How Tired Are We?

Abstract

When I was a transport nurse, we were dispatched to the scene of a motor vehicle crash. A woman had been hit head-on by another car and sustained injuries that eventually killed her. The other driver was one of the residents at the hospital where I worked who had just completed a multiplehour shift (estimated to have been well over 24 hours) and had fallen asleep on the drive home. That day, the resident’s life was changed forever because he had not gotten enough rest, due to carrying out the requirements of his job. If one looks up the word fatigue, one finds there are multiple components to its definition. Examples include mental or physical exhaustion (sometimes both); inability to respond to a stimulus; and an inability to respond to a critical situation. Shift work is a part of emergency nursing. Nursing care in the emergency department needs to be available to patients 24 hours a day, 7 days a week. Most ED nurses would like to have a life beyond work, so many of us will manipulate our schedules to make that possible, doing things such as scheduling several shifts in a row, which can contribute to fatigue. However, research has also found that shift work in nursing leads to increased fatigue both on and off shifts. Medication errors, errors in clinical judgment, and failure to recognize co-worker errors are some of the problems that have occurred in relation to healthcare worker fatigue. In addition, driving home from work drowsy as well as offshift family conflicts have been attributed to the cumulative fatigue that comes with shift work. Physical complaints such as gastrointestinal disorders and increased absenteeism can also result from fatigue. The Joint Commission issued a sentinel event alert in December 2011 that cited challenges that can be the result of fatigue or insufficient quality and quantity of sleep associated with excessive shift work. These included memory lapses, impaired communication, reduced motivation, and indifference and loss of empathy for staff and patients. These errors and problems related to fatigue not only cause patient and staff safety issues, they are costly as well. It has been estimated that a loss of $2,000 to $10,000 per employee annually can be attributed to fatigue. What can we do? First, evaluate the effects of shift work in your environment. One study that looked at the positive aspects of shift work pointed out that some of the “negative impacts” of shift work may be more a part of the organization rather than the nursing professionals. The authors noted that allowing the nurse to control and determine when he or she may work and the work schedule itself may actually have a positive impact on fatigue and employee satisfaction. Second, employ some interventions to prevent fatigue. Some of these interventions may be adjusting shift lengths; analysis of the workload; rest days; incident analysis; and providing rest between shifts and breaks during the shift. Finally, a resolution will be introduced during this year’s ENA General Assembly in San Diego. The resolution, entitled Healthcare Worker Fatigue, is authored by the Tennessee and Utah State Councils. It asks that the ENA IENR (Institute for Emergency Nursing Research) develop an ENR (Emergency Nursing Resource) on the work environment and fatigue; develop a position statement with recommendations for number of safe work hours and shift rotations; and for the ENA to collaborate with regulatory and other profession healthcare organizations to identify and promote the use of effective fatigue countermeasures. We have all experienced both mental and physical exhaustion connected to our work in the emergency department. If we do not provide input into our practice, others will continue to do it for us. If you cannot attend this year’s General Assembly, please let your representatives know of your concerns and the possible solutions you may have to this problem. Renee S. Holleran is Editor-in-Chief of Journal of Emergency Nursing.