The Impact Of Nurse Fatigue

The term 12 hour shift is used to refer to a two shift system associated with an extended working day, as supposed to an eight hour workshift. Twelve-hour shifts have become the normality and standard shift option for nursing over recent years across the United States (Harris, Sims, Parr, & Davies et al., 2014 p.606). Longer work hours are viewed as a positive impact on recruitment, potential financial savings, retention, and enhanced continuity of care (National Nursing Research Unit, 2013; NHS Evidence, 2010). However, it’s also evident that longer shifts result in nurse fatigue, errors, and reduced alertness. The concept of longer hour shifts have become quite the controversial topic among the healthcare system.

Whether or not mandatory overtime is required varies from facility to facility. Like many other issues, there are both pros and cons to this topic. Witkoski,S, Sloane, D, and Aiken L (2012) did a study and concluded that nurses who worked 10 or more hours a shift were more likely to experience burnout and were dissatisfied with their jobs with an intent on quitting. Burnout can affect the quality of care a nurse provides to patients. Burnout can be the cause of a nurse not noticing subtle changes of patients which could potentially lead to patient neglect. Although there are cons to working long shifts there are some pros. When nurses work 12hour shifts, they often meet or exceed their weekly hours over the course of a 3day work week. Since they would only be working a three-day work week, it provides nurses with a better work-life balance and flexibility (Witkoski,S, Sloane, D, and Aiken L 2012), giving nurses more time outside of their job to do whatever they would like. Getting this kind of flexibility is great for nurses like myself who are either back in school or have families to take care of, or just need a little more time to recover and

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

According to Pennsylvania Patient Safety Reporting System (PA-PSRS), nurses stated fatigue as a contributing factor to errors related to procedures, treatments, tests, and medication administrations (Gardner, Dubeck, 2016). Many "near" errors, or “close-calls” were also attributed to mental fatigue and lack of recovery time between shifts (Maust Martin, 2015). It is reported that errors and "near" errors are related to factors, such as, lapses in attention, reduced motivation, compromised problem solving, and diminished reaction time. The Joint Commission believes that fatigue is a factor that greatly contributes to the increased number of sentinel events among patients (Gardner, Dubeck, 2016).

(Senteniel) Additional studies show risk of errors and close calls were related to longer shift length and were associated with decreased attentiveness. Nurses also suffer higher rates of occupational injury when working shifts more than 12 hours. (Joint Commision, 20111) The ANA acknowledges the relationship between working long hours and increased risk for sleep disturbances, injuries, musculoskeletal disorders, gastrointestinal problems, metabolic syndrome, cardiovascular disease, cancer, and adverse reproductive outcomes. (NANN, 2012) In addition to clinical outcomes, there is an association between nurses who worked 13 or more hours in the hospital and lack of communication with patients regarding pain control. Burnout is common among nurses working long shifts and they are more than likely to leave their job within the first year. Shifts scheduled for 12 hours often exceed that timeframe, as many as 40% of the work shifts logged for their study exceeded 12 hours. (Martin, 2012) There are many reasons for fatigue, but shift length is the one that is most obvious and easy to fix. It is no wonder for nurse fatigue when 12 hour shifts are the norm. Twelve hour shifts are standard practice even though the Institute of Medicine recommends limiting them. At a recent nursing management congress Cole Edmonson stated that 12 hour shifts may cause more problems than they solve. While research is aiding us comprehend the dangers nurse fatigue brings to patients and nurses themselves, he called 12 hour shifts “a dead idea whose time has passed”. Eliminating 12 hour shifts is obvious if the fact is acknowledged that nurse fatigue is a serious problem. (Hendren,

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

Nursing burnout is serious and in order to ensure that nurses are taken care of, the administration must implement incentives and policies that will provide nurses with the resources to maintain a healthy work life balance. Burnout accounts for many of the medication errors and patient injuries in healthcare facilities. Most nurses are overwhelmed because of the caseload and longer workdays necessary to complete charting. Many nurses are also disgruntled because of denied vacation requests that cannot be approved because of non-coverage. Research has shown that when employees are happy then there are less errors and injuries 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

