The 28-Hour Workday Controversy – Do Long Working Hours Help Or Harm Patients?

This article was republished with permission from SCRUBS Magazine.

In recent days, the medical world has seen itself mixed up in a bit of controversy, related to the long working hours common among medical professionals – including doctors, nurses, and other hospital staff.

The root of this controversy lies in a regulation passed by ACGME – The Accreditation Council For Graduate Medical Education – first passed in 2011.

This regulation, meant to protect first-year medical residents from making errors due to excessive tiredness, caps the maximum workday of a first-year medical resident at a maximum workday of 16 hours.

This regulation also added further restrictions involving time off between shifts, and other stipulations. And, as of July 1, 2017, it will be repealed – allowing first-year residents to work shifts of up to 28 hours.

Does A Shorter Workday Protect First-Year Residents – Or Harm Patients?

Proponents of the original 2011 law argued that first-year medical residents were more likely to make errors when they were tired, and that placing a first-year resident directly into a 24-hour shift cycle – which is allowed for all year 2-10 medical residents – had negative effects on patient outcomes.

However, those critical of the law pointed out that second-year residents and doctors often worked 24-hour shift cycles, and that understanding how to mitigate the effects of tiredness and provide the continuity of care required in the medical profession was essential for first-year residents.

They argued that this bill was counterproductive – simply reducing the hours that first-year residents could work would lead to ill-prepared residents who would provide less comprehensive care.

It seems that ACGME agrees with critics of the 2011 bill – it was recently announced that these restrictive regulations would be lifted. Starting on July 1, 2017, new regulations will allow first-year residents to work up to a standard 24-hour shift, with 4 more hours available to transition care to another medical provider – adding up to a 28-hour workday.

This change is spurred by a comprehensive ACGME study, which found that young residents who work 24 hour days are not harming patients or making excessive mistakes – and that restrictive 16-hour days can often have a larger negative effect on patient care.

To give you a better perspective on this hot-button topic, let’s take a deeper look at the benefits – and drawbacks – of long working hours for medical professionals, including doctors, nurses, and first-year residents.

The Benefits Of Allowing Long Working Hours For Medical Professionals

Those who argue for a longer workday cite many benefits. Here are a few of the benefits often cited by those who are in favor of longer working hours.  

  • Better continuity of care in acute situations – Long hours allow medical professionals to provide exceptional continuity of care in an acute, emergency situations. There is no wasted time briefing new doctors or nurses on the situation, filling out sign-out forms, or repeat patient interviews, leading to a better overall level of patient care in acute situations.
  • Increased flexibility – One of the primary criticisms leveled at the 16-hour first-year resident work rule implemented in 2011 was inflexibility. Even if a resident could provide much better care with just an extra hour or two, they would be required to leave – and be unable to provide that care.

Having the option to extend their working day could lead to an overall increase in flexibility – and better patient outcomes.

  • Lower risk of miscommunication – Constantly turning over a patient to another nurse, doctor, or resident can lead to miscommunication – you may forget to mention something important, or otherwise neglect to inform your coworker about the specifics of a patient’s situation.

Longer working hours for residents would allow for a lower level of case turnover and can prevent simple mistakes caused by miscommunication.

  • Stronger patient/case connection – If you’re a nurse, you know this feeling. Working overtime – a 16 hour day or longer, in some cases – and being by a patient’s side the whole time, doing your very best to treat them, helping them through their sickness, injury, and disease – it can be powerful.

Working long days can help medical professionals feel invested in specific patients or cases – leading to an overall stronger connection and a higher level of care and attention.

The Drawbacks Of Allowing Long Working Hours For Medical Professionals

While all of the above benefits sound good on paper, the fact remains that working long hours does have a negative impact on all medical professionals – from residents working 24-hour work days to nurses pulling 16-hour overnight shifts.

  • Increased supervision required to avoid mistakes – This is especially true of newer nurses or first-year residents. Mistakes happen – and the more fatigued you are, the more likely you are to make a silly mistake. But in the medical world, even a silly mistake can be the difference between life and death.

Because of this, increased supervision is often required in hospitals that routinely allow medical professionals to work extremely long hours.

  • Excessive tiredness can lead to burnout – working 24-hour days may have some benefits, but it’s not normal. Those of us in the medical profession may lose sight of this – but there are very few other professions where a 24-hour workday is common – or even legally allowed!

Particularly among residents, these extreme hours can lead to “resident burnout”. It has been estimated that up to 70% of residents experience some level of burnout. In minor cases, this can lead to a poorer level of care and a negative mental state – in extreme cases, residents may leave the medical profession entirely.

  • Lack of work-life balance – Doctors, nurses, and residents are all human – and all of us want to live a life that isn’t just about work. 16 and 24-hour shifts can lead to a terrible work-life balance, and a large majority of medical professionals report poor work-life balance as one of the primary drawbacks of their profession.

Now, some level of sacrifice is obviously required to provide great medical care. Broken bones don’t care that you want to go out to eat with your husband – meningitis doesn’t care that you planned a weekend in the Poconos. If you’re a nurse, doctor, or resident, you have to accept that you will, occasionally, have your life come second – and your work will come first.

But your life shouldn’t always come second – and long working hours can often make you feel as if your life is only about work.

The Medical Community Agrees With The ACGME Decision

When the repeal of the 16-hour workday regulation was announced, it generated quite a bit of buzz among medical organizations, and most of it was quite positive.

According to the ACGME, over 110 professional and medical organizations wrote statements or testimonies about the potential changes in first-year resident working hours – and the vast majority were positive.

Many organizations pointed out that the 28-hour limit was just that – a limit – and that the vast majority of physicians and residents never exceed 18-20 hour days at all, except in rare cases, and that the maximum limit of 80 hours of work per week was still in place for all physicians and residents.

So, despite the controversy, it seems that the medical community at-large has decided that longer working hours are worth the risks.

So what do you think? Do you have experiences working long shifts alongside residents? Have you felt the negative effects of an 18-hour – or longer – workday? Do you agree with the decision? Let us know in the comments – we’d be happy to hear your thoughts.

This article was republished with permission from SCRUBS Magazine.


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