Ball J, Pike G. Past imperfect, future tense: results from the RCN employment survey.London: RCN; 2009

Ball J, Maben J, Murrells T, Dat T, Griffiths P. 12-hour shifts: Prevalence, views and impact.London: National Nursing Research Unit, King's College London; 2015

Bloodworth C, Lea A, Lane S, Ginn R. Challenging the myth of the 12-hour shift: a pilot evaluation. Nurs Stand. 2001; 15:(29)33-36

Chen J, Davis KG, Daraiseh NM, Pan W, Davis LS. Fatigue and recovery in 12-hour dayshift hospital nurses. J Nurs Manag.. 2014; 22:(5)593-603

Midwifery 2020.London: Department of Health and Social Care; 2010

Dall'Ora C, Griffiths P, Ball J, Simon M, Aiken LH. Association of 12 h shifts and nurses' job satisfaction, burnout and intention to leave: findings from a cross-sectional study of 12 European countries. BMJ Open. 2015; 5:(9)

European Union (EU) rules on drivers' hours and working time: simplified guidance.London: The Stationery Office; 2017

Compassion in Practice. Nursing, Midwifery and Care Staff: Our vision and strategy.London: DH; 2012

Dwyer T, Jamieson L, Moxham L, Austen D, Smith K. Evaluation of the 12-hour shift trial in a regional intensive care unit. J Nurs Manag.. 2007; 15:(7)711-20

Estabrooks CA, Cummings GG, Olivo SA, Squires JE, Giblin C, Simpson N. Effects of shift length on quality of patient care and health provider outcomes: systematic review. Qual Saf Health Care. 2009; 18:(3)181-8

Ferguson SA, Dawson D. 12-h or 8-h shifts? It depends. Sleep Med Rev.. 2012; 16:(6)519-28

Fields WL, Loveridge C. Critical thinking and fatigue: how do nurses on 8- & 12-hour shifts compare?. Nurs Econ.. 1988; 6:(4)189-95

Freer Y, Murphy-Black T. Work rotas and performance levels: evaluating the effects of twelve hour shifts against eight hour shifts on a neonatal intensive care unit. J Neonatal Nurs.. 1995; 1:(4)5-9

Geiger-Brown J, Rogers VE, Trinkoff AM, Kane RL, Bausell RB, Scharf SM. Sleep, sleepiness, fatigue, and performance of 12-hour-shift nurses. Chronobiol Int.. 2012; 29:(2)211-19

Gillespie A, Curzio J. A comparison of a 12-hour and eight-hour shift system. Nurs Times. 1996; 92:(39)36-9

Griffiths P, Dall'Ora C, Simon M Nurses' shift length and overtime working in 12 European countries: the association with perceived quality of care and patient safety. Med Care. 2014; 52:(11)975-81

Hazzard B, Johnson K, Dordunoo D, Klein T, Russell B, Walkowiak P. Work- and nonwork-related factors associated with PACU nurses' fatigue. J Perianesth Nurs.. 2013; 28:(4)201-9

The development of a fatigue/risk index for shiftworkers.Norwich: HMSO; 2006

Jackson P, Hilditch C, Holmes A, Reed N, Merat N, Smith L. Fatigue and road safety: a critical analysis of recent evidence.London: Department for Transport; 2011

Kecklund G, Axelsson J. Health consequences of shift work and insufficient sleep. BMJ.. 2016; 355

Lea A, Bloodworth C. Modernising the 12-hour shift. Nurs Stand.. 2003; 17:(19)33-6

McGettrick KS, O'Neill MA. Critical care nurses - perceptions of 12-h shifts. Nurs Crit Care. 2006; 11:(4)188-97

Mills ME, Arnold B, Wood CM. Core-12. Nurs Res.. 1983; 32:(6)356-61

National Audit Office. NHS ambulance services: report by the comptroller and auditor general. 2017. (accessed 7 November 2018)

Staff survey 2015 detailed spreadsheets: key findings. 2016. (accessed 19 April 2016)

Staff Survey 2017 detailed spreadsheets: key findings. 2018a. (accessed 23 August 2018)

NHS staff survey 2017 detailed spreadsheets: question level data. 2018b. (accessed 23 August 2018)

Safe midwifery staffing for maternity settings [NG4].London: NICE; 2015

National maternity and perinatal audit: Organisational report 2017.London: RCOG; 2017

