Beyond 12 hours: A national survey of neonatal nurse practitioners perceptions on shift length and professional...

The neonatal nurse practitioner (NNP) is a pivotal member of the neonatal intensive care unit (NICU) care team. To ensure 24-hour coverage in this high-acuity environment, NNPs often work shifts exceeding 16 hours. However, little is known about how prolonged shifts affect NNP fatigue, clinical performance, and overall well-being.

A mixed-methods survey was distributed via postcards containing a QR code to board-certified NNPs. The survey assessed demographics, shift practices, and perceptions of fatigue when working shifts greater than 16 hours.

A total of 623 participants initiated the survey; 371 completed all items. Most were experienced NNPs working in level III NICUs. Preferred shift lengths included 24-hour and 12-hour day shifts. Awareness of the National Association of NNP position statement on shift length was high (73%), with 76% agreeing with its recommendations. Over half (51%) supported continuing 24-hour shifts. Eighty-five percent agreed that unit census/acuity contributes to fatigue. Nearly half (49%) reported feeling unsafe driving after shifts >16 hours; among those who did acknowledge feeling unsafe to drive, this occurred an average of 17% of the time. Sixty percent denied ever feeling unable to perform duties after extended shifts; among those who did, the average frequency was 17.4%.

Neonatal nurse practitioners report a preference for extended shifts despite acknowledging associated fatigue-related concerns. Although these findings provided valuable subjective insight, findings are limited by self-reporting and sample representation.

Additional objective data and qualitative analysis are needed to guide evidence-based strategies that prioritize both provider well-being and patient safety.