Nurses work long hours and play a critical role in keeping patients healthy. Many nurses feel that fatigue “comes with the territory” of such a high-stress, high-impact job. But what’s really at risk when a nurse is fatigued?
Nurse fatigue contributes to billions of dollars in healthcare costs annually, driven by medical errors, staff turnover, and decreased productivity.1
Mental exhaustion can lead to mistakes, and when those mistakes affect the health and wellbeing of patients, the consequences can be devastating.
Burnout and fatigue are intricately linked. Recent reports indicate that approximately 62% of nurses experience burnout, with many citing exhaustion, stress, and workload as contributing factors.2
Imagine a tired nurse misinterpreting a healthcare provider’s orders to continue home medications, causing a diabetic patient to miss their insulin. Consider a patient who’s allergic to penicillin being mistakenly prescribed the drug to combat an infection, only to result in an allergic reaction, anaphylactic shock, or worse.
Nurses have a responsibility to themselves and their patients to be well-rested in order to provide the highest quality care possible. Working long shifts, night shifts, and rotating shifts, as well as mandatory or voluntary overtime, contributes to nurse fatigue, which results in accidents, mistakes, and errors
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Recent research also suggests that nurses may not accurately assess their own fatigue. In one study, more than one-third of nurses underestimated their fatigue levels when compared to standardized assessment tools.
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But beyond the safety and ethical implications, fatigue can also lead to legal consequences, including loss of license. Although nurses are accountable for their individual practice, employers also have a responsibility to keep nurses, patients, the facility, and the public safe.
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ANA weighs in
The American Nurses Association’s (ANA) current stance on patient safety emphasizes two key areas: RNs’ responsibility to assess their level of fatigue when deciding whether to accept work beyond their regularly scheduled hours (including mandatory or voluntary overtime), and employers’ responsibility to promote healthy nurse work hours across all roles and practice settings.
As advocates for health and safety, registered nurses are accountable for their practice and have an ethical responsibility to address fatigue and sleepiness in the workplace that may result in harm and prevent optimal patient care.7
There must be a collaborative effort between employers and nurses to help prevent the risks presented by fatigue. The ANA encourages employers to establish policies and procedures to promote healthy work hours and patterns that don’t go beyond the limits of nurse and patient safety.
8 Evidence indicates that prolonged work hours, rotating shifts, and insufficient breaks slow reaction time, decrease attention to detail, promote errors, compromise problem solving ability, and reduce motivation.
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The Joint Commission has emphasized the importance of recognizing fatigue-related risks associated with long and irregular work hours and adopting strategies to reduce those risks.
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Shifting the “Blame Culture”
As professionals, nurses are ethically bound to strive to prevent errors. But many nurses are deterred from reporting an error for the fear of punishment or being viewed negatively by peers. This “blame culture” is counterproductive to preventing mistakes, because a lack of identifying the problem means a lack of fixing it.
Most nurses report having experienced the “blame culture” in response to reporting errors, which discourages accountability for practice improvements.11
The ANA advocates for a culture that recognizes that mistakes result from human error and faulty systems. This approach encourages an investigation of the events leading to the error and discourages blaming individuals involved.
12 If the mistake is associated with an environment that’s not supportive of safety, flaws in the system should be identified and corrected.
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More recent findings suggest that cultural norms – such as pride in working long hours and reluctance to speak up – continue to prevent open discussion of fatigue, limiting organizational accountability and increasing patient safety risks.
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Steps to Ensure Nurse and Patient Safety
Nurses working in healthier work environments are significantly less likely to leave their jobs, highlighting the importance of addressing fatigue as part of broader workforce retention strategies.
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Some key strategies that can help prevent the costly consequences of fatigue include:
Designing schedules and organizing work to reduce nurse fatigue.16
The Joint Commission recommends healthcare facilities assess their policies to identify fatigue-related risks, such as off-shift hours and consecutive shift work, and review their staffing to address areas that may be contributing to nurse fatigue.