Nurses work long hours and deal with high levels of stress during the workday which leads to nurse burnout. Nurse burnout is classified as physical and mental fatigue, which strongly affects the nurses emotions and motivation. (“Nursing Burnout”). Burnout is caused by various factors within the workplace, such as dealing with a hectic, fast-paced environment, caring for too many patients at one time, and working odd hours. When nurses deal with multiple patients per shift, high levels of responsibility, and their own personal problems, they can become exhausted and overwhelmed. Stress due to burnout can also affect the nurse’s mood in a negative way, causing the nurse to become impatient or irritable, which can oftentimes results in verbal or emotional abuse towards the

Mandatory overtime has become an increasing problem for nurses who work in many hospital settings. Mandatory overtime is defined as additional hours added to a nurse’s current shift, making the nurse feel as if it’s a threat of being fired or disciplinary action will be taken in some form if they refuse to stay and work. Extensive overtime studies have established and confirmed that there are serious dangers to both the nurse and the patient being cared for in all types of healthcare settings.

A fatigued nurse can lead to many errors and compromise the care given to a patient. Nurse fatigue has been found to increase depression. If a nurse has an altered mindset to begin with, they will not be able to take care of anyone else adequately. Nurse fatigue can also increase irritability. A nurse with increased irritability could lead the nurse to make irrational decisions. The nurse with sleep deprivation has an increased risk for error. A nurse is responsible for administering drugs. When a nurse is extremely tired, it could lead them to mess up the medications prescribed for the patient or to overlook reactions that the patient may experience from the medications. The nurse is also responsible for focusing on the care provided to the patient. A fatigued nurse could be too tired to notice crucial changes in the patient. The fatigued nurse will be affected in his or her performance. Nurse fatigue could also result in the nurses injuring themselves. Nurse fatigue could influence a nurse to make shortcuts and that can also endanger the nurse. For example, if a nurse has to lift a patient using a hoyer lift, but misjudges the situation because of lack of energy, the nurse could end up lifting the patient by herself and hurting her back. This is how nurse fatigue relates to the safety of the practicing nurse and patient

Nurses are especially vulnerable to several related effects of stress, such as burnout, job dissatisfaction, increased interpersonal problems, increased health complaints, disturbances in sleep patterns, as well as clinical depression and anxiety (Villani, Grassi, Cognetta, Toniolo, Cipresso, & Riva, 2013). The potential for stress can be reduced by resolving difficulties in the workplace promptly, addressing staff shortages, turnover and absenteeism, and developing clear objectives and plans (McIntosh, & Sheppy, 2013). Learning to manage and reduce stress by developing insight and coping strategies will help to maintain and promote nursing integrity and consistent patient care (McIntosh, & Sheppy, 2013).

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

Nurses, always involved in patient care, sometimes experience detrimental effects with prolonged stress or “burnout” during their career throughout the years. Burnout is defined as an extended response to physical or emotional stressors. Some examples of these stressors are; memories of witnessing death, patient and family suffering, emotional stress of losing patients, feeling emotionally and physically drained, or emotional disconnect from staff which can all contribute to burnout. As a result, nurses can experience; exhaustion, anxiety, dissatisfaction and low capacity. Overall, burnout can have negative effects not just on the emotional and physical health of nurses but also on; patient satisfaction, outcomes and mortality of nurses and patients. Although, there are ways to reduce or prevent these negative effects of burnout from manifesting. For example, nurses can apply interventions to reduce these risks including; staff support, onsite counselors and psychiatrists for nurses and salary increases and reimbursement opportunities for nurses through clinical ladder programs. Nurses can also start by just saying no to certain requests, being aware of their tolerance level, by taking care of themselves and having fun outside of work. On the other hand, others do not think nursing burnout is fatal and nurses just need a break from their job to initiate change. Although, the issue of burnout is prevalent in nurse’s careers which need to be addressed more in society in

The first topic focused on in an article by Stimpfel et al. (2012) looked at the effect of longer shifts on nurses. Compared to the past, nurses are working twelve-hour shifts, instead of eight-hour shifts. The reason for these changes in shift lengths is for it to allow for nurses to have more flexibility in their schedules and to give them more time at home. This study revealed that the hours actually worked by nurses are unpredictable. Due to the fluctuations of patient needs and unanticipated staffing on the unit, leads to nurses having to work over their scheduled time (Stimpfel et al. 2012). This study also pointed out that there are no national policies for nurses that dictate the maximum number of hours a nurse can work. Nurses often end up working several hours over their shift because they feel forced into working those hours and thereby leading to burnout.