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Conditions that are causing burnout among nurses were a problem before the pandemic


From COVID surges to staffing challenges, it's no surprise many nurses are saying they're burned out right now. But a foremost researcher in the field of nursing points to a another reason - the 12-hour shift. Stacey Vanek Smith and Adrian Ma from our daily economics podcast The Indicator take a look at the unintended consequences of this industry standard.

ADRIAN MA, BYLINE: As kids, we've all had heroes, right?

STACEY VANEK SMITH, BYLINE: Linda Aiken's childhood hero was a little bit different - not a superhero, but a young student nurse named Cherry Ames.

MA: Cherry Ames was the star of this series of books

LINDA AIKEN: They were stories of people's search for cures to things or care after accidents or the birth of their babies.

MA: And so naturally, Linda grew up, and she became her own Cherry Ames. She became a nurse. And pretty quickly, she realized that real life is not like the storybooks. She says she often felt overworked and under-supported. And so over time, she started to wonder what she could do to improve the system.

VANEK SMITH: So Linda got into research. For the last three decades, she's been studying nursing at the University of Pennsylvania. And it was through this research that she came to question what is today a pretty standard practice - the 12-hour workday.

AIKEN: So when I started out, shifts were eight hours, and I thought that was a lot. I was really exhausted.

VANEK SMITH: But in the 1970s, that started to change. There was this nurse-led push for longer days. And the thinking was, same number of hours per week but fewer days equals more flexibility. And hospital managers said fewer shifts to coordinate - that would actually make our jobs easier. Sure. It seemed like a win-win.

MA: But in the mid-2000s, Linda and her colleagues started to wonder, could this have some unintended consequences? So they combed through surveys from hundreds of nurses at different hospitals.

AIKEN: We found, no, it's really not good for the nurses, that nurses that worked 12-hour shifts were more likely to experience high nurse burnout, job dissatisfaction and intend to leave their job. I think they weren't really even aware of it.

MA: And then there was arguably the most important finding from that study involving medical errors. That might mean a nurse mixing up medication or administering a treatment at the wrong time.

AIKEN: What we found was that any time after 12 hours, the medical errors that nurses were involved in started to escalate dramatically. And the reason that this was important is we found in our study that most nurses that were scheduled to work 12 hours really were there 13 or 14 hours.

VANEK SMITH: And that has been especially true during COVID. So one big idea from Linda's research is that it's time to rethink the standard 12-hour shift. Shortening the day or being better at preventing overtime would lead to fewer errors and less burnout.

MA: Of course, if you want to prevent overtime and burnout, Linda says there is a better way for hospitals to do that - hire more nurses.

AIKEN: We've never had enough nurses to take care of the patients. We added the COVID emergency on top of what was already a terrible situation.

VANEK SMITH: And yet here is a surprising indicator - the American Association of Colleges of Nursing says enrollment in programs for new nurses increased about 5% in 2020. So despite COVID and all the hours of stress, interest in nursing is up.

MA: So a lot of future Cherry Ameses.

VANEK SMITH: Fingers crossed.

MA: Adrian Ma.

VANEK SMITH: Stacey Vanek Smith, NPR News.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.

Adrian Ma
Adrian Ma covers work, money and other "business-ish" for NPR's daily economics podcast The Indicator from Planet Money.
Stacey Vanek Smith is the co-host of NPR's The Indicator from Planet Money. She's also a correspondent for Planet Money, where she covers business and economics. In this role, Smith has followed economic stories down the muddy back roads of Oklahoma to buy 100 barrels of oil; she's traveled to Pune, India, to track down the man who pitched the country's dramatic currency devaluation to the prime minister; and she's spoken with a North Korean woman who made a small fortune smuggling artificial sweetener in from China.