Fighting Nurse Fatigue Since the early days of nursing when nurses would work extended shifts and even lived on the wards where they worked, nurse fatigue has been a much discussed issue. During the late 1800s and into the early 1900s, workers spanning several industries fought for the eight hour work day and eventually won with the passage of the US Fair Labor Standards Act in 1938 (Miller, 2011). In the years since then, the extended shift has again become popular, particularly in the field of nursing. Though many nurses and organizations laud twelve hour shifts as beneficial to staffing needs and personal lives, the risks to patient and nurse safety must be considered.
Effects of Nurse Fatigue
Merriam-Webster (2014) describes fatigue as “weariness or exhaustion from labor, exertion, or stress”. Fatigue can be caused or worsened by extended hours of wakefulness, acute or chronic sleep debt (Birmingham, Dent, & Ellerbe, 2013), and increased stress of workload including higher acuity patients. The effects of fatigue on nurse and patient safety have been shown to increase the risk of patient care errors three fold with an increase in the risk of near errors and occupational injuries, as well (Joint Commission, 2012). Nurses have reported experiencing an increase in medication errors, difficulty staying awake and decreased productivity in the last four hours of their twelve hour shift (Keller, 2009). Patient hand-off reports are also a high-risk area that suffers when the
A considerable amount of literature has been published on the impact of working hours (8 vs. 12 hour shifts) on fatigue among the nurses. These studies revealed that twelve-hour shifts increase the risk of fatigue, reduce the level of alertness and performance, and therefore reduce the safety aspect compared to eight-hour shifts (Mitchell and Williamson, 1997; Dorrian et al., 2006; Dembe et al., 2009; Tasto et al., 1978). Mills et al. (1982) found that the risk of fatigues and performance errors are associated with the 12-hour shifts. Beside this, Jostone et al. (2002) revealed that nurses who are working for long hours
Another cause of nurse fatigue is lack of adequate sleep. First, working 12 hour shifts means that nurses only have 12 hours to sleep and also conduct other activities of life outside the workplace, while other professionals have 16 or more hours for rest and social activities. This is the reason for the few hours of sleep recorded by nurses with some opting to not sleep at all but take short naps. These are
Within the recent years, hospitals and medical facilities have been experiencing nursing shortages that necessitate more nurses to be present to compensate for the care needed to be given. This requires nurses to be dealt with imperative extended work hours along with their normal shifts with no denial or excuse accepted. Working extra hours are accompanied with negative effects that have an impact on the nurse, coworkers, and patients. A major concern that occurs with overtime is that nurses become fatigued or burnout. Fatigue that is experienced is a result of sleep deprivation from working overtime that is associated with arduousness neurobehavioral functioning
As a result, overtime can compromise patients ' health or safety. Medical residents cited fatigue as a cause for their serious mistakes in four out of 10 cases (Boodman 2001), and two studies linked infection outbreaks at hospitals to overtime work (Arnow et al. 1982; and Russell et al. 1983). Indeed, the California Nurses Association reports that more nurses are refusing to work in hospitals with unsafe conditions, in which they include being forced to work unplanned overtime. The American Nurses Association (ANA), in a national survey of 7,300 of its members, found, disturbingly, that 56% of nurses believe that the time they have available for care for each patient has decreased, and 75% feel that the quality of patient care at their own facility has decreased in the last two years. The cited inadequate staffing as the chief reason.
Patients in a hospital and/or healthcare facilities have to be cared for all day and all night, everyday of the week by nurses. The usual way to fulfill this need is to divide up the day into three 8-hour shifts. Different shifts have been put into place to help improve nurse satisfaction, decrease the nursing shortage and save the hospital money. The 24-hour day is made up of two 12-hour shifts; 12 hours in the day and 12 hours at night. There has been quite an ongoing debate over the years regarding this issue of nurses working over 8 hours in a single day. Many people, such as hospital nursing administrators, have reason to believe that working long hour shifts causes more errors in
Can you imagine costing a patient their life due to your lack of sleep, long shifts, and working to many hours? Me either. “In 2011, the Joint Commission issued a Sentinel Event Alert to call attention to health care worker fatigue as it relates to patient safety, noting a link between healthcare worker fatigue and adverse events. In addition to patient safety concerns, there is an increased risk of injury in fatigued healthcare workers (Martin, 2015).” Lets explore the dangers of fatigue, and its importance to nurses, way that nurses can prevent fatigue, and possible ways to lower fatigue and enhance sleep. What standards are in place in the nurse practice
Since majority of nurses prefer 12-hour shifts it is very unlikely that they will return to 8-hour shifts. Excessive over time still remains an issue, so therefore there are strategies that are being made to protect both nurses and patients safety. These strategies include making sure that nurses working 12-hour shifts, get mandatory breaks and leave work on time and that napping is available for night shift workers.
