Career challenges: Nursing Fatigue

Career challenges: Nursing Fatigue

The author of a 2014 study has called 12-hour shifts one of the worst trends in nursing and would like industry leaders to proactively address the issue of inadequate sleep among nurses.

The study specifically looked at critical care nurses and appeared in the American Journal of Critical Care. In the abstract, the authors state, “The effects of inadequate sleep on clinical decisions may be important for patients in critical care units, who are often more vulnerable than patients in other units. Fatigued nurses are more likely than well-rested nurses to make faulty decisions that lead to decision regret, a negative cognitive emotion that occurs when the actual outcome differs from the desired or expected outcome.”

A majority of the nurses surveyed reported moderately high fatigue, significant sleep deprivation, and daytime sleepiness. All of these things affect their ability to be alert and vigilant and to make critical decisions. Perhaps the worst news is that the nurses studied were not able to sufficiently rest and recover from the fatigued state during nonworking hours – which is exactly what led the study authors to call for shorter shifts, as well as workplace policies that not only allow but encourage 15-minute naps in designated areas.

This isn’t the first study to link fatigued nurses to patient safety issues. A 2013 study found that, not surprisingly, hand-hygiene compliance rates drop significantly during the course of the typical 12-hour shift. This is probably a contributing factor in yet another study, which found that high rates of burnout among nurses correlate with higher rates of hospital-acquired infections as well.

Is a 12-hour shift really too long? Many nurses say they prefer working 12-hour shifts in order to have longer stretches of time off and a better work-life balance. Yet a recent article in HealthLeaders Media makes the case that too many nurses are picking up extra shifts or working multiple jobs on the days they are scheduled to be off their primary jobs. It points out the ANA has a position statement on fatigue, which states “nurses should consider the impact that multiple jobs have on their level of fatigue and ability to practice safely” and “all registered nurses have an ethical responsibility to carefully consider their level of fatigue when deciding whether to accept any assignment extending beyond their regularly scheduled work day or week.” And one of the experts interviewed in the article believes that state nursing boards should take steps to limit the number of hours per week that nurses can work, similar to the way the aviation industry limits the working hours of flight crews.

While we usually think of the physiological fatigue that results from factors like working long hours, being on our feet constantly, or not getting enough sleep, there are other forms of fatigue as well. A 2014 study looked at an issue that researchers have dubbed “compassion fatigue,” which occurs when the need to be constantly empathetic with patients and families creates a state of emotional exhaustion. The authors of the study conclude that compassion fatigue can lead to anything from headaches to impaired judgment to hostility toward other caregivers.

So what can you do about fatigue?
Good workplace policies start at the organizational level, so if you have concerns or suggestions, it’s best to speak up so nurse managers or nurse executives understand there is a problem. The best bet is creating a hospital culture that recognizes high fatigue levels among the nursing workforce as an unacceptable risk – and addresses the issue through flexible work schedules, limits on overtime, opportunities to rest during long shifts, a non-punitive approach to requests for time off, and even carefully thought out patient handoff procedures at shift changes so nurses can leave promptly rather than spending additional time on paperwork. On an individual level, you can get enough rest, make time for stress relieving activities, and use your time off in a manner that promotes good work-life balance.

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