Thesis (Noridja's Group)

CHAPTER 1

THE PROBLEM AND ITS SCOPE

Introduction

Every hospital has its own policy regarding shift pattern for nurses. These shifting

patterns refer to the hourly schedule of nurses regarding service in the hospital. Different shifting

patterns are as follows: 8-hour, 12-hour, and 16-hour (rare).

In Pagadian City, only the Pagadian City Medical Center (PCMC) has adopted the 12-

hour shift. This was adopted in response to the need for enhanced cost effectiveness in extending

health services. However, there have been claims that this scheme makes nurses less effective in

the work place. For example, according to the University of Maryland, Baltimore (UMB) study

presented at the 24th annual meeting of the Associated Professional Sleep in San Antonio, that the

common practice of successive 12-hour shifts for U.S. hospital nurses leaves many with serious

sleep deprivation, higher risk of health problems, and more odds of making patient errors.

According to Jeanne Geiger-Brown, PhD, RN, associate professor of the school of

Nursing at UMB, the 12-hour shift trend started in the 1970s and 1980s when there were nursing

shortages. Hospitals started giving nurses often prefer working a bunch of 12-hour shifts and

then lost of time off, Geiger-Brown contended that it was not a good thing for nurse planning. In

her article, Brown analyzed from several recent scientific studies of the safety risk involved with

long work hours, and challenges the current scheduling paradigm. She pointed out the increasing

evidence that 12-hour shift adversely affect performance. In 10 previously published studies of

the effects of 12-hour shifts, none showed positive effects, while four showed negative effects on

performance.

Geiger-Brown cited a study that involved 80 registered nurses, working three successive

12-hour shifts, either day or night. The study found out that the nurses achieved short duration of

sleep between 12-hour shifts. Over 50% of shifts were longer than 12.5 hours, and with long

commutes and family responsibilities, nurses have very little opportunity to rest between shifts.

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The study also found out that the averaged total sleep time between 12-hour shifts was only 5.5

hours. Night-shift nurses averaged only about 5.2 hours sleep was extremely fragmented. They

experienced micro sleep periods, little lapses in attention, and intershift fatigue.

Most recent studies cited in her article point to an increase in patient care errors related to

successive 12-hour shifts. Geiger-Brown cited one study of 393 nurses. In 5,317 shifts which

were surveyed anonymously, the odds of making errors by those who reported working more

than 12 hours in shifts were three times greater than nurses who reported working 8.5-hour

shifts. Experiencing partial sleep deprivation chronically, over many years, is dangerous to the

nurse’s health and to the patients. The most common problems with an over emphasis on 12-hour

shift are needle-stick injuries, musculoskeletal disorders, drowsy driving, and other health

breakdowns related to sleep deprivation.

Another study by Carlson et al., 2000, twelve-hour shifts could alleviate emotional

interference, which results from time spent “recovering” from mental fatigue on rest days.

Twelve-hour shift workers may also need less time at home recovering if their shift system

produces less conflict with sleep (Lowden, Kecklund, Axelsson and Akerstedt, 1996). Impaired

or truncated sleep is perhaps the most frequent complaint of shift workers on traditional

schedules and it is a particular problem on night shift (Akerstedt, 1998; Knauth, 2001). Shift

workers are more likely to take naps during leisure hours, use days off to catch up on sleep

(Winwood, Winefield, and Lushington, 2006). These sleep problems may be minimized under a

12-hour shift system because there are fewer night shifts. The reduction in night shifts is

undoubtedly one of the most important potential benefits of 12-hour shifts as there is less

disruption to sleep, and less conflict with internal timing mechanisms, both of which are known

to cause health problems and fatigue in shiftworkers (Akerstedt 1988; Lowden, et al., 1996).

While existing literature points to the deep impact of 12-hour shift has on the overall

performance of nurses and on their health, there is an impending curiosity on the particular issue

regarding the positive and negative effect of the shifting pattern. To address this issue, this

particular study was conducted to specifically explore the impact of 12-hour work shift to the

level of performance of nurses especially in relation to giving emotional and psychological

support to patient and carry out interventions and orders and nurse’s health and well-being.

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Conceptual Framework

The framework for this research is based on Kurt Lewin’s field theory. He postulated the

needs to organize perception of the field and acting within it. He believed that behavior is

purposeful and visualizes the individual as existing in a field of forces which included +valence

forces which attract people, and –valence forces which repel people. The blending of this field

produced an approach/avoidance dynamic. In this field theory, a field is defined as the totality of

co-existing facts which are conceived as mutually interdependent. Individuals were seen to

behave differently according to the way in which tensions between perceptions of the self and of

the environment were worked through.

