Nurse Fatigue Hilary Edmondson Megan Keast Learning Objectives

Nurse Fatigue Hilary Edmondson Megan Keast

Learning Objectives

Introduction ▪ Nurse fatigue: fatigue that affects nurses due to ▪ Working long shifts ▪ Insufficient amount of sleep between shifts ▪ Disturbance in circadian rhythms, especially for night shift workers ▪ Balancing work, personal and social obligations (Phillips & Moffett, 2013) ▪ Working consecutive shifts ▪ Subjective feeling ▪ Physical and mental tiredness or exhaustion ▪ Interferes with ability – both physical and mental – to function at normal capacity (Rahman, Abdul-Mumin & Naing, 2016) ▪ Symptoms of fatigue ▪ Physiological ▪ Yawning ▪ Drooping eyelids and head ▪ Rubbing eyes ▪ Digestive problems ▪ Slowed or slurred speech ▪ Cognitive ▪ Difficulty concentrating ▪ Lapse in attention ▪ Short term memory loss ▪ Failing to communicate ▪ Emotional ▪ Unusually quiet or withdrawn ▪ Lack of motivation or energy ▪ Mood changes ▪ Long-term disorders ▪ Chronic illness (Phillips & Moffett, 2014)

Assessment of the Health Care Environment ▪ Policy ▪ Research ▪ ANA ▪ Insufficient sleep has adverse effects on ▪ Employers should ensure ▪ Sufficient resources ▪ Work schedule offering adequate time off for rest and recuperation ▪ Sufficient compensation so that RNs don’t feel the need for working another job ▪ Appropriate staffing ▪ Co-workers watching out for each other (Phillips & Moffett, 2014) cognition, performance and mood ▪ Shift duration inconclusive ▪ Working long hours and physical health (Rogers, 2008)

Assessment of the Health Care Environment (cont. ) ▪ Financial ▪ Retention ▪ Medical errors ▪ Overtime ▪ Resources ▪ Healthy sleep ▪ 7 -8 hours ▪ Avoid nicotine, alcohol and caffeine prior to bedtime ▪ Sleep in a dark, quiet room ▪ Exercise early in the day (American Nurses Association, 2017) ▪ Quality and safety ▪ Increased risk of errors ▪ Patient safety ▪ Personal health and safety

Root Cause Analysis ▪ Problem: Nurse fatigue ▪ Data: ▪ Long work hours ▪ Not enough time between shifts ▪ No breaks ▪ Overtime ▪ Poor sleep quality ▪ Causative factors ▪ Lack of resources ▪ Lack of knowledge ▪ Lack of education ▪ Lack of adequate compensation ▪ Root cause ▪ 12 hour shifts ▪ Implementation

Inferences Long Shifts Workload Life Stressors Patient Acuity Suboptimal Patient Outcomes Medical Errors

Implications Sleep Duration in 24 Hour Period Adverse Effects on Patient Safety Adverse Effects on Health < 7 hours More likely to report struggling to stay awake during work shift 14 Increased risk of developing cardiovascular disease and DM among nurses 187 Increased risk of becoming obese over a 10 -year period 53 ≤ 6 hours Risk of making an error is 3. 4% during a work shift among nurses who slept ≤ 6 hours in 24 hours prior to shift (Dawson, personal communication) Increased prevalence of DM and altered glucose metabolism 56, 168 Risk of obesity is 23% greater than subjects sleeping 7– 9 hours 53 < 5 hours Increased subjective and objective Increased risk of developing DM sleepiness, and reduced performance on demonstrated in nurses 187 cognitive tasks 22, 161 Risk of obesity is 50% greater than among subjects sleeping 7– 9 hours 53 ≤ 4 hours Altered levels of appetite-regulating hormones (leptin, cortisol, and thyrotropin)57 Risk of obesity is 73% greater than among subjects sleeping 7– 9 hours 53 Source: Hughes, R (2008)

Consequences Nurses are at a high risk for fatigue Nurse Fatigue Alcohol Intoxication Nurse Fatigue Impairment Medical Errors

Recommendations ▪ Evidence based recommendations ▪ Employee education ▪ Short breaks ▪ Improve performance & reduce fatigue ▪ May help decrease safety risks ▪ Exercise ▪ Increased alertness ▪ Improved cognitive performance ▪ Often short lasting ▪ Others ▪ Napping ▪ Stimulants (Rogers, 2008)

Conclusion/Summary ▪ Nurses who are fatigued are putting their own health and their patients’ health at risk. ▪ Nurses must take an ethical responsibility in regards to patient care. ▪ Nurse managers and administrators need to change the culture in regards to nurses long shifts to help limit a nurses’ fatigue.

References American Nurses Association. (2017). Healthy sleep. Retrieved from http: //www. nursingworld. org/Main. Menu. Categories/Workplace. Safety/Healthy-Nurse/Healthy-Sleep Freeman, G. (2015). Nurse fatigue, a “huge” threat to patient safety. Healthcare Risk Management. Retrieved from: https: //www. ahcmedia. com/articles/134803 -nurse-fatigue-a-huge-threat-to-patient-safety-but-can-beaddressed Griffiths, P. , Ball, J. , Drennan, J. , Jones, J. , Reccio-Saucedo, A. , & Simon, M. (2014). The association between patient outcomes and nurse/healthcare assistant skill mix and staffing levels and factors that may influence staffing requirements. South Hampton, GB: University of South Hampton. Hughes, R. (2008). Patient safety and quality: An evidence based handbook for nurses. Rockville, MD. The Joint Commission -- Sentinel Event Alert: Health care worker fatigue and patient safety. (2011). Alaska Nurse, 61(4), 12. Martin, D. J. (2014). Literature Review: Nurse Fatigue Related to Shift Length. Missouri State Board Of Nursing Newsletter, 16(1), 7. National Association of Neonatal Nurses. (2015). The effect of staff nurses’ shift length and fatigue on patient safety and nurses health [PDF]. Retrieved from: http: //nann. org/uploads/About/Position. PDFS/1. 4. 1_Effect%20 of%20 Staff%20 Nurses%20 Shift%20 Length %20 and%20 Fatigue%20 on%20 Patient%20 Safety%20 and%20 Nurses%20 Health. pdf

References (cont. ). Phillips, S. A. , & Moffett, C. (2014). The Implications of Nurse Fatigue. Missouri State Board Of Nursing Newsletter, 16(1), 8 -10. Rahman, H. A. , Abdul-Mumin, K. , & Lin, N. (2016). A study into psychosocial factors as predictors of work-related fatigue. British Journal Of Nursing, 25(13), 757 -763. Randolph, S. A. (2015). Fatigue Risk Management. Workplace Health & Safety, 63(5), 236. doi: 10. 1177/2165079915589194 Rogers, A. E. (2008). The effects of fatigue and sleepiness on nurse performance and patient safety. In Hughes, R. G. (ed), Patient safety and quality: An evidence-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from https: //www. ncbi. nlm. nih. gov/books/NBK 2645/ Stimpfel, A. , Sloane, D. M. , Aiken, L. H. (2012). The Longer The Shifts For Hospital Nurses, The Higher The Levels Of Burnout And Patient Dissatisfaction. Retrieved from https: //www. ncbi. nlm. nih. gov/pmc/articles/PMC 3608421/. doi: 10. 1377/hlthaff. 2011. 1377