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Critical Error: The Role of Nurse Fatigue in Patient Safety

Career News August 3, 2013

Nurses fatigue patient safety is a topical subject in modern health care because responsibility for patient care is increasingly being shifted to nurses. For instance, U.S. Politics Today recently reported on a study at the University of Pennsylvania’s School of Nursing, which linked an increase in nurse fatigue due to higher than average patient loads, with a corresponding increase in patient infection, injury, and death.

But what are nurse fatigue, and what do medical professionals need to know about it?

Nurse Fatigue—Defined

According to the U.S. Department of Health & Human Services‘ Agency for Healthcare Research and Quality, “fatigue” is sometimes considered synonymous with “sleepiness,” but the two conditions are actually distinct. “Sleepiness” means a person feels the need to go to sleep, whereas “fatigue” is “an overwhelming sense of tiredness, lack of energy, and a feeling of exhaustion associated with impaired physical and/or cognitive functioning.” Nonetheless, a person experiencing fatigue may experience a sensation of sleepiness.

Causes of Nurse Fatigue

The Wisconsin Nurses Association has identified three primary causes of nurse fatigue. They are insufficient sleep, nonstandard work hours, and being awake for too many hours. The Association cites the findings of Ann Rogers, Ph.D., RN, and FAAN, whose landmark study found that RNs average well under the necessary eight hours of sleep on workdays; they work extended shifts of 12 hours or longer, providing patient care while standing up and being physically active; and finally, that nurses stay awake for too many hours in a row. A nurse who has been awake for 19 hours has the cognitive impairment of a person whose blood alcohol content is 0.05 percent, and a person who has stayed awake for 24 hours has the cognitive impairment of a person with a blood alcohol content of 0.10 percent.

Effects of Nurse Fatigue

The Joint Commission, a non-profit that accredits more than 19,000 American health care organizations and programs, recently issued a Sentinel Event Alert because it found nurses fatigue patient safety to be a recurring national problem with severe consequences. The Alert noted that nurses can suffer a variety of impairments if they are excessively fatigued, including memory lapses, compromised problem solving, diminished reaction time, reduced empathy, and an inability to stay focused.

Since nurses must make key decisions to provide quality patient care, nurse fatigue has a deleterious impact on patient safety. The Alert noted that nurses who work shifts in excess of 12.5 hours are three times more likely to err in patient care, to be less vigilant, and to suffer more occupational injuries. Thus, both nurses and their patients suffer when nurses are fatigued.

Preventative Measures to Avoid Nurse Fatigue

The Joint Commission recommends that organizations review staffing policies, to ensure that fatigue isn’t a de facto job requirement. It recommends ensuring that patient hand-offs, which occur at a time when nurses going off-shift are likely to be fatigued, are not compromised by nurses fatigue patient safety. Organizations should work collaboratively with staff to design shifts that don’t cause fatigue, and provide education and support around the problem of fatigue. Double-safety checks should be implemented for critical patient care tasks, and if an adverse event occurs, the potential role of fatigue should always be considered.

The Wisconsin Nurses Association also suggests that nurses should also be trained to confront other nurses who are impaired by fatigue and proactively document unsafe staffing levels. It recommends that nursing schools and professional associations should develop curricula and public education campaigns designed to alert both medical professionals and the general public about the patient safety impact of nurse fatigue and the need to maintain safe staffing levels.

Finally, the Rogers study recommends that nurses working extended shifts ameliorate their fatigue and increase alertness by taking frequent brief rest breaks (including naps, if possible), using caffeine in moderation, and exercising briskly from time to time, for up to ten minute interludes.

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