A nurse’s typical day isn’t without stress; it is usually a lot of complex planning, critical thinking, time management, an abundance of communications with all departments of the hospital, and documenting events that have happened throughout the day on their entire patient assignment. “Nurses who are mandated following the completion of their regular shift are often ill-equipped to continue working. They have not planned for that situation with: proper advanced rest, arrangements for
Those of us who graduated from nursing school and started their first job were full of dreams, aspirations, and had every intention of making a difference. Now fast forward five years; these same nurses have been on their feet for 16 hours and have not had time to eat or use the bathroom since leaving their homes this morning. The call lights will not stop going off long enough for them to give report to the oncoming nurses and once again they are late for their children’s dance recitals or soccer games. They can forget about trying to squeeze a yoga class in this week. I understand what it is like to rush to your car feeling as if some important task was forgotten; was Mr. Smith’s tube feed restarted, did room 8 receive their pain medication? Nurses all over the world are experiencing “burnout”. To avoid burnout, nurses must properly care for themselves by separating work from personal life, knowing when to say no, and making time for enjoyable activities to manage stress, because we cannot provide quality patient care if we are neglecting ourselves.
To provide high-quality care for the patient it is essential for the nursing staff to have enough time for recovery from long hours of demanding work. Eight-hour shifts for hospital nurses have become a standard of the past. Nowadays, 12-hour shifts for three days a week have become typical in most hospitals as recommended by the Institute of Medicine (IOM) (Stimpfel, Sloane & Aiken, 2012). The length of the shifts and the working days; however, are often unpredictable due to increased demand for patient care and high census episodes. Nursing shortages, along with a weak economy, have left hospital nurses with no choice, then to work extended hours and overtime. Long hour shifts, as well as mandatory overtime, has become an increasing
The risks of making an error were significantly increased when work shifts were longer than twelve hours, when nurses worked overtime, or when they worked more than forty hours per week. (Trossman, 2009). Working longer hours in a high stress area will always increase the error rate. Designating an adequate number of RN positions to ensure nurses work an appropriate schedule without overtime and that their workload allows for breaks. Managerial staff must work to develop specific policies about the length of work times based on the setting, patient and provider needs. Those policies should limit nurses from working more than 12.5 consecutive hours. Provide education for all care providers on the hazards and causes of fatigue. Continue to document unsafe staffing conditions and work with others to change the current work culture so that it recognizes the effects of fatigue on patient safety, as well as the nurse. (Berger, et al. 2006)
Stressful work environments, long work hours and inadequate sleep all contribute to an increase in physical and mental exhaustion amongst nurses. Typically, people choose nursing as a career to help others and to make a difference in their lives, without realizing the number of duties this career demands. Nurses may suffer in silence when they are experiencing stress. The effects can impact safe and reliable care by decreasing job satisfaction, decreasing productivity, causing poor personal health, and compromising patient care. Many facilities would benefit from implementing evidence-based strategies to address nurse fatigue and burnout.
When nurses experience fatigue due to excessive overtime, effects that can occur are reduced decision making ability, reduced communication skills, increased forgetfulness, increased tendency of risk taking, reduced ability to handle stress on the job, decreased ability to do complex planning, and inability to recall details which can all danger patients wellbeing. Unfortunately even with all the
“Burnout has been widely studied in the health service profession, and nursing is recognized as one of the occupations with the highest burnout prevalence rates” (Harkin & Melby, 2014, p. 152). Nursing burnout affects many nurses in the profession in one way or another. In the nursing world, a typical shift length is now twelve hours or longer. This shift length has changed from the past in which nurses worked a normal shift of eight hours. While there are benefits and disadvantages to each of these shifts, there has to be a regulation of total hours worked in a week. Nurses who work at the bedside of critically ill patients witness marked human suffering (Sacco, Ciurzynski, Harvey, &
It is likely that most people have heard about the nursing shortage for years now, and perhaps they believe it’s been fixed. However, the nursing profession is experiencing a reoccurring deficiency. According to Brian Hansen, (2002), there was a nation wide shortage in 2001 of 126,000 full-time registered nurses, but the shortage will surge to 808,000 by 2020 if something isn't done. This pattern is a persisting cycle of high vacancies followed by layoffs and a high over supply of registered nurses. Various factors contribute to the lack of nurses within the health care facilities, but today’s shortages are a little different. Many feel that this scarcity is severe and long-drawn-out. The four major issues contributing to