The schematic diagram of this study is presented in Figure 1. As shown, the independent

variable is the twelve-hour work shift while the dependent variables are the nurses’ performance

and their health and well-being.

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Figure 1. Schematic Diagram

Statement of the problem

The purpose of this research was to determine the effects of 12-hour work shift on the

health and well-being of the nurses at PCMC as well as on their performance.

This study sought to answer the following specific questions:

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Twelve-Hour Work Shift

Work-Related Health-RelatedEffects on

Nurses

Effects on

Nurses

1. How does the 12-hour work shift affect the nurses’ health and well-being?

2. How does the 12-hour work shift affect the performance of nurses particularly on the

following aspects:

2.1 Carrying out interventions and orders

2.2 Giving emotional and psychological support to patients?

Hypotheses of the Study

1. The 12-hour work shift does not adversely affect the nurses' health and well-being.

2. The 12-hour work shift does not adversely affect the nurses' performance particularly on

the following aspects:

2.1 Carrying our interventions and orders

2.2 Giving emotional and psychological support to patients.

Significance of the Study

The findings of the study will benefit the following:

Nurses. The results of the study will help them understand the underlying effects of the

12-hour work shift and its impact on their performance, health and well-being. In addition, the

results would be advantageous to them in terms of developing their ethics of service.

Doctors. Study findings may also provide information to the primary healthcare

providers regarding the performances of the different staff, and the underlying effects of the shift

to their co-healthcare worker.

Hospital Administrators. The study will give them direction as to what steps should be

taken to protect nurses from occupational stress that may have been caused by the 12-hour work

shift in order to decrease nurses turnover which negatively affect safety and effectiveness of

services provided.

Other Researchers. This study will possibly serve as a prelude to further investigations

to determine other aspects of 12-hour shift pattern. It is hoped that the results of this study may

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lend renewed insights into the 12-hour shift pattern and that the recommendations of this study,

in particular, could be applied to the management of 12-hour shift pattern.

Scope and Delimitation of the study

The study focused on the effects of the 12-hour work shift on the performance of the

nurses and on their health and well-being. It was conducted at Pagadian City Medical Center. It

is confined in the nurses of Pagadian City Medical Center as the respondents. It covers 40 nurses

working in different areas of the hospital namely: Emergency room, Operating room, Delivery

Room, Intensive Care Unit, and Wards. The study was conducted last August 2011 until October

2011. The instrument used was questionnaire-checklist.

Definitions of Terms

To give a clearer understanding, the following words are defined operationally:

Adverse Effects. Effects that are unfavorable or acting against a person, goal or

circumstance. In this study, the terms refer to effects that are unfavorable to the nurses’

performance and health and well-being.

Healthcare. The field wherein patients are the subject for health intervention by the

healthcare providers such as the physician, nurses, etc. for maintenance and restoration of

individual’s health.

Intervention. In this study, the term refers to the action that is to be provided to clients

depending on their type of needs/problem. One example is that, providing an oral feeding to

patient who unable to feed himself/herself. It may be independent (nurses action), dependent

(with the aid of the physician) and collaborative (team action) intervention.

Order. The term refers to the physicians’ plan of intervention that is being referred

and/or responsibility of the nurse to intervene for the patient. Any order made by the physician

should also be written or recorded in the patient’s chart. Example is the administration of

medications.

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Pagadian City Medical Center (PCMC). The only tertiary hospital in Pagadian City that

has complete state-of-the-art facilities and equipment.

Performance. Refers to the staff nurses’ capability to behave and carry out orders and

interventions in hospital settings.

Shift Pattern. Refers to the work schedule of the staff nurses at PCMC. It may either be

the 7:00 am – 7:00 pm work shift (morning shift) or the 7:00 pm-7:00 am work shift (night shift),

each of which is equal to 12 consecutive working hours.

Staff Nurse. A licensed nurse who is assigned in any of the four clinical areas of the

hospital namely, medical-surgical unit/ward, intensive care unit, operating/delivery unit, and

emergency unit. A staff nurse provides primary interventions to the patient such as vital signs

Well-being. In this study, the term is used to refer to the state of goodness of the nurses’

health including his body, mind, and soul.

