TITLE (TOPIC) - ClinicalReasoningandLengthofShift

Report
CAT
Critically
Appraised
Topic
Length of Shift and Critical Thinking
Among ICU Staff Nurses
Molly Falkner SN, Tawny Nicoly SN, Elizabeth Van Tuinen SN
Carroll University, Waukesha, WI
Collaborating ICU Practice Council Member: Cat Zyniecki, BSN, RN
Waukesha Memorial Hospital, Waukesha, WI
PICO QUESTION: Do ICU staff nurses who work 12-hour shifts have decreased
critical thinking ability compared to ICU staff nurses who work 8-hour shifts?
CLINICAL BOTTOM LINE:
There is no significant difference in critical thinking ability between ICU staff
nurses who work 8 and 12-hour shifts.
Level of Evidence
Fields, W., & Loveridge, C. (1988). Critical thinking and fatigue: how do nurses on 8- & 12-hour shifts
compare? Nursing Economic$, 6(4), 189-191.
Design: Quasi-Experimental
Sample: 102 RNs in the Critical Care Department of an acute-care hospital in California. Of the 102, 50
worked an 8-hour shift and 52 worked a 12-hour shift.
Findings: The Three-Minute Reasoning Test was completed by RNs in the first and last hour of their
shift, and it was concluded that there was no significant difference in critical thinking ability between
the 8-hour shift group and 12-hour shift group.
Washburn, M. S. (1991). Fatigue and critical thinking on eight-and twelve-hour shifts. Nursing
Management, 22(9), 80A, 80D, 80F-80H.
Design: Quasi-Experimental
Sample: 117 nurses at a hospital in Ohio. Of those nurses, 94 were RNs and 23 were LPNs. 46 RNs worked
in critical care; 48 RNs and all 23 LPNs worked on medical/surgical units. 68 nurses worked an 8-hour shift
and 49 worked a 12-hour shift.
Findings: The Three-Minute Reasoning Test was completed by nurses in the first and last hour of their
shift, and no statistical difference was found between the 8 and 12-hour shift nurses’ critical thinking
scores. Critical thinking ability did not differ by department (critical care vs medical/surgical).
Scott, L., D., Arslanian-Engoren, C., & Engoren, M., C. (2014). Association of sleep and fatigue with decision
regret among critical care nurses. American Journal of Critical Care, 23(1), 13-23.
doi:10.4037/ajcc2014191
Design: Descriptive, non-experimental
Sample: Simple random sample of 605 full-time critical care nurses who were members of the American
Association of Critical-Care Nurses. 475 nurses worked 12-hour shifts, 53 worked 8-hour shifts, and 16
worked other lengths of shift. (605/3500= 17% response rate)
Findings: Results from the questionnaires showed that nurses who reported decision regret (regretted a
clinical decision that they made at work when sleepy) were more likely to work nights and to work 12hour shifts than were nurses without decision regret.
Comments on
the Evidence
Applicability
Evidence Search
Keywords
Strengths: The sample sizes were appropriate. A valid and reliable tool (Three-Minute Reasoning Test) was used to measure
critical thinking ability. All studies focused on the ICU or broke down the results by department.
Weaknesses: Some studies were not current and also lacked vital information about the study methodology and data
analysis, decreasing their credibility. Decision regret has different conceptual and operational definitions than critical
thinking ability.
There is considerable support for the 12-hour shift in ICU nurses. Reasons include financial benefits for the hospital,
increased flexibility in scheduling for nurses, and increased continuity of care. Older studies indicate no significant difference
in critical thinking ability between ICU staff nurses who work 8 and 12-hour shifts. However, current sources that are
relevant to this particular PICO question are scarce. Future studies with random assignment and more control over
confounding variables are necessary in order to fully ascertain the effect of shift length on critical thinking ability in ICU staff
nurses. ICU patients are a vulnerable population, so an ICU nurse’s critical thinking ability is paramount.
Academic Search Premier, CINAHL, HealthSource, MedLine, PubMed
Critical care, ICU, nurse, clinical reasoning, decision, critical thinking, shift length, 8-hour, 12-hour

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