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Developing a fatigue management plan.
Nurses working three consecutive 12-hour shifts suffer from sleep deprivation; they report an average of 5.2 hours of sleep on work days.
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Nurses report disturbance in their personal relationships, reduction in work productivity, and negative attitudes toward work.
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Educating staff on sleep hygiene and the effects of fatigue on nurse health and patient safety.
Chronic lack of sleep causes problems that include needle-stick injuries, musculoskeletal disorders, and drowsy driving.
Nurse burnout is on the rise due to fatigue, causing health issues such as diet disorders, headaches, ulcers, depression, and increased alcohol and nicotine consumption.
Providing opportunities for staff to express concerns about fatigue and taking action to address those concerns.
By keeping the lines of communication open between management and staff, healthcare organizations can encourage and empower nursing staff to solve fatigue-related issues without fear of reprisal by management.
Making sure extended shifts have adequate staff support and rest periods.20
To prevent fatigue and patient injury, managers should closely monitor nurses’ work hours.
Conclusion
Patient safety hinges on nurses’ well-being, and it’s important for nurse health to be front-and-center in the minds of both healthcare organizations and nurses themselves.
Nurses can decrease their level of fatigue by working as a team in support of each other during extended shifts, and by encouraging good personal sleep habits. But ultimately, it’s each nurse’s responsibility to refuse an assignment if he or she is impaired by fatigue.
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RNs should consider the impact that working multiple or extended shifts will have on their level of fatigue before accepting extended shift assignments, and should work proactively with their organization to establish safe schedules and fatigue management plans.
References
- 1Medical Safety & Global Health. (2023). The Impact of Nursing Fatigue on Patient Safety: A Perception on Nursing Burnout.
- 2Nursing World. (2024). What is Nurse Burnout? How to Prevent It?
- 3National Academy of Medicine. (2021). A Path to Improved Health Care Working Well-Being and Lessons from the Covid-19 Pandemic.
- 4, 5American Nurses Association. (n.d.). Position statement: Employers’ role in promoting healthy nursing work hours.
- 6American Nurses Association. (n.d.). Position statement: Registered nurses’ responsibility to guard against working when fatigued.
- 7American Nurses Association. (2014). Addressing nurse fatigue to promote safety and health: Joint responsibilities of registered nurses and employers to reduce risks.
- 8American Nurses Association. (n.d.). Position statement: Employers’ role in promoting healthy nursing work hours.
- 9American Nurses Association. (n.d.). Nurse fatigue. Retrieved from https://www.nursingworld.org
- 10The Joint Commission. (2011–2012). Health care worker fatigue and patient safety.
- 11Brewer, K. (2011). How a “just culture” can improve safety in health care. American Nurse Today, 6(6).
- 12American Nurses Association. (n.d.). Nurse fatigue. Retrieved from https://www.nursingworld.org
- 13Brewer, K. (2011). How a “just culture” can improve safety in health care. American Nurse Today, 6(6).
- 14National Academy of Medicine. (2021). A Path to Improved Health Care Working Well-Being and Lessons from the Covid-19 Pandemic.
- 15Health Services Safety Investigations Body. (2023). The impact of staff fatigue on patient safety in acute hospital settings.
- 16American Nurses Association. (2014). Addressing nurse fatigue to promote safety and health: Joint responsibilities of registered nurses and employers to reduce risks.
- 17The Joint Commission. (2011–2012). Health care worker fatigue and patient safety.
- 18University of Maryland School of Nursing. (2010). Study reveals widespread fatigue and risk for errors with 12-hour nursing shifts.
- 19Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). Nurse staffing, burnout, and health care–associated infection. American Journal of Infection Control, 40(6), 486–490.
- 20The Joint Commission. (2011–2012). Health care worker fatigue and patient safety.
- 21American Nurses Association. (n.d.). Nurse fatigue. Retrieved from https://www.nursingworld.org
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