Nursing Fatigue And Patient Safety

How Nurses Can Prevent Burnout

So how to prevent nurse burnout? Fortunately, its possible to prevent nurse burnout before it occursand to treat it immediately when it happens. For medical institutions, preventing nurse burnout protects their employees, patients, and their bottom line. Nurse managers and nurse leaders can initiate burnout prevention and help lower the risk in their workplace. And nurses themselves can take preventive and therapeutic measures for self-care.

Table : Xiao And Seagulls Taxonomy Of Alarms: 5

Actionable alarms indicate a physiologically abnormal state, which requires that the anesthesia professional intervene in order to avoid patient harm.

A mild deviation might require only assessment of the patient and heightened alertness for further change, while others might indicate an urgent, life-threatening problem.6 Nonactionable alarms can be caused by monitoring artifact , or a true deviation from the alarm limits that represents a clinically insignificant abnormality .

Nurse Fatigue: The Cost Of Care

In recognition of the American Nurses Association noting 2017 as the “Year of the Healthy Nurse,” Stevenson University will be exploring the topics of nurse fatigue as well as balancing the mind, body, and spirit to combat the stresses within the nursing field.

What is nurse fatigue? Nurse fatigue is a feeling of persistent tiredness or exhaustion experienced by nurses, making it difficult to perform tasks.

For 15 consecutive years, the Gallup poll has reported that nurses are rated as the most trusted professionals with the highest honesty and ethical standards. Those standards, however, may come at a cost.

What causes nurse fatigue? Perhaps to their own detriment, nurses are known to go above and beyond to serve, protect, and care for their patients and community. Additionally, nurses are routinely scheduled to work 12-hour shifts, and usually work over those hours due to staffing shortages. Per two studies referenced in Patient Safety and Quality: An Evidence-Based Handbook for Nurses, the majority of hospital staff nurses now work 12-hour shifts, some nurses report being scheduled to work for periods as long as 20 consecutive hours. While enduring these long shifts, nurses often do not take breaks or rest, which can be a key contributor to causing nurse fatigue.

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Nurse Fatigue And Its Effect On Patient Safety

By: Conor Burke in Podcasts, Top Stories, WorkforceMarch 12, 20190

How many hours do you work a day, and how much sleep do you think you get a night?

According to Dr Ann Rogers, it probably isn’t enough. And if that’s the case, your patients are at risk. Studies have shown that the likelihood of a clinician making an error can increase by 36 per cent after working 12-hour shifts on consecutive days.

Fatigue can manifest itself in a number of ways. Forgetfulness, poor decision making, slowed reaction times, reduced vigilance or bad moods, and the obvious nodding off.

An internationally renowned expert in sleep deprivation, Rogers is in Australia to present a paper titled ‘Staff Nurse Fatigue and Patient Safety’ at a public seminar hosted by the Charles Darwin University College of Nursing and Midwifery.

“Everybody needs to be conscious not having enough sleep affects the nurse’s health, it affects patient safety, but it also affects the health of the community,” Rogers said. “Because a tired worker driving home can be very dangerous if they’re trying to stay awake.”

Rogers told Nursing Review about a study that showed a 3.4 per cent probability of an error when a nurse obtained less than six hours sleep at night. In a hospital with 1000 nursing shifts per day, this would translate to a probability of 34 errors per day.

Nursing Review spoke with Rogers ahead of her talk to discuss nurse fatigue.

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Why Fatigue Management Is Key To Patient Safety

Estimated read time: 5 minutes

Fatigue is a workplace hazard that affects the health and safety of patients, health care providers and the community. Early in my nursing career, I was on an exhausting, mandated schedule of working three eight-hour night shifts, followed by one night off, then seven eight-hour night shifts, followed by three nights off. Later, I progressed to a day/night rotation which meant flip-flopping between days/nights without a day for sleep. Next, the introduction of the coveted 12-hour shift enabled me to be home more.

After decades in nursing, shift rotation continues and 12-hour shifts are still here. As I think back to the times I fell asleep at the stop light on my way home from work or was unable to remember what I was supposed to be doing, I can recognize these instances as signs of fatigue.

