Recuperate: In my personal experience, the 8-hour shifts are rarely distributed evenly throughout the week, it often happens that one needs to show up on the evening shift after working the night, and then show up again on the morning shift, creating huge burnout and dissatisfaction. 

The 12-Hour Shift

On the other side of the deal, 12-hour shifts have gained popularity for various reasons. From a staffing perspective, fewer shifts mean fewer handovers, which can enhance continuity of care and reduce the potential for communication errors. Nurses often appreciate having more consecutive days off, allowing extended periods for rest and personal time.

That said, the extended hours can be physically and mentally taxing. Honestly, I have more experience with 8-hour shifts and 16-hour shifts, but the 16 ones were just never-ending. Yes, you get to treat the same patients as you did just now, but, towards the end, it is so hard! And the same was true for the people around me.   

Why yes?

• An Obvious Enhanced Continuity of Care: longer shifts allow nurses to spend more time with patients, improving the continuity of care, which is particularly vital in critical care settings​.
• Fewer Workdays: with 12-hour shifts, nurses often work fewer days per week, which can improve overall work-life balance despite the longer hours. This schedule is also attractive to those who prefer consecutive days off or have long commutes​.
• Reduced adaptation time: many shift workers need a ramp-up period to get adjusted to each shift, i.e., adjusting monitors and organizing tools, etc. 
• Reduced Absenteeism:  shift workers often “think twice” about taking a shift off, doing so uses 12 hours of leave time and/or can result in a smaller paycheck. They also tend to feel more accountable to their crew or to the person who may need to be called in on a day off for 12 hours of relief coverage.‍
• Simple Scheduling: It is so much easier for a staffer or personnel manager to staff two shifts a day versus three. Less paperwork, fewer people needed, and everyone comes to a tidy 36 hours a week.

Why not?

• Higher Risk of Burnout: extended hours can lead to significant physical and mental fatigue, increasing the likelihood of burnout. Studies show that nurses on 12-hour shifts report higher levels of burnout and job dissatisfaction​.
• Increased Error Rates: The risk of making errors rises with longer shifts, particularly when they extend beyond 12 hours. This is critical in ensuring patient safety, as fatigue can impair vigilance and decision-making​​.
• Extra recuperation time: a 12-hour shift can be so draining that you spend more of your time off resting and re-energizing.

Are there alternatives?

I often speak to nursing leaders in different healthcare organizations and large IDNs), and I hear lots of ideas on how to manage the nursing pull in big facilities and even, across the whole IDNs. Currently, there is a lot of talk about so-called – ”flexible work schedules” which allow healthcare professionals to choose their working hours within established limits. This may involve a combination of different shifts (8-hour, 12-hour) or even a customized schedule agreed upon individually. Flexibility in scheduling helps accommodate personal preferences and life circumstances, which can improve overall well-being and job satisfaction among nurses. 

Why it can be a great solution?

• Reduced Burnout: The ability to tailor work schedules to individual needs lowers stress and burnout levels​.
• Increased Job Satisfaction: Nurses on flexible schedules report higher job satisfaction due to a better work-life balance​.
• Improved Quality of Care: Flexibility allows nurses to manage their time more effectively, leading to better focus and higher-quality patient care​.

What can be not so great about it?

• Complex Planning: Implementing and managing flexible schedules requires more sophisticated administrative solutions and the integration of new technologies​. Or put it in other words: it is an administrative nightmare.
• Potential Team Conflicts: If not all staff preferences are considered, conflicts and uneven workload distribution can arise​.
• Continuous Monitoring Needed: Flexible schedules require ongoing oversight to prevent staff overload and ensure team cohesion​.
  
  

Here’s the gist: A simple table to sum it all up

The Nursing Shortage and How Flexible Scheduling Can Help

Flexible scheduling offers a promising alternative to burnout in healthcare, but it comes with its own set of challenges. Manually managing flexible shifts is complex and time-consuming, requiring careful balancing of nurse preferences, patient needs, and available resources. Inconsistent application of flexible schedules can also lead to variability in care quality.

Some researchers highlight that while the potential benefits of flexible scheduling include reduced burnout and improved job satisfaction, the manual balancing act often results in inefficiencies and stress​.

Research by Griffiths et al. (2014) indicates that better-managed schedules not only improve nurse satisfaction but also enhance patient care quality, reducing the pressure to constantly recruit additional staff.

For now, if I had to be a director of nursing or anybody even close to having to deal with flexible shift scheduling, I would probably hate that. I mean, how do you even balance all the preferences, putting pieces of shifts together and making sure nobody is harmed in the process?? Yet, rapidly involving technologies (especially regarding annoying bureaucracy tasks), can mix and match and solve that puzzle much faster than any human. 

The Role of AI in Shaping the Future of Nursing

As a former nurse, I've seen the challenges that inflexible scheduling creates in healthcare: stress for nurses, overwhelm administrators, and compromised patient care. This is where AI steps in to reshape the way we approach not only scheduling but the entire nursing workflow.

AI can predict staffing needs based on historical data, which helps reduce the risk of overwork and burnout. By integrating AI into nurse scheduling, healthcare facilities can create more adaptive, efficient schedules while predicting optimal staffing levels that reduce both under and over-staffing. As a result, we get a healthier, more sustainable work environment where nurses feel more in control, hospitals operate smoothly, and patients receive the best possible care..  

Sure, beyond scheduling, AI supports nurses in other essential ways, improving diagnostics through predictive analytics, reducing errors, and optimizing patient monitoring. It also enhances remote care by continuously tracking patient conditions, enabling timely interventions.

Balancing the pros and cons of 8-hour versus 12-hour shifts has long been a challenge in nursing, but both shifts can have drawbacks in terms of nurse well-being. The core issue isn’t just about shift length—it's about how we can support our nursing staff to prevent burnout and reduce turnover. Traditional models, often fail to address the real-world demands and pressures faced by nurses today.

Flexible scheduling, supported by advanced AI technology, can offer a promising solution, giving nurses more control over their hours, improving job satisfaction, and helping retain skilled professionals. As technology continues to evolve, I believe it can make a meaningful difference in the future of nursing, ensuring that our healthcare teams are supported, valued, and able to thrive in their roles.

‍

Authors

Sergey Vasilenko
Sergey is a passionate care provider who spent 8 years as a neurosurgical CCRN treating patients in one of the most challenging environments and turned to technology to help nurses gain a better and safer working environment. Sergey is a Co-Founder and the CNO of In-House.

Galit Kats
Galit is a dedicated professional with a medical background and experience in healthcare education. She now serves as an Operations Manager at In-House, driving efficiency and innovation in healthcare management.