ADDRESSING NURSE FATIGUE TO PROMOTE SAFETY AND HEALTH: A JOINT RESPONSIBILTY

BARBARA B. HOBBS, PHD, RN

SOUTH DAKOTA NURSES ASSOCIATION

OCTOBER 5, 2015

PREVAILING MESSAGES

Little acceptance by nursesWe all worked nights and shiftwork; Expected as part of the job. New RNs need to “get over it” I am safe even when I tired.RNs should be fired for napping; it is patient

abandonmentPatients come first; meal breaks are a luxury

PURPOSE

Articulates the ANA’s position of the joint responsibility of RNs and Employers to:Reduce risks r/t sleepiness and fatigueCreate and sustain a culture of safetyHealthy work environmentWork-life balance

DEFINITIONS

Fatigue – impaired function resulting from physical labor or mental exertion.Physical – reduces physical capacity Objective – reduced productivitySubjective – weary, unmotivated

Sleepiness – Inc. propensity to fall asleep resulting from an imbalance of the sleep/wake cycle.Decreased sleep quality and quantity

REVIEW OF THE EVIDENCE

SHIFTWORK & LONG WORKING HOURS

Growing body of evidence on the effect inadequate sleep and resulting fatigue Inability to provide optimal patient careRisk of error; reduced job performanceHealth and safety issue Safety, drowsy drivingDirect costs and financial impact

JOINT RESPONSIBILITIES OF RNS AND EMPLOYERS

Collaboration to achieve safe, quality care for patients.

Supports AACN Standards for Establishing and Sustaining Healthy Work Environments (AACN, 2005)

Recommendations to adopt evidence-based strategies to reduce health and safety risks (JCAHO, 2001& 2012)

IOM (2004) recommendations not exceed 12 Hrs. in 24 Hrs. or60 total Hrs. / 7 days

Best Evidence more than 40 Hrs. per 7 days linked patient safety

and nurse health.

ANA Recommendation≤ 40 Hrs.- (paid + unpaid) work in 7 days

RNS’ ETHICAL RESPONSIBILITY

Address fatigue and sleepiness in the workplace leading to harm or prevent optional care;

Practice healthy behaviors;Take meals, rest breaks;

Implement fatigue countermeasuresnaps, caffeine, exercise, etc.;

may refuse an assignment that compromises availability of sufficient time to sleep;

Implement fatigue countermeasures 11 evidence-based strategies

seek health care provider input when fatigue or health symptoms are unresolved.

EMPLOYERS’ RESPONSIBILITY

Establish a culture of safety

Adopt policy that allow RN to accept or reject assignments to prevent risks from fatigue.

Limit work hours to 40 Hrs. / 7 daysIncluding meetings, in-service, on-call hours

Regularly audit scheduling practices

Verify nurses get breaks and meals;

Support 20-30 minute naps;

Limit extra shifts scheduled;

Adopt and implement ANA’s key (7) and additional workforce and scheduling strategies.

TAKE HOME MESSAGE:

Reflect on your own habitssleep/wake; meal breaks, exercise

Know and follow the evidenceRole model healthy work behaviors Communicate & support implementation of

the ANA recommendations.