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Nurses’ Working Conditions And Patient Safety

The causal relationship between nurse-to-patient ratios and patient outcomes likely is accounted for by both increased workload and stress, and the risk of burnout for nurses. The high-intensity nature of nurses’ work means that nurses themselves are at risk of committing errors while providing routine care. Human factors engineering principles hold that when an individual is attempting a complex task, such as administering medications to a hospitalized patient, the work environment should be as conducive as possible to carrying out that task. However, operational failures such as interruptions or equipment failures may interfere with nurses’ ability to safely and effectively perform such tasks several studies have shown that interruptions are virtually a routine part of nurses’ jobs. These interruptions have been tied to an increased risk of errors, particularly medication administration errors. While some interruptions are an entrenched part of patient care, the link between interruptions and errors is one example of how deficiencies in the day-to-day work environment for nurses is directly linked to patient safety.

Proper Nursing Education Is The First Step To Reducing The Problem Of Nurse Fatigue

When your welfare is in someone elses hands, you want that someone to be alert. Thats obvious, and yet nursesfrom RNs to nurse practitionersare at constant risk of fatigue due to their stressful jobs and demanding work schedules.

This is especially true in a pandemic, as nurses and other medical personnel work around the clock to fight the deadly virus. The COVID-19 pandemic accentuates the dynamics associated with nursing fatigue, says Dr. Mary A. Bemker, core faculty member with Walden Universitys College of Nursing. Caring for self as well as one does others is paramount to positive nursing practice. One minute of deep breathing can decrease stress. Visualizing a peaceful place, closing one’s eyes and listening to music, and watching comedies can also be stress and fatigue relievers.

Numerous studies have shown stress to be a serious problem, including a study by the University of Pennsylvania School of Nursing that concluded fatigue can result in expensive job turnover, and can negatively affect patient care.1

To prevent nurse fatigue, we need better nursing education centered on the causes and consequences of fatigue and better strategies to reduce fatigue. Here are a few facts about the problem, and tips on how to address it.

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Nurse Staffing And Patient Safety

Nurse staffing ratios

Nurses’ vigilance at the bedside is essential to their ability to ensure patient safety. It is logical, therefore, that assigning increasing numbers of patients eventually compromises a nurses ability to provide safe care. There are many key factors that influence nurse staffing such as patient acuity, admissions numbers, transfers, discharges, staff skill mix and expertise, physical layout of the nursing unit, and availability of technology and other resources.1,2

Several seminal studies linked in this sentence have demonstrated the association between nurse staffing ratios and patient safety, documenting an increased risk of patient safety events,morbidity, and even mortality as the number of patients per nurse increases. The strength of these data has led several states, beginning with California in 2004, to establish legislatively mandated minimum staffing ratios. According to the American Nurses Association, only 14 states have passed nurse staffing legislation as of March 2021 and most states do not specify registered-nurse -to-patient ratios, which vary by state and are also setting-dependent.

Nurse staffing and settings of care

Adequate nurse staffing depends on several factors such as lack of training, administrative demands, distractions, and interruptions that can impact nurses work.5

Nurse staffing and education and training

Shift Work And Nurse Fatigue

The U.S. Occupational Safety & Health Administration describes a normal work shift as a work period of no more than 8 consecutive hours during the day, 5 days a week with at least an 8-hour rest. Nurses whose work environment demands 12-hour shifts are working what OSHA describes as an extended or unusual shift that incorporates more continuous hours, requires more consecutive days of work, or requires work during the evening. These shifts may be more mentally, physically, and emotionally taxing to employees, leading to increased fatigue, stress, and lack of concentration, which in turn may result in a heightened risk of error, injuries, and accidents. To put this into perspective, Petrov and colleagues equated the traditional night-shift schedule of two or three sequential 12-hour shifts from 7 pm to 7 am followed by 2 to 5 days off to the jet lag experienced when flying roundtrip from San Francisco to Tokyo every few days.

