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

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 And, as of July 1, 2017, it will be repealed – allowing first-year residents to work shifts of up to 28 hours.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.

Page Two: The Drawbacks