CHAPTER 2

REVIEW OF RELATED LITERATURE AND STUDIES

Related Literature

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It has often been claimed that the 12-hour shift is best for both the nurses and patients.

However, although the research has, indeed, found positive effects on satisfaction with working

hours and free time, the effects on employee fatigue, health and performance has been neutral or

negative. Below are some of the claims regarding both the positive and negative effects of the

12-hour shift on nurses.

Positive Effects of the 12-Hour Shift

According to Moore-Ede et al of Circadian Technologies, Inc. (Moore-Ede 2007), impact

of 12-hour shift includes increased productivity, fewer errors, increased continuity, reduced

absenteeism, reduced turnover and better morale. In New York City hospitals (Stone 2006)

nurses working 12-hour shifts were more satisfied with their jobs, had less emotional exhaustion,

all without impacting patient outcomes. One key element to worker satisfaction with 12-hour

shift seems to be how the change was developed and implemented.

One of the potential beneficial aspects of 12-hour shift is the reduction in handoffs. In

fact, in most hospitals reduction in handoffs is touted as the most important benefit of 12-hour

shift because you only have two handoffs with 12-hour shift. According to Richardson (et al.,

2007), some nurses perceive long work days (12 hour shifts) as a benefit by reducing the number

of staff hand-offs and increasing continuity of care. They also prefer fewer days at work and

therefore less commute time and easier scheduling of home life responsibilities. 

The study of Carlson (et al., 2000) shows that, 12-hour shift alleviate emotional

interference, which results from time spent “recovering” from mental fatigue on rest days, and

reduces both the quantity and quality of family contact time (Jackson et al., 1985). Emotional

interference may be alleviated under 12-hour shifts because workers may be able to use their

increased number of days off work to structure their recovery time around their partners’,

friends’ or children’s schedules.

Despite the feelings of sleepiness, Williamson, Gower and Clarke (1994) state that 12-

hour shift actually reduce feelings of tiredness throughout the work week. Other effects of 12-

hour work shift in relation to tiredness included: decreased amount of time the employees woke

up feeling tired; decrease in tiredness during their shift at work and decrease in tiredness after a

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day or a night shift. Thus, the effect of sleep deprivation day to day may have little effect, but

longer periods of time may increase sleepiness that may consequently increase levels of fatigue

some employees may feel.

Baker, Olson and Morisseau (1994) more recently have argued that the 12-hour work shift

may have positive consequences. For example, it may be safer to have employees work in order

to finish a significant task. Here the authors argue that the 12-hour shift can reduce the number of

shift turnovers which decreases the potential for error and may offset any potential error resulting

from fatigue. Duchon, Keran and Smith (1994) used fatigue sensitive behavioral and

physiological performance measures which showed no change or improvement with 12-hour

shifts, concluding that 12-hour shifts do not pose a hazard with respect to occupational health or

safety. Safety remains for everyone a central issue. Research into the impact on professionals has

consistently identified a range of negative in nurse’s health related and work related outcomes.

Negative Effects of the 12-Hour Shift

The existing scientific studies indicate that shift work affect both sleep and waking by

disrupting circadian regulation, familial and social life (Gordon, Cleary, Parker, & Czeisler,

1986; Labyak, 2002; Lee, 1992). Sleep obtained during the day at irregular times is poorer

quality than that obtained during normal nighttime sleep. Chronically restricted sleep patterns

and the subsequent sleep debt that accumulates over time may be most pervasive in such

professions as health care delivery that functions 24 hours a day, 7 days a week. The disruption

of the body’s natural circadian rhythms by shift work can result in changed sleep patterns,

gastrointestinal disorders, chronic fatigue, weakened concentration or alertness, increased stress,

pressures on one’s family and social life, cardiovascular disease (Shields, 2002; Costa, 1996;

Glazner, 1992; Williams, 2008).

Twelve-hour shifts are infamous in nursing and many studies cite exhausted and

dissatisfied staff as a reason for the negative press (Fitzpatrick et al 1999, Todd et al 1993). In

particular, Todd et al(1989) claimed that the quality of patient care was negatively affected on

wards that used a 12-hour shift pattern. 

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An article of Jacqueline A. Miller, BSN, RN, NE-BC, “When Time Isn’t on Your Side:

12-hour Shifts” shows a concern about the negative effects that extended shifts can have on

patients and staff. Research supports that long shifts of 12 hours or greater can have a negative

effect on nurse performance and, therefore, a negative effect on patient care outcomes. In

addition to fatigue, 12-hour shifts have also been shown to have adverse effects on the health of

the nurse and may contribute to conditions such as diabetes, depression, unhealthy behaviors,

and hypertension.

