Nurse Fatigue: The Risks of being Tired on the Job

Does anyone get enough sleep these days? We juggle family, work, school and activities while we text, email, tweet and chat. We do so much simultaneously, and there still never seems to be enough time. We yawn, and sometimes we doze when no one is looking.

Being tired when you’re a nurse has serious implications. Sleepy eyes can misread medication orders; a quick cat-nap can cause you to miss a patient’s treatment. The Agency for Healthcare Research and Quality (AHRQ) reports that the risk of errors is increased by 3.4 percent when nurses do not get 6 or more hours of sleep in the 24 hours preceding their shift. In a hospital with 1,000 nursing shifts per day, that translates to 34 more errors per day.¹ We know that in many hospitals nurses work shifts exceeding eight hours; the 12 hour shift is becoming the norm.

Not only can fatigue lead to error, but it can also lead to burnout and job dissatisfaction. As educators, we see how nursing students juggle school, work and family. In some ways, students are in training for the real job, but through a combination of making sure we’re preparing them for the challenges of the job and instilling good health habits in them we can ready the next generation of nurses for success in the ever-demanding health care environment.

Studies analyzing fatigue on the job offer solutions that may be counter to a hospital’s current policies:

In hospitals which had higher proportions of nurses working longer shifts, higher percentages of patients reported that nurses sometimes or never communicated well, pain was sometimes or never well controlled, and they sometimes or never received help as soon as they wanted.
Dr. Witkoski Stimpfel and co-authors recommend restricting the number of consecutive hours worked, that state boards of nursing consider whether restrictions on nurse shift length and voluntary overtime are advisable, and nurse management should monitor nurses’ hours worked, including second jobs.

“Nursing leadership should also encourage a workplace culture that respects nurses’ days off and vacation time, promotes nurse’s prompt departure at the end of a scheduled shift, and allows nurses to refuse to work overtime without retribution,” noted Dr. Witkoski Stimpfel. “These types of policies that facilitate manageable work hours can contribute to the development of a healthier nursing workforce, prepared to manage the complex care needs of patients and their families.” ²

But new nurses may not yet have the voice to campaign for such changes. As new graduate nurses work to establish themselves, it’s important that they are able to take care of fatigue in manageable ways. Initially, new nurses want to be sensitive to time management. It’s easy to agree to take on tasks or shifts, because new nurses want to be recognized for working hard. The risk of over-extension, however, can be counter-productive. Three simple rules to consider³:

• Arrive at work rested and prepared.
• Recognize that multiple workloads and work settings affect fatigue levels.
• Limit the hours they agree to work to 12 hours in a 24-hour period and no more than 60 hours in a seven-day period.

Additionally, nurses need to remember how important it is for them to take care of themselves before they can fully take care of others. De-stressing is an important tool to help nurse cope with such a stressful job! Here are some additional suggestions⁴:

1. Think positive self-thoughts – Appreciate who you are, and don’t focus on what others may want you to be. If you do make a mistake, and you will, learn from it.
2. Identify stressors – Different things can stress people. It’s important to acknowledge and be ready for what can set you off. As a safety net, you can always go back to remembering why you got into nursing in the first place!
3. Collaborate with administration to resolve workplace issues – Be proactive. Learn the correct governance procedures at your hospital. Complaining without working towards solutions can only exacerbate stress.
4. Take time for yourself—Learn to take time-outs and time off, and don’t feel guilty when you do it.
5. Support each other—Nurses are critical of themselves and need to learn to remember that everyone is working for the best outcomes. Teamwork is critical!
6. Adopt healthy habits—Get enough sleep, eat well, and stop smoking. You give this advice to patients on a daily basis. Take your own advice.
7. Try yoga therapy—Yoga goes beyond exercise because it forces you to focus on mind and body in the present moment. It can be a difficult adjustment at first, but a yoga session can truly be a mini-vacation.
8. Give back to others—Volunteering may seem like another drain on precious time, but spending time on something you’re passionate about is incredibly energizing and rewarding.
9. Find joy in life—Studies show that avid television watchers are not as happy as folks who don’t watch much television. A new hobby or activity is just the thing to revive you.

Start with one item on this list, and grow from there. Your co-workers and your patients will thank you!

References:
¹ Agency for Healthcare Research and Quality. (2010). Staff nurse fatigue and patient safety. Retrieved from the World Wide Web: http://www.ahrg.gov/.
² http://www.nursing.upenn.edu/media/Pages/NursingMediaResources.aspx#chrome
³ http://blog.lydiasuniforms.com/blog/stylish-scrubs/guidelines-for-reducing-nurse-fatigue
⁴ http://www.nursezone.com/nursing-news-events/more-news/the-keys-to-stress-less-nursing_34984.aspx

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