Extended work shifts for nurses have been linked to increased risk of errors. This large-scale study aimed to provide new information on hospital nurses' shift length and to estimate the effects on nurse-reported hospital safety and quality. Most hospital staff nurses were found to work extended shifts of at least 12 hours. Nurses that worked shifts of 10 hours or longer were more likely to report a poor safety grade compared with nurses working 8- to 9-hour shifts. Some authors have proposed harm reduction strategies for nurses that must work 12-hour shifts. A high-profile fatal medication error that occurred while a nurse was working a double shift previously spotlighted the issue of long nursing hours.