Also, Geiger-Brown and colleagues presents the idea that 12-hour shift affects multiple

parameters. These include needle stick injuries, musculoskeletal and other work related injuries,

and increased rates of motor vehicle collisions or near-misses while driving home from extended

shifts. They also discuss potential health consequences of long-term sleep deprivation. 

Related Studies

A study by Bloodworth, Lea, Lane, & Ginn (2001) was conducted to assess whether

changing a nursing shift pattern to incorporate 12-hour shifts would have positive effects for

patients and staff in a ward environment. The results showed that the new shift pattern offer

benefits for patients through improved communication, increased continuity of care and more

content staff. The study illustrated potential a new nursing shift pattern involving 12-hour shifts

has for patient care, as well as for staff job satisfaction and efficient management.

Fields and Loveridge (1988) researched 8-hour and 12-hour shifts related to critical

thinking and fatigue in a quasi experimental study. The two experimental groups 12(n=102)

consisted of critical care nurses working either 8-hour or 12-hour shifts at an urban 415-bed

hospital. The nurses were tested with the Three Minute Reasoning Test and the subjective

symptoms of Fatigue. The two instruments were administered during the first three hours and

last three hours of their shift, evaluating critical thinking and fatigue at the beginning and end of

the shift. Findings indicated fatigue increased over the duration of the shift and it increased in

both the 8-hour and 12-hour shifts. Nurses working 12-hour shift did not perceive significantly

higher levels of fatigue than 8-hour nurses. No significant difference between groups was found

on scores for the Three Minute Reasoning Test. The researchers did, however, find that critical

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thinking improve in the last three hours of the shift as compared to the first three hours of the

shift for both 8-hour and 12-hour shift workers. Researchers found that although nurses were

more fatigue by the end of both shift types critical thinking, was greater at the end of the shift.

Therefore the conclusion was 12-hour shifts do not appear to decrease critical thinking or

increase fatigue any more than 8-hour shift (Field and Loveridge 1998). Although there are some

studies indicating that workers experience more fatigue on a 12‐ hour shift than on an 8‐hour

shift – especially during the end of the long shift – there are other studies that reached the

opposite conclusion. An evaluation of 8‐ and 12‐hour shifts at a power station (Mitchell, 2000)

found that there was an increase in error rates at the end of a 12‐hour shift.  This was attributed

to increased fatigue with longer work hours.  The conclusion of the authors, however, was that

the employer should explore ways of reducing risk of error towards the end of a 12‐hour shift

and ensure that more critical tasks be scheduled at the beginning of the shift.

Cruzio’s (2008) study was carried out to compare to medical wards which had been

operating at 12-hour shift for more than one year with two medical wards which had carried on

with a conventional shift system over the same period of time. Staff questionnaire, patient’s

interviews, documentation review, and analysis of a number of organizational issues were

undertaken to evaluate the effect of the shift pattern worked. Viewing the shift pattern from a

variety of perspective indicates that there were no significant differences between patterns with

regard to the staff perception, patient, documentation and organizational issues. However, some

aspects of the 12-hour shift produce more favorable responses from the staff; less fatigue was

reported by those working the 12- hour shift and documentation was more complete on these

wards, however the length of time available for the hand over was identified as a problematic

area. Staff surveyed had chosen to work these are hours which may positively have influenced of

this shift pattern on both staff and patient’s. This work demonstrates the complexities in

evaluating patterns of work in providing patient care over 24 hours.

A study of 54 nurses at NHS hospital in England (McGettrick, 2006) reported that nurses

saw many positive impacts of 12‐hour shifts. The respondents felt there was improved patient

care, more job satisfaction, more off duty time, and improved family life.  Staff found that 12‐

hour shifts allowed for more flexibility, more time at home and enhanced family relationships.

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In the Australian hospital study, (Dwyer, 2007) the majority of health staff reported that

they slept ‘quite well’ or ‘moderately well’ after moving to a 12‐hour shift.  The end time of the

shift was a greater factor contributing to fatigue than the length of the shift.   One participant

from the study commented, “After an 8‐hour shift that finishes at 23:00 hours, I would feel quite

lethargic and since there are no 12‐hour shifts finishing then, I feel much better now.”

