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Improve Shifts in Nursing for Better Health Outcomes

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Nurses work hard to deliver high-quality care to patients and their families. So much is given to others every single day, where nurses work hours that many people wouldn't consider doing. Nurses are passionate about their jobs, and so they are flexible with their ever-changing shifts and long hours. Shift work is a part of nursing that most nurses come to love. For a nurse, shift work is life. However, there are some issues with shifts that need to be addressed.

A rotating roster in nursing will usually include a mixture of morning, evening and night shifts. A nurse may be required to work varying shifts, alternating between mornings and evenings, and quick shifts throughout the week without any consistency. Quick shifts being evening shifts followed by morning shifts, and night shifts followed by evening shifts. Quick shifts can also occur due to overtime, and when nurses are on call, where an on call shift is closely followed by a rostered shift. 

Shift irregularity in itself is bad, but when a nurse is also subjected to a number of quick shifts a week, this makes it increasingly hard on the body. The concern with quick shifts is that nurses are often required to work after having only an eight-hour break.

Eight hours is not enough time to factor in travel, activities of daily living, time to wind down and also get a sufficient amount of sleep. With much research having been done on sleep, 7-8 hours has shown to be imperative for overall good health and particularly mental functioning. In addition, nursing is known to be stressful and a good night's sleep is vital to help in reducing that stress. If shifts were more regular, and perhaps done in blocks then this issue could be avoided. 

Irregularity in sleeping patterns, particularly caused by quick shifts, can contribute to insomnia and an array of other health issues, due to its negative effect on the body's natural circadian rhythm. Australia needs to start thinking about the health of our nurses. How will nurses provide optimum care to patients if they become unwell? Surely this has an impact on the amount of sick leave taken and staff retention rates. 

The detrimental effects of shift work can be minimised by making rostered shifts more consistent and by increasing the minimum break between shifts to at least 10 hours. This is important to ensure that nurses are providing safe care to patients.

Currently, the Nurses Award 2010 states that: 'An employee will be allowed a rest break of eight hours between the completion of one ordinary work period or shift and the commencement of another ordinary work period or shift.' In my experience, most places of work provide only an eight-hour break, regardless of whether the shifts are ordinary or not. The award needs to change! Moreover, this is especially unfair considering that other health professionals are entitled to a 10-hour break between shifts, under the Health Professionals and Support Services Award 2010. Why is this?

The Nurses Award 2010, however, does not cover all nurses in Australia, where other modern nursing awards and agreements are in place. Many of the nursing awards, both state and enterprise, uphold a similar clause related to the minimum breaks between shifts. Although, I have been advised that some awards and agreements do offer a 10-hour break between shifts. The rest of Australia needs to follow suit!

Australia wide legislation needs to be put in place to ensure that breaks between shifts in nursing are at least 10 hours, where the applicable awards and agreements are changed to correspond with this.

Nursing is an exacting profession with no room for error. One small mistake could cause harm or even be fatal to a patient. Fatigued nurses are an accident waiting to happen! Nurses who are working irregular shifts, quick shifts and those who do over time with only an eight-hour break are all at risk of fatigue. This problem must be addressed. On another note, we should also consider whether frequent double shifts are safe.

I understand that there are staffing, financial and various other implications as to why eight-hour breaks are viewed as acceptable, however, we need to acknowledge that the health and safety of people are what is most important. It is also imperative for quality improvement in health care. Essentially, there needs to be organisational restructure across the board.

To reduce fatigue in nursing, shifts need to be more consistent and the minimum break between shifts increased to at least 10 hours. I believe this change will lead to better health outcomes for all.  

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