Fatigue in the workplace A system approach to

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Fatigue in the workplace: A system approach to mitigate fatigue Linsey M. Steege Ph.

Fatigue in the workplace: A system approach to mitigate fatigue Linsey M. Steege Ph. D; Barbara J. Pinekenstein DNP, RN-BC; Jessica G. Dykstra BSN, BA, RN Background Design and Sample • Occupational fatigue in nurses has been identified as a significant healthcare challenge with implications for patient safety, nurse well being, and nurse retention. Studies have shown increased risk for errors, adverse events, and patient safety. 1 • Effective resolution of fatigue requires management across nursing leadership levels. The nurse executive has a key role to lead and partner on the development of a fatigue risk management system. 2 Fatigue in the Workplace • A multidimensional state in workers exposed to excessive demands through their work tasks, environment, and schedules. 3 • Relatively high prevalence - survey study of registered nurses across practice environments (n=745), 65% experience acute fatigue, 50% experience chronic fatigue. 4 • Increasing emphasis on strategies to monitor fatigue and manage associated risks to nurse, patient, and organizational outcomes. 5 Multi-Level Fatigue Risk Management in Healthcare Systems 2 Semi-structured interviews with nurse managers, nurse executives, and patient safety officers. • 10 nurse managers from two Midwest hospitals • 11 nurse executives from across Wisconsin • 3 patient safety officers from across Wisconsin Findings • In general, nurse leaders perceive negative relationships between fatigue and patient safety and/or staff nurse wellness. • Multiple participants also identified negative implications of their own fatigue on sustainability in nurse leadership positions. • Nurse leaders expressed mixed views on the current level of and feasibility of implementation of ANA guidelines for addressing fatigue in their organizations. • Participants perceived some discrepancies between ANA defined roles for individual nurses and organizations in addressing fatigue and what occurs in practice. • Identified barriers to fatigue monitoring and management in practice included: lack of resources (e. g. , sufficient staffing), few data sources for monitoring and management of fatigue, and nursing culture. Recommendations for Leaders • Conduct system assessments to identify existing and/or needed data sources to describe work demands, worker capacity, and indicators of fatigue. • Establish partnerships with systems engineers to develop tools and analytical decision-support. • Implement hierarchical controls beginning with sources of fatigue. • Champion a transparent fatigue culture to facilitate ongoing monitoring, reporting, and communication about fatigue, and to acknowledge hazards associated with fatigue. Implications for Research • The role of nursing professional culture needs to be further clarified and addressed before roles in fatigue monitoring and risk management can be resolved and appropriate accountability can be achieved at each level of nursing leadership. • There is a need for new fatigue monitoring and assessment tools that can be used in hospital settings on a daily basis. References and Resources Health care worker fatigue and patient safety. (2011) Oakbrook Terrace, IL: The Joint Commission. 2 Steege, L. M. , & Pinekenstein, B. (2016) Addressing Occupational Fatigue in Nurses: A Risk Management Model for Nurse Executives. Journal of Nursing Administration, 46(4), in press. 3 Barker Steege, L. M. , & Nussbaum, M. A. (2012) Dimensions of fatigue as predictors of performance: A structural equation modeling approach among registered nurses. IIE Transactions on Occupational Ergonomics and Human Factors, 1(1), 16 -30. 4 Barker, L. M. & Nussbaum, M. A. (2011) Fatigue, performance, and the work environment: A survey of registered nurses. Journal of Advanced Nursing, 67(6), 1370 -1382. 5 Addressing Nurse Fatigue to Promote Patient Safety and Health: Joint Responsibilities of Registered Nurses and Employers to Reduce Risks. (2014) ANA Position Statement (pp. 1 -16). Silver Spring, MD: American Nurses Association. Portions of this work were funded by the University of Wisconsin-Madison School of Nursing Research Committee. 1