In a study of 738 nurses in Israel, (Hanna, 2008) the researchers found that nurses who

only worked day shift complained significantly more than shift nurses about health problems and

sleep disturbances. Although this appears to contradict existing research on shift work (Glazner,

1992; Costa, 1996), the researchers were able to determine that gender, age and weight were

significant factors that impact the well‐being of nurses.  The nurses who only worked day shifts

tended to be older on average than the nurses who worked rotating shifts. The research also

found lower absenteeism rates among the shift work nurses than among the daytime nurses,

which the researchers felt could also be explained by differences in age. An article written by

Shullanberger (2000) summarizes his comprehensive literature review of nursing staff

issues.  Shullanberger refers to a study by Gillespie and Curzio (1996) which found that nurses

working 12‐hour shifts reported less fatigue than those who worked 8‐hour shifts.  In interviews,

80% of respondents who worked 8‐hour shifts believed tiredness was a problem, compared with

20% of 12‐hour shift nurses. The results of the Nottingham evaluation (Lea, 2003) found that

sporadic sickness during the trial year of longer shifts was almost half that of the previous

years.  The evaluation also showed fewer sharps and drug errors during the trial year compared

to the previous year. Having fewer nurses involved with the care of a patient on a single day

meant improved communication between nurses and health care professionals, which reduced

the margin for communication breakdown and error.

Fatigue may also be the result of shift workers cutting back on sleep to have more work‐

life balance.  Williams (2008) notes that shift workers are more likely to cut back on sleep to

have more time for other tasks than regular daytime workers (70% vs. 50%). The impact of 12‐

hour shifts on patient care.

In the evaluation of the move to 12‐hour shifts from 8‐hour shifts in an Australian

hospital (Dwyer, 2007), the majority (75%) of participants felt that the 12‐hour shift contributed

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to better continuity of patient care.  Having fewer nurses involved with the care of a patient on a

single day meant improved communication between nurses and health care professionals, which

reduced the margin for communication breakdown and error.

In another study published in the Journal of Nursing Management, (Richardson,

2007)  two focus groups of nursing staff felt that the 12‐hour shift made planning and prioritizing

patient care easier.  The authors believe this may be related to the ‘pacing effect’ which results in

staff feeling less pressured to complete assigned responsibilities in a 12‐hour time frame.  Staff

feel rushed on shorter shifts, especially on the morning shift, and the longer period of 12 hours

enables staff to obtain a better knowledge of the patient. McGettrick’s study (2006) also

foundthat nursing staff overwhelmingly agreed that patient care improved under the 12‐hour

shift rotation because staff has more time to plan care and spend time with both the patient and

the patient’s family.

In Shullanberger’s summary of Gillespie and Curzio’s research, he noted that the

researchers found that there was more complete documentation from the nurses who worked 12‐

hour shifts than from those who worked 8‐hour shifts.  In terms of the impact on patient care, the

same study found that patients cared for by 12‐hour shift nurses were more likely to know their

nurse’s name than patients cared for by 8‐hour shift nurses.

   Lea and Bloodworth (2003) also report improved patient care with 12 hour shifts.  The

final evaluation of the year‐long trial concluded that the new shift system enhanced patient care

and improved the health and wellbeing of nursing staff.  All ward staff felt that the new system

provided for continuity of care and gave them the chance to build a therapeuticrelationship

between the nurse and the patients during the day and a longer period of time to monitor patients.

The only study that raised concerns about risk to patient safety was one examining

excessive working hours in the United States (Trinkoff, 2006).  This study of 2,273 Registered

Nurses found that more than a quarter of nurses typically worked 12 or more hours per day, and

that almost one‐quarter of nurses with more than one job worked 50 or more hours per

week.  Many nurses worked in hospitals with mandatory overtime policies which contributed to

the excessive work hours. The authors state that the average hours worked by nurses exceeds the

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recommendations of the Institute of Medicine and that this raises concerns about fatigue and

health risks to nurses as well as the safety of patients.

CHAPTER 3

METHODOLOGY

This chapter presents the research design, respondents of the study, research instrument,

data gathering procedure and statistical tools used in the study.

Research Design

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This research study design is a descriptive, quantitative, survey approach. Since the

researchers endeavored to investigate the experiences and perceptions of nurses, a research

design, which is quantitative and descriptive in nature, is found to be most appropriate for the

study. In this regard, Likert scale questionnaire was selected as an appropriate tool to gather the

data. The instrument designed by the researchers, required answers to closed- and open-ended

questions. The application of this “quantitative-descriptive” approach using the questionnaire is

also seen as “survey approach”. In this regard, surveys are said to be intended to give a general

idea of representative sample of a large population as well as give descriptions of the phenomena

‘…practices, opinions, attitudes and other characteristics of people.’ (Mouton, 2001:152; Knapp,

1998:67).

