The Royal College of Nursing (RCN) Congress meets on 13-17 May in Harrogate, and its UK Safety Representatives committee has tabled a motion bringing the conference’s attention to growing scientific evidence about the dangers of shift work.
The committee acknowledges that 24-hour health care means that nurses and other health workers must work shifts, and traditionally this was addressed by having three eight- hour shifts. Increasingly, the 12-hour shift is becoming the norm because managements see it as the most “cost effective”. Some people think the EU working time directive offers protection to those who work 12-hour shifts – but that directive allows only for two 20-minute breaks in the 12 hours. Take a large London hospital like the Royal Free: by the time the lift has reached the staff canteen in Lower Ground from the 13th Floor it is nearly time to return to work. Just like others working 12-hour shifts in factories and call centres, health care staff are increasingly found to be deficient in vitamin D from lack of sunlight.
The safety effects of long shifts have long been known. For example, fatigue and shift working arrangements were cited as major contributory factors in disasters such as Bhopal, Clapham Junction and Chernobyl. More routinely RCN safety representatives know that fatigue is a recognised factor contributing to patient safety incidents, such as drug errors.
But in a year when the government is suggesting nurses should work until they are 68 before getting their pension, the new research on shift work is important. There is growing evidence to show the decreased tolerance to shift working in older workers. This means that older workers working 12-hour shifts are more likely to make errors (often experiencing this as professionally devastating) and also more likely to harm their own health. So the extra years of work is a win–win for the government: pay the pension later and the worker dies sooner.
Shift work can exacerbate long-term conditions such as diabetes or epilepsy, while the link between breast cancer and working long shifts is becoming increasingly clear after work by the Danish nursing association. Currently chronic ill health drives between 20 and 25 per cent of people to leave shift work and to leave early in their working lives. ■