Preventing nurse fatigue to keep our patients safe
Monday, December 01, 2014
With the holiday season upon us, it is not unusual to feel the stress of this busy time of year. Our schedules become filled with fun times with family and friends, but our own health often gets neglected.
However, as healthcare providers, we have a responsibility to our patients. They rely on us to have sharp minds and quick responses to their ever-changing needs. They need us to keep them safe. Therefore, it is imperative for nurses to take measures to prevent fatigue.
In many high-risk professions, time on the job is limited in order to ensure proper rest. This in turns keeps the professional alert and sharp when making decisions that can impact others lives and safety. Some professions with work/rest limitations are truck drivers, pilots and even physicians. However, there are no regulations to prevent the hours worked by a nurse or any mandated rest time in between shifts.
In September 2014, the American Nurses Association (ANA) updated its position stated on nurse fatigue — Addressing Nurse Fatigue to Promote Safety and Health: Joint Responsibilities of Registered Nurses and Employers to Reduce Risk.
The statement calls for a collaborate effort by not only the employer, but also the nurse. The ANA recognizes that nurse fatigue directly affects patient care and has been linked to increases in errors, ability to learn, risk taking and impaired mood and communication.
Not only is the job performance affected, but also the health of the nurse. Fatigue and shift work has been linked to sleep pattern disturbances, injuries, obesity, diabetes mellitus, cancer and adverse reproductive outcomes, to name a few.
The risk to the nurse and the public is further impacted from drowsy driving after long shifts and/or little quality rest time. Multiple studies have determined that driving after being awake for more than 17 hours mimics that of someone driving while intoxicated.
In 2004, the Institute of Medicine recommended that nurses not exceed 12 hours of work in a 24-hour period and 60 total hours in a seven-day work week. However, considering the scientific research that demonstrates adverse patient safety and nurses' health, the ANA recommends that nurses not exceed 40 hours in a seven-day work week.
Responsibilities of registered nurses
As advocates for our patients, we must also be advocates for ourselves. Nurses need to be responsible for practicing healthy behaviors that assist them in providing optimal patient care. Some recommended evidence-based fatigue countermeasures to reduce fatigue include:
- According to the National Sleep Foundation, get at least 7-9 hours of sleep with in a 24-hour period. Make sure your sleep environment is conducive to sleep (dark, quiet, cool) and remove distractions such as the TV, cellphone and computer.
- Be cautious and aware of side effects of any medication you are taking that may impair alertness while on the job.
- Improve your overall health with appropriate stress management, diet and exercise.
- Ensure you are taking meal and rest breaks during your shift.
- Be aware of drowsy driving to ensure safe driving. Stop when feeling drowsy and find other modes of transportation home or, if necessary, sleep at an alternative site closer to work. Remember, most techniques such as putting the windows down or the radio volume up do not work.
- Take into consideration the length of your commute when seeking employment.
Responsibilities of employers
A healthy work environment includes a culture of safety. Employers should strive to adopt policies that are evidenced-based and respect the registered nurse's right to accept or reject a work assignment based on the risk of fatigue.
In other words, nurses should not be mandated to overtime shifts or pressured to work scheduled overtime to meet the needs of the facility. They should be allowed to decline extra shifts without being penalized. A 40-hour work week should be the norm in their culture of safety.
Some recommended strategies suggested by the ANA include:
- Eliminating mandatory overtime as a staffing solution.
- Adopt official policies that nurses have a right to accept or reject work assignments on the basis of preventing fatigue.
- Develop anonymous reporting systems for employees for accidents, errors and near misses.
- Incorporate the nursing staff in the work schedule design. Use regular and predictable schedules so nurses can plan accordingly.
- Coordinate the number of on-call shifts in a seven-day period.
- Establish protected time off to ensure adequate sleep can be obtained in between shifts.
- Assist in the prevention of drowsy drivers by providing transportation home when a nurse feels unable or by providing sleep rooms.
Prevent fatigue seems like such a fundamental issue in our complex medical environment. However, as we provide more complex care, we have not kept up with caring for the caregiver.
Take steps this holiday season — especially as we make our New Year's resolutions — to evaluate what measures you have in place to prevent nurse fatigue. Our patients are relying on us.
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