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Ways To Fight Nursing Fatigue

• Nursing fatigue and burnout are not the same things, but nursing fatigue can contribute to burnout.
• Nursing exhaustion can sneak up on a nurse quietly and quickly it’s important to take preventive steps and address the problem early if it happens.
• Tips to help prevent nursing fatigue include ruling out any underlying medical conditions, taking mental health days, adjusting your schedule, and using stress management strategies.

Nursing fatigue and nursing burnout are not the same things. However, according to the American Nurses Association nursing fatigue is a significant contributing factor to burnout. Nursing fatigue may also contribute to ulcers, depression, and increased alcohol consumption.

The Medscape Nurse Satisfaction Report for 2021 revealed that 35% of registered nurses described themselves as “burned out” or “very burned out.” This was the highest level of all the healthcare professionals surveyed, an indication that the pandemic has taken a considerable toll on their mental health.

Discover 10 tips our two nurses share, which have helped them and their colleagues fight nursing fatigue.

Dangers Of Nurse Burnout

Nurse burnout is a substantial concern for all concerned: nurses, employers, and patients. Nurses themselves are at risk for developing depressive disorders and other mental health conditions and for quitting their job. For institutions, a decrease in the quality of patient care can affect their reputation and bottom line. For patients, nurse burnout can directly impact their health.

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What Can Be Done To Reduce Nurse Fatigue

Both nurses and those who employ them can take steps to reduce the problem of fatigue.

Nurses can:

• Prioritize sleep, making every effort to get enough despite work schedules.
• Participate in physical activities outside of work such as jogging, walking, weight training, or swimming.
• Keep a regular eating schedule and eat healthy foods such as whole grains, fruits, nuts, and lean proteins.
• Stay hydrated and avoid the overconsumption of caffeine.
• Maintain an active social and/or family life.

• Avoid medications that can cause drowsiness, and keep alcohol consumption to a minimum.
• Take breaks and lunch in a quiet area, if possible.
• Monitor personal health for signs of fatigue.
• If fatigued, make an effort to take time off to recharge.v

Nurse employers can:

• Design work schedules that reduce the risk of fatigue, limiting scheduling changes and using 12-hour shifts judiciously.
• Limit the number of consecutive days nurses can work, particularly if nurses are working 12-hour shifts.
• Maintain adequate staffing levels.
• Not require mandatory overtime and limit the use of voluntary overtime, even for recent nursing school graduates.

• Schedule staff meetings so they dont require anyone to get up early or stay up late.
• Provide staff education on the risks of nurse fatigue and the importance of sleep.
• When reviewing negative outcomes, investigate the possible role of fatigue.

Healthy Nurse Healthy Nation

The ANA Enterprise Healthy Nurse, Healthy Nation Grand Challenge, launched in 2017, aims to improve the nations health by supporting nurses as they pursue their personal wellness. Adequate rest is key to that effort. The nurses who face the greatest challenge to wellness and quality sleep are those who staff the night shift. Evidence-based tips for night nurses are seemingly as elusive as the sleep they need, but some best practices do exist.

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Develop A Strong Support System

Seidu believes that one of the most important ways you can maintain your sanity is to connect with your coworkers and develop a strong support system both inside and outside work. Good relationships can make the shift run smoother a strong support system of friends and relatives outside work can help relieve some of your stress.

“I’ve found that talking and joking around with my coworkers makes the time fly by. It can make the shift go by much quicker,” she says. “We often joked and had fun on our shifts, which made the long hours more bearable.”

The Dangers Of Nurse Fatigue

The mental impairments and physical tiredness caused by nurse fatigue can lead to decreased work performance, which can compromise patient safety and satisfaction. Being tired all the time also can decrease our own job satisfaction.

Fatigue is linked to various health problems, such as cardiovascular disease. Work related injuries, such as needlestickes, are more likely to occur when youre not paying attention. And falling asleep at the wheel can easily happen when youre tired.