National Quality Board. Safe, sustainable and productive staff: An improvement resource for maternity services. 2018. (accessed 27 August 2018)

NHS Digital. NHS vacancy statistics England: February 2015 – September 2016, provisional experimental statistics. 2017. (accessed 23 August 2018)

NHS England. Compassion in practice: two years on. 2014. (accessed 2 June 2016)

The Code: Professional standards of practice and behaviour for nurses and midwives.London: NMC; 2015

Nursing and Midwifery Council. NMC briefing: appropriate staffing in health and care settings. 2016. (accessed 31 August 2018)

Raising and escalating concerns: Guidance for nurses and midwives.London: NMC; 2017

Office for National Statistics. Births in England and Wales: 2017. 2018. (accessed 20 August 2018)

Reid N, Robinson G, Todd C. The quantity of nursing care on wards working 8- and 12-hour shifts. Int J Nurs Stud.. 1993; 30:(5)403-13

Richardson A, Dabner N, Curtis S. Twelve-hour shift on ITU: a nursing evaluation. Nurs Crit Care. 2003; 8:(3)103-8

Richardson A, Turnock C, Harris L, Finley A, Carson S. A study examining the impact of 12-hour shifts on critical care staff. J Nurs Manag.. 2007; 15:(8)838-46

Rogers AE, Hwang WT, Scott LD, Aiken LH, Dinges DF. The working hours of hospital staff nurses and patient safety. Health Aff.. 2004; 23:(4)202-12

The Royal College of Midwives submission to the NHS pay review body.London: RCM; 2015

Evidence to the NHS pay review body.London: RCM; 2016

Evidence to the NHS pay review body.London: RCM; 2017

Scott LD, Rogers AE, Hwang W-T, Zhang Y. Effects of critical care nurses' work hours on vigilance and patients' safety. Am J Crit Care. 2006; 15:(1)30-7

Stone PW, Du Y, Cowell R Comparison of nurse, system and quality patient care outcomes in 8-hour and 12-hour shifts. Med Care. 2006; 44:(12)1099-106

Todd C, Reid N, Robinson G. The quality of nursing care on wards working eight and twelve hour shifts: a repeated measures study using the MONITOR index of quality of care. Int J Nurs Stud.. 1989; 26:(4)359-68

Unison's staffing levels survey 2015. Red alert: unsafe staffing levels rising.London: Unison; 2015

Witkoski Stimpfel AW, Sloane DM, Aiken LH. The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Health Aff.. 2012; 31:(11)2501-9

Is it shift length or working practices that most affect midwives' wellbeing and ability to safely deliver care?

02 December 2018
12 min read
Volume 26 · Issue 12


Midwives continue to experience high levels of work-related stress. Challenges in staffing and demands on services may contribute, but there are also indications that shift length or working practices may also be a factor, especially if midwives regularly work beyond their contracted hours or miss rest breaks. In the nursing literature, longer shifts have been associated with higher levels of fatigue, yet this has also been found in nurses working 8-hour shifts, due to the high number of consecutive shifts worked, suggesting that working practices also contribute to fatigue. Longer shifts have also been linked to poorer quality of care, yet this only appears significant when shifts exceed 12 hours. There are mixed views on job satisfaction, which may be due to personal preferences or the availability of flexible working. However, the findings of many studies are often limited by poor quality designs and cannot easily be applied to midwifery settings, where there continues to be a lack of research in this area. Further research is therefore required to understand the impact of shift length and working practices on the wellbeing of midwives and their ability to safely delivery care.

In 2016, the results from the NHS Staff Survey revealed that midwives reported the highest levels of work-related stress, more than any other NHS staff group (National NHS Staff Survey Co-ordination Centre, 2016). Two years on, ambulance technicians narrowly took the top spot, with 51% reporting this (National NHS Staff Survey Co-ordination Centre, 2018a), yet the reported levels of worked-related stress among midwives remained unchanged between the two surveys, at just under half. Interestingly, there are a number of parallels between the two staff groups: both the ambulance and maternity services face challenges in staff shortages, retention of staff, the rising complexity of care needs and often the unpredictable demand on services (Chief Nursing Officers, 2010; Royal College of Midwives (RCM), 2016; National Audit Office (NAO), 2017; NHS Digital, 2017; Office for National Statistics, 2018). Both services also provide 24-hour care, leading to a need for shift work, and while there may be a variety of shifts in operation, both use the longer 12-hour shifts (RCM, 2015; NAO, 2017).

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