Impact of 12-hour shifts on nurse, patient and organizational outcomes. A critical review

Introduction. The use of 12-hour shifts has been considered beneficial in reducing staffing costs, attracting more nurses, improving work- life balance, and organizing care more efficiently. Objective. The aim of this review is to critically examine the available evidence on the impact of 12-hour shifts on nurse, patient, and organizational outcomes. Methods. A critical review of the literature was undertaken. Quantitative, qualitative and mixed methods studies analyzing the effect of long shifts (>12 working hours) were included. The search was performed on MEDLINE through PubMed and Cinhal. Results. Fifty-four articles were included, covering publications from 1976 to 2024. Evidence suggests that nursing care and patient safety may deteriorate with 12-hour shifts, with mixed findings on continuity of care. 12-hour shifts can lead to increased nurses' fatigue, without a decrease in job performance, and can have negative impacts on physical health, continuing education, burnout, and job satisfaction. While qualitative studies indicate improved work-life balance, this is not supported by empirical evidence. One study suggests a decrease in costs, but the effects on sick leave are inconclusive. Additionally, intention-to-leave among nurses appears to increase. Conclusions. The evidence generally does not support the use of 12-hour shifts. However, due to methodological limitations in the included studies, firm conclusions cannot be drawn. Organizations and nurses should carefully consider the introduction of 12-hour shifts, evaluating nurses' needs and implementing patient-centered care models that support nursing professionalism, along with a continuous monitoring of patient, nurse, and organizational outcomes.