Research Environment

The study was conducted with staff nurses at Pagadian City Medical Center (PCMC)

which is the only tertiary hospital in Pagadian City. The hospital has an in-patient (24-hour)

service area with a capacity of 100 beds. The in-patient service facility comprises 11 major

clinical areas: Operating Room, Delivery Room, Hemodialysis Unit, Intensive Care Unit, Post-

operative Care Unit/ Recovery Unit, Neonatal Intensive Care Unit, Emergency Room, Private

Rooms, Female Surgical Ward, Male Surgical Ward, and Pediatric Ward.

Research Subjects

The study population consisted of 40 nurses working in 10 different major clinical areas

of PCMC. Both male and female nurses were selected for the study. The respondents were

selected using non-probability, convenience sampling. In this method, the nurses who were

present at the time of distribution of the questionnaire were selected as the respondents of the

study.

Research Instrument

The survey questionnaire was used as the main data-gathering instrument for this study

(See Appendix B). The questions were formulated to explore the perceptions of nurses on the

effects of 12-hour work on their health and well-being and on their performance. The questions

were structured using the Likert scale. Five choices were provided for every item. The choices

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represent the respondents’ degree of agreement or disagreement to each item. The scale below

was used to interpret the responses of the respondents for every item by computing the weighted

mean:

Range                                                Interpretation

4.01 - 5.00                                        Strongly Agree

3.01 - 4.00                                      Agree

2.01 - 3.00 Uncertain

1.01 - 2.00                               Disagree

0.00 – 1.00                               Strongly Disagree

Data Gathering Procedure

A letter of request was given to the Medical Director of the hospital asking his

permission to allow the researchers to conduct a survey. Questionnaires were distributed to the

nurses who were assisted by the researchers in answering the questions. The questionnaires were

then retrieved. The data gathered were analyzed and interpreted.

Statistical Treatment

After gathering all the completed questionnaires from the respondents, total responses for

each item were obtained and tabulated. The data were computed using frequency distribution and

weighted mean.

Frequency distribution is an arrangement of the values that one or more variables take in

a sample. Each entry in the table contains the frequency or count of the occurrences of values

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within a particular group or interval, and in this way, the table summarizes the distribution of

values in the sample.

Weighted mean is the average wherein every quantity to be averages has a corresponding

weight. These weights represent the significance of each quantity to the average. To compute for

the weighted mean, each value must be multiplied by its weight. Products should then be added

to obtain the total value. The total weight should also be computed by adding all the weights.

The total value is then divided by the total weight. Statistically, the weighted mean is calculated

using the following formula:

Formula:

WM = FW

N

Where:

F = Frequency

W = Assigned Weight

N = No. Of Respondents

WM = Weighted Mean

CHAPTER 4

PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

This chapter presents the data gathered which were analyzed and interpreted.

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Table 1 Frequency distribution and Weighted Mean of the Respondents’ Responses on Work-related

Effects

Work-related effects 5 4 3 2 1 WM Rank Description

A. Carrying out interventions and

orders

1. Effective nursing intervention 12 3 4 15 6 3 3 Uncertain

2. Greater percentage of appro-priate

medication administration

11 7 5 7 10 3.05 2 Agree

3. Better charting 8 6 7 14 5 2.95 4 Uncertain

4. Less minor incidents 13 7 4 13 3 3.35 1 Agree

Average Weighted Mean 3.09 Agree

B. Giving emotional and

psychological support to patients

5. Giving emotional and psycho-

logical support to patients

9 5 4 15 7 2.85 6 Uncertain

6. Effective nurse-patient interaction 7 6 5 14 8 2.75 8 Uncertain

7. Effective maintenance of patient’s

safety

7 8 5 11 9 2.82 7 Uncertain

8. Effective nurse-patient relationship 8 4 5 13 10 2.68 9 Uncertain

9. Longer nurse-patient interaction 7 3 8 8 14 2.52 10 Uncertain

10. Increased patient’s coping 9 5 7 11 8 2.90 5 Uncertain

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Average weighted mean 2.75 Uncertain

Total Average weighted mean 2.92 Uncertain

Average Weighted Mean

Carrying out interventions and orders – 3.09 “Agree”

Giving emotional and psycho-logical support to patients – 2.75 “Uncertain”

Total Average Weighted Mean = 2.92 “Uncertain”

Range                                                Interpretation

4.01 - 5.00                                        5 Strongly Agree

3.01 - 4.00                                       4 Agree

2.01 - 3.00 3 Uncertain

1.01 - 2.00                                        2 Disagree       

0.00 – 1.00                                        1  Strongly Disagree

Table 1 presents the frequency distribution and weighted mean of the nurses’ responses.

