Editor-in-Chief, Associate Executive Director, Patient Care Services/Nurse Executive, Lenox Hill Hospital/North Shore-LIJ Health System, New York, N.Y.
Have we really looked at the myriad issues surrounding tired nurses with an eye toward proactive management?
It was heartbreaking to read about the Ohio nurse who crashed her car coming off a night shift last year, leaving behind a husband and two young children. Lately, it seems that no matter where I turn, there's another reminder of nurse fatigue. Have we really looked at the myriad issues surrounding tired nurses with an eye toward proactive management?
Weary nurses aren't practicing at the top of their game. We all know sleep deprivation can be equivalent to legal intoxication in terms of cognitive function. And there are many research studies supporting the deleterious effects of nurse fatigue, including impaired decision making and judgment, as well as health consequences. It's well known that driving while drowsy is a major cause of motor vehicle accidents and fatalities. In and out of the workplace there are safety problems related to tiredness, so where does the responsibility and accountability lie? I believe it's a shared responsibility between staff and managers.
Mandatory overtime is illegal in many states except for emergencies. Mandating staff members to routinely work overtime against their will is akin to management negligence when all other options haven't been exhausted. If a team member tells us that he or she is too tired to work another shift or another 4 hours, we should listen and act accordingly. Voluntary overtime is a different matter entirely. In my state, the New York Board of Nursing considers voluntarily working beyond 16 hours to be a factor in the “willful disregard of patient safety” and grounds for unprofessional conduct. Scheduling is a factor here, as well as on-call commitments. Everyone's tolerance is different and we're obligated as managers to identify performance issues in at-risk employees, especially night-shift workers. In turn, staff members are obligated to maintain sleep patterns during scheduled time off that promote safe functioning when they report for duty.
What about the management responsibility to allow staff members to rest during their breaks? Working through breaks may happen on “bad days” but, again, this shouldn't be routine. If it is, it's time to address staffing. What about allowing shift workers to sleep during their breaks? Napping—in a private area, of course—is an evidence-based way to prevent fatigue. Encouraging “martyrdom” with nonstop work isn't the culture you want to establish.
I often hear about new nurses on the night shift having difficulty adjusting to altered sleep-rest patterns. They should reach out to us. There are tips for sleeping during the day, such as darkening the room and wearing an eye mask and earplugs, that can help. Nutritional balance is also critical. When I worked nights, I didn't have trouble sleeping but I wanted to eat breakfast for every meal—my appetite was definitely altered. I recall poster presentations at several Nursing Management Congresses on this topic with great results. Having a toolkit or resources available for those in need is a management necessity.
And then we have the thorny issue of driving while drowsy. Don't! There are options—pull over and take a nap, call a cab, take public transportation, or get a ride. We share responsibility for patient and nurse well-being. Heed the warnings. Protecting patient safety and managing nurse fatigue are closely related. It's just too important to leave off of our radar screens when patients' and nurses' lives are at stake.