We’ve heard of intern and resident fatigue, and certainly fatigue in our patients. Finally, there is a report on nurses’ fatigue. What does it look like within our ranks?
The Nursing Practice and Research Councils at the University of North Carolina hospital system undertook a baseline survey of fatigue in their registered nurses, clinical support technicians, nursing assistants, and health unit coordinators prior to implementing a house-wide fatigue management program for their staff.1 They used the 15-item Occupational Fatigue Exhaustion Recovery (OFER) scale to assess fatigue levels.
Dimensions within this scale measured chronic fatigue (i.e., enduring fatigue over time), acute fatigue (i.e., workplace demands varying from shift to shift or week to week), persistent fatigue (i.e., aspects of work and their influence on sleep hygiene), and intershift recovery (i.e., ability to recoup between shifts). In general, higher scores were considered undesirable and indicated a greater presence of the construct. The exception was scoring of the intershift recovery item where low scores suggested a compromise in recuperation. Over 1,000 staff completed the online survey and results revealed the following. Three factors – position, shift worked, and age – were indicative of different elements of fatigue.
Interestingly, a greater number of younger staff had high acute fatigue scores as compared with older respondents. Those who worked rotating shifts made up the largest percentage of staff in the moderate/high range of persistent fatigue. Day shift staff had the largest percentage in the low level range of persistent fatigue. Registered nurses, as compared to assistive personnel, scored the highest on both the chronic fatigue and acute fatigue scales. Intershift recovery was less than ideal for all respondents.
The authors suggested that management should address the possibility of allotted break times where a short nap for staff could occur. This made me think back when I worked at an inpatient hospice center where a designated “quiet room” was provided for nursing staff for breaks. It also made me recall one of my first 13-hour flights to Australia where I would periodically observe flight attendants disappear into a small cabin at the back of the plane for their designated “downtime.”
With enough evidence to report a relationship between nurse fatigue and errors, reduced productivity, and other negative corollaries, perhaps a “SSHHH, Nurse = Napping!” sign will soon appear on patient care units nationally!
Finally, the authors made a key statement which is important to relay:
Management paradigms must consider nursing staff as a limited resource – one that requires rest and respite at work and adequate recuperation time – if patients are to receive the best quality and safest care possible (p.334).1
- Blouin AS, Smith-Miller CA, Harden J, Li Y. Caregiver Fatigue: Implications for Patient and Staff Safety, Part 1. J Nurs Adm, 2016 Jun;46(6):329-35.