The effects of extended workdays on fatigue, health, performance and satisfaction in nursing


  • Edith J.C. Josten PhD,

  • Julie E.E. Ng-A-Tham PhD,

  • Henk Thierry PhD

Edith Josten, OSA Institute for Labour Studies, PO Box 90153, 5000 LE Tilburg, The Netherlands.


Background.  Several authors have claimed that 12-hour shifts in nursing are better for both employees and patient care. However, although the research has found positive effects on satisfaction with working hours and free time, the effects on employee fatigue, health and performance have mostly been neutral or negative.

Aim.  Work schedules should preferably be beneficial for satisfaction, fatigue, health and performance. This study therefore investigated whether shifts that are extended only slightly can combine the positive effects of the 12-hour shift with the positive effects of the 8-hour shift. The study investigated the effects of 9-hour shifts.

Method.  A total of 134 nurses from three nursing homes in the Netherlands completed a questionnaire on fatigue, health, performance and satisfaction. One group worked 8-hour shifts, and the other worked 9-hour shifts.

Results.  Nurses who worked 9-hour shifts were on average more fatigued, had more health complaints, and were less satisfied with their working hours and free time than those who worked 8-hour shifts. Their performance was slightly poorer. About 70% to 80% of the 8- and 9-hour nurses preferred to work a maximum of 8 hours during morning/early and afternoon/late shifts.

Conclusions.  The 9-hour shift seemed to combine the negative aspects of the 12-hour shift with the negative aspects of the 8-hour shift. It is suggested that the 9-hour shift had more negative effects than the 12-hour shift because: (1) nurses could not choose what shift length they worked; (2) many worked part-time; and (3) they already had many days off. It is also suggested that increases in workload since the 1980s make current extended shifts in nursing more fatiguing.