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This article from NurseConnect.com offers insight into long hours and sleep deprivation in the nursing profession. If you can relate, which I’m sure many of you can, continue reading to see what it has to say about the effects of nurse fatigue and solutions for reducing it.

Association Offers Guidelines for Reducing Nurse Fatigue
By E’Louise Ondash, RN, contributor at NurseConnect

To NICU veteran Bill Willis, RNC, it’s no mystery why the National Association of Neonatal Nurses (NANN) has issued a formal position paper outlining risk-reduction strategies to decrease nurse fatigue.

“Every hospital I’ve worked in has always been understaffed,” he said in a phone interview from Lancaster, California, “and the NICU is typically the busiest unit in the hospital. They like you to work 60 hours and some hospitals work you two weeks on days, then two weeks on nights. It’s hard doing the turnaround like that. I don’t think it’s a good idea. It’s best on your body to stay with one shift or the other.”

The authors of the August 2008 paper agree and outline specific ways to reduce stress and fatigue in all areas of the hospital, including the neonatal unit. Follow these guidelines the association says and the safety of both patients and nurses will be improved.

Some of NANN’s suggestions include:
• Assigning nurses to one shift permanently. If an employee must work both day and night shifts in the same week, he/she should be scheduled to work the day shift first. • Limiting the number of patient-care hours a nurse can work to a maximum of 12 hours in a 24-hour period, and no more than 60 hours in a seven-day period. • Incorporating the number of on-call shifts in a seven-day period into a nurse’s total scheduled hours.

The statement also lists nurses’ responsibilities. They include:
• Arriving at work rested and prepared. • Recognizing that multiple workloads and work settings affect fatigue levels. • Limiting 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.

The position paper also cites a survey conducted by the American Nurses Association, which found that:
• Between 2 and 5 percent of nurses work more than 60 hours a week. • 28 percent of RNs work shifts that are 12 hours or longer. • 36 percent of those who work in intensive care units put in more than 12 hours a day, on average.

The survey concluded that the nurse shortage will make it difficult to change these patterns now or in the future.

The paper also notes that some researchers suggest that extended shifts (beyond 12 hours) may improve continuity of care. Because there are fewer changes in care providers, there may be fewer errors. This, however, has been actively debated since the Accreditation Council for Graduate Medical Education implemented work-hour restrictions in 2003.

Others researchers argue that the team-based care model is superior because it focuses on good communication, the use of documentation systems and appropriate workload distribution, allowing “greater ease in transitioning care from one clinician to another.”

NANN’s position is that, regardless of which model is adopted, “Nurse fatigue is an unacceptable risk and hospitals should schedule sufficient numbers of nurses,” said Marilyn Rutkowski, a social worker and senior marketing manager for NANN, which is headquartered in Chicago.

She also said that NANN will send its paper to nursing organizations across the country and all state boards of nursing so they know the organization’s position. “When they are called to establish policies, they can use this as a reference.”
Jenny Selan, BSN, RNC, agrees that there is a need for a balance between work and rest. She currently works the night shift in the NICU at Kapi' olani Medical Center for Women and Children in Honolulu, Hawaii. She noted that many of her co-workers pull extra shifts – meaning they add four hours to their regular 12-hour shifts, adding up to twice the number of hours that most jobs require.

“Some don’t seem to mind working four hours on top of their 12-hour shift,” she said, “and some don’t mind working multiple extra shifts. The nurses that I see who do that are fine, but they have no social life or normal life, because they are always working or sleeping. But being sleep deprived probably opens up some room for error.”

In general, Selan added, “I think hospitals overwork night-shift workers, mainly because they are short staffed. If they call us to come in early on a shift, and we’ve worked the night before, they don’t take into account that at the time they are calling us, we are sleeping.”

Willis, who has worked in NICU since he graduated in 1992, admits that on occasion, he has worked too many 12-hour shifts. His record is 13 consecutive 12-hour shifts. “That’s not advisable, though,” he admitted.

One answer to avoiding fatigue and sleep deprivation, he added, is for states to enact a mandatory nurse-to-patient ratio, like the law passed in California.
“I really like California because of their mandatory staffing ratios,” he said. “It’s the best of anyplace I’ve been. This type of legislation is good.”

For more information, visit NANN’s Web site.

Copyright © 2008. AMN Healthcare, Inc. All Rights Reserved.