This is to determine whether the 12-hour work shift had adversely affected their performance.

Under “Carrying out interventions and orders,” item number 1, “Effective nursing intervention,”

has a weighted mean of 3 and ranks 3rd which is interpreted as “uncertain;” item number 2,

“Greater percentage of appropriate medication administration,” has a weighted mean of 3.05 and

ranked 2nd which is interpreted as “agree;” item number 3, “Better charting,” has a weighted

mean of 2.95 and ranks 4th which is interpreted as “uncertain;” and item number 4, “less minor

incidents”, has a weighted mean of 3.35 and ranks 1st which is interpreted as “agree.”

The average weighted mean of the respondents’ responses in terms of carrying out

interventions and orders is 3.09 which are interpreted as “Agree.”

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Items number 5, 6, 7, 8, 9, 10 under “Giving emotional and psychological support to

patients have weighted means of 2.85, 2.75, 2.82, 2.68, 2.52, 2.90 and ranked 6th, 8th, 7th, 9th, 10th,

5th, respectively which are all interpreted as “agree.”

The total average weighted mean of the respondents in terms of their performance is

2.92 interpreted as “uncertain”. Based on this data, it implies that the 12-hour work shift might or

might not adversely affect the performance of the nurses as perceived by the nurses themselves.

Table 2. Frequency Distribution and Weighted Mean of the Respondents’ Responses on

health-related Effects

Health-related Effects 5 4 3 2 1 WM Rank DESCRIPTION

A. Nurses’ health and well-being

1. Fatigue 24 8 0 3 5 4.08 4 Strongly Agree

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2. Sleepiness during the shift 24 12 1 2 1 4.4 1 Strongly Agree

3. Low energy level 18 16 2 2 2 4.15 3 Strongly Agree

4. Disorientation 12 5 7 6 10 3.08 7 Agree

5. Exhaustion 24 9 3 0 4 4.22 2 Strongly Agree

6. Irritability 15 8 11 2 4 3.7 5 Agree

7. Insomnia 14 9 9 3 5 3.6 6 Agree

Average Weighted Mean 3.89 Agree

Range                                                Interpretation

4.01 - 5.00                                        5 Strongly Agree

3.01 - 4.00                                       4 Agree

2.01 - 3.00 3 Uncertain

1.01 - 2.00                                        2 Disagree       

0.00 – 1.00                                       1  Strongly Disagree

Table 2 presents the frequency distribution and weighted mean of the nurses’ responses

on whether the 12-hour work shift had adversely affected their health and well-being. Under

“Nurses health and well-being,” item number 1, “Fatigue,” had a weighted mean of 4.08 and

ranks 4th which is interpreted as “strongly agree;” item number 2, “Sleepiness during the shift,”

had a weighted mean of 4.4 and ranked 1st which is interpreted as “strongly agree;” item number

3, “Low energy level energy,” had a weighted mean of 4.15 and ranked 3 rd which is interpreted

as “strongly agree;” item number 4, “Disorientation,” had a weighted mean of 3.08 and ranked

21

1st which is interpreted as “agree,” item number 5, “Exhaustion,” has a weighted mean of 4.22

and ranks 2nd which is interpreted as “strongly agree;” item number 6, “Irritability,” had a

weighted mean of 3.7 and ranks 5th which is interpreted as “agree,” and item number 7,

“Insomnia,” had a weighted mean of 3.6 and ranked 2nd which is interpreted as “agree.”

The average weighted mean of 3.89 implies that the 12-hour work shift had adversely

affected the health and well-being of the nurses.

Weighted mean:

1. Work-related effects:

A. Carrying out interventions and orders = 3.09

B. Giving emotional and psychological support to patients = 2.75

2. Health-related effects: 3.89

3. General Weighted Mean?

GWM: 2.92 + 3.89

= 3.41 “Agree”

The general weighted mean of work-related and health-related effects is 3.41 which is

interpreted as “agree”.

