Nurses typically work shifts around the clock and many facilities require nurses to work 12 hour shifts. According to a recent study this may be the reason nurses are frequently exhausted. The study also revealed that nurses who work long shifts make more mistakes. "The effects of inadequate sleep on clinical decisions may be important for patients in critical care units, who are often more vulnerable than patients in other units. Fatigued nurses are more likely than well-rested nurses to make faulty decisions that lead to decision regret, a negative cognitive emotion that occurs when the actual outcome differs from the desired or expected outcome."
In the study they questioned 605 nurses and their objective was to "To examine the association between selected sleep variables, impairment due to fatigue, and clinical-decision self-efficacy and regret among critical care nurses. Decision regret was the primary outcome variable."
The study concluded that nurses who experience inadequate sleep experience errors that can negatively impact patient outcomes. This is especially true for nurses who work in the critical care arena, because these patients are typically high risk and unstable and their response to such errors can be grave.
"Decision making regret" occurred most commonly in male nurses, who worked 12-hour shifts. But perhaps the worst news of all is that nurses nurses were unable to fully recover from the fatigue during their off-time and this has actually prompted the authors of the study to request shorter shifts and allow 15-minute naps for nurses during their shifts.
Between June 2004 and August 2013, 1,600 incidents were reported (in Pennsylvania alone) . Out of the 1,600 , 88.5% were the result, "in part" from healthcare worker fatigue. Four of these errors resulted in death of the patient and thirty-seven of the incidents resulted in serious harm to the patient.
According to Theresa V. Arnold, DPM, manager of clinical analysis for Pennsylvania Patient Safety Authority (PPSA) “The most common medication errors made involving healthcare worker fatigue were wrong dose given, dose omission, and extra dose given,” Arnold says. “The most common errors related to a procedure, treatment or test were laboratory errors, and other miscellaneous errors included radiology or imaging problems and surgical invasive procedure problems.”
Long night-shift hours can be particularly difficult on nurses, but 12- hour shifts can make it hard to stay awake and alert regardless of which shift the nurses work. It can also triple the risk of making errors and the longer the nurse works, the more chance for error and serious outcomes for patients.
In a survey by Health Affairs, 80% of nurses reported being very happy with their work schedule and shifting to to a different schedule would not be easy for hospitals who have become accustomed to nurses working 12 hours. The study also showed that nurses who work more than 10 hours daily are more dissatisfied with their job and experience burnout. So what seems like a great idea at the time, may ultimately have negative consequences, both for the patient and the nurse.
The Health Affairs reports that the Institute of Medicine recommends that nurses be prohibited from working any more than 12 hours in any 24-hour period, and over 60 hours in a seven-day period. Some states have actually prohibited mandatory overtime.
The American Nurses Association (ANA) recommends that any nurse who works a 12-hour shift be allowed to leave on time and without requiring the nurse to stay for additional meetings or education. But only time will tell whether the nursing community will eventually make 12-hour shifts obsolete.
As a nurse who has worked 12 hour shifts and night-shifts, I can tell you that they are very difficult, especially when they're consecutive. But having four days off in-between adds a lot of flexibility and time with family. I understand too, that nurses should always be the patient's advocate and if that means we should be working less hours during the day, then so be it.
I think it's also important to consider the other variables in the equation. It's not safe for patients to have nurses doing never-ending paperwork, taking minimal breaks (if any) and being assigned more patients than is humanly possible to care for.
If a nurse makes a serious error she must answer to the board of nursing in her state and her license is in jeopardy. The facility and the board immediately point their finger at the nurse. Why is the facility not accountable for the error? They are the ones that assigned the nurse too many patients and gave her a ridiculous amount of paperwork and red-tape to deal with.
I think many nurses make mistakes, not always because they're fatigued, but because they're overwhelmed with the workload. Facilities should be more accountable for the assignments they bombard nurses with and instead of blaming nurse fatigue for errors we should be taking a closer look at reasonable workloads for nurses.
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