The 12-hour shift

The 12-hour shift can be a hot-button topic. These shifts make it possible for nurses with family and other personal responsibilities to have a full-time job without working 5 days a week. But the evidence is clear that 12-hour shifts can lead to fatigue that may result in errors and impact patient and staff safety. Research has shown that the most patient errors occur in the last 4 hours of a 12-hour shift. However, eliminating 12-hour shifts entirely may lower nurse satisfaction rates.

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Ways To Fight Off Nurse Fatigue

1. Set Boundaries

Everyone has limits. Even nurses.

You should know which triggers will cause you to reach your maximum level of safe nursing practices. When nurse fatigue and medication errors occur, it is time to set boundaries.

Dont feel guilty for not picking up another shift. Only work as many shifts per week as you feel is safe for you and your patients. Nurse fatigue and patient safety is a major problem in the medical field.

Stick to your boundaries. Learn to say no.

2. Self-Care

Your body and mind need rest to combat nurse fatigue. As Cardillo says, Nurses must understand that self-care is not a luxury but rather routine maintenance for the body, mind, and spirit.

The National Sleep Foundation backs this up. The organization recommends adults get 79 hours of sleep per night.

If you work nights, use darkening blinds in your bedroom to help balance your circadian rhythms. Go to sleep at the same time every day, even on your days off.

Eat a balanced diet, especially when working. Many nurses are guilty of skipping meals and bathroom breaks on busy days. Dont. Make sure you take care of your body. Make time for small frequent meals and healthy snacks.

3. Talk It Out

When nurse fatigue gets you down, reach out to someone you trust. Find a friend, colleague, or counselor who will listen to you.

Many times, if we simply have the ability to discuss our feelings, the solutions become clearer.

4. Socialize

5. Have an Accountability Partner

Nurse Fatigue A Huge Threat To Patient Safety

EXECUTIVE SUMMARY

Nurse and staff member fatigue increasingly is recognized as a significant threat to patient safety. Risk managers should adopt strategies to reduce fatigue caused by scheduling, overtime, and excessive workloads.

High turnover rates among nurses can indicate fatigue risks.

Hospital culture must encourage staff to admit fatigue and to report fatigue in others.

Creative scheduling can reduce nurse fatigue.

When fatigue is addressed in the healthcare workplace, attention often goes first to physicians and particularly medical residents who are sleep-deprived and overworked. Increasingly, risk managers are focusing on the patient safety threats posed by nurses and other staff members who are too tired to do their jobs properly.

Fatigue poses a huge threat to patient safety, says Richard C. Boothman, JD, chief risk officer and executive director of clinical safety at the University of Michigan Health System in Ann Arbor. The healthcare industry has not connected the dots between how clinical and business pressures can fatigue nurses to the point of threatening patient safety, he says.

The nurse was charged initially with a felony, criminal neglect of a patient causing great bodily harm, but was allowed to plead no contest to two misdemeanors. The Wisconsin Board of Nursing suspended her license for nine months, and she lost her job.

Comparable to alcohol

Risk managers must lead

Brandi Crow, BSN, RN, Clinical Analyst, MD Buyline, Dallas. Email:

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How An Msn Program Can Help You Reduce Nurse Fatigue

If you want to help nurses and their employers reduce incidences of fatigue, one of the best choices you can make is to become a nurse educator. And one of the best ways to get a nurse educator job is to earn a Master of Science in Nursing . Whether youve been working as a nurse for years or are just entering the profession, a masters degree in nursing with a focus on nursing education can help you gain the skills you need to address a wide range of health and nursing issues, including nurse fatigue.

For many nurses and other professionals, going to nursing school can seem unmanageable, given work schedules and other responsibilities. But online MSN programs can eliminate these obstacles and make it possible to earn your MSN degree, even if youre working full time. Thats because the online education platform provides the flexibility and convenience you need to complete your coursework from home, on a schedule that allows you to manage your family, social, and professional commitments. Plus, a number of online masters in nursing programs allow you to go straight from RN to BSN to MSN, helping you earn your Master of Science in Nursing faster.

Earning a masters in nursing online can put you in position to be a successful nurse educator. Its a great first step if you want to address issues such as nurse fatigue.