Generally, the results reject the null hypothesis and accept the alternative hypothesis

which establishes that there is a significant adverse effect of the 12-hour work shift on the overall

performance of nurses.

22

CHAPTER 5

SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

This chapter presents the summary of findings, conclusions and recommendations of the

study.

Summary23

Based on the data gathered, it was found that the respondents expressed strong agreement

that the 12-hour work shift adversely affect their health and well-being as it causes sleepiness

during shift, exhaustion, low energy level, and fatigue. Lesser effects as perceived by the nurses

were irritability, insomnia and disorientation.

The findings also revealed that the respondents expressed disagreement that the 12-hour

work shift has negative effects on their performance particularly on carrying out interventions

and orders and on giving emotional and psychological support to patients.

Conclusion

After analysis of the findings, the researchers have come up with the conclusion that

the 12-hour work shift does not have a negative effect on the nurses’ performance; however, it

does have negative effects on their health and well-being.

Recommendations

For further studies the effects of the 12-hour work shift on nurses, the researchers would like to

recommend the following:

1. To provide a more compelling information and discussion as to the effects of 12-hour shift to

the nurses’ overall performance, future researchers are encouraged to do continuing study, in a

wider range, about the work-related and health-related effects of 12-hour shift. This way, nurses

and other concerned individuals will have more awareness on how to find solutions to problems

affecting them.

2. A comparative study of the effects of the 12-hour and 8-hour work shift among the nurses in

the different hospitals in Pagadian City should also be done by researchers.

3. To make future studies more substantial, it is highly recommended to employ qualitative

methods in order to complement the quantitative data and give the results more meaning.

4. The hospital management of should include in their plans and programs the conduct of semi-

nars, trainings and orientations for the nurses and other medical personnel and staff of the institu-

tion at least twice a year to have consistency of evaluation and to provide feedback to the con-

cerned individuals as to their performance and well-being for them to cater a more effective ser-

vice to the patients.

24

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27

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APPENDICES

Appendix A

Letter to the Medical Director

MENDERO COLLEGE

Pagadian City

August 10, 2011

DR. SAMUEL J. MENDERO

Medical Director

Pagadian City Medical Center

Pagadian City

Sir:

Good day!

28

We, the students of Mendero College are currently conducting our study titled,

“EFFECTS OF 12-HOUR WORK SHIFT ON NURSES.” We have chosen the nurses in your

hospital as respondents for our study.

Along this line, may we request your good office to allow us to gather the necessary data

that bear substantial importance to our present study.

We hope that this request may grace acceptance and approval.

Thank you and God Bless.

Very Truly yours,

BSN- IV STUDENTS

Appendix B: Letter to Respondents

MENDERO COLLEGE

Pagadian City

August 10, 2011

Questionnaire-Checklist

Dear Sir/Madam:

Good day!

The undersigned are presently conducting a research study titled, “EFFECTS OF THE 12-

HOUR SHIFT ON NURSES” as part of the requirements for the degree of Bachelor of Science

in Nursing (BSN). This study aims to determine whether the 12-hour shift has positive or

negative effects on the nurses’ performance and health and well-being.

29

In this connection, we would like to request you to be one of our respondents. Kindly

accomplish the attached questionnaire. Rest assured that your responses will be held

confidential.

Thank you for the full support and cooperation.

Very truly yours,

Yusop, Noridja

Group Coordinator

Appendix C

QUESTIONNAIRE

Instructions: Kindly indicate your agreement or disagreement to the following items by

encircling number that corresponds to your answer.

5 - Strongly Agree

4 – Agree

3 – Uncertain

2 – Disagree

1 – Strongly Disagree

1) Possible effects on the Nurse’s Performance

A.) Carrying out interventions and orders

30

5 4 3 2 1

Effective nursing interventions

Greater percentage of appropriate

Medication administration

Better Charting

Less minor incidents

B.) Giving Emotional and Psychological Support to Patients.

5 4 3 2 1

Giving emotional and psychological support to patients

Effective nurse-patient interaction

Effective maintenance of patient’s safety

Effective nurse-patient relationship

Longer nurse-patient interaction

Increased patient’s coping

31

2.) Possible effect on the nurse’s health and well being:

5 4 3 2 1

Fatigue

Sleepiness during the shift

Low energy level

Disorientation

Insomnia

Exhaustion

Irritability

Others: (You may add) specify: _________________

_________________

32