Although most research on medical error has been conducted on adult inpatient units, the few studies conducted in pediatric settings suggest that errors occur more frequently in neonatal intensive care units (NICUs) than in other inpatient units. The effects of fatigue, due to long work hours, working at night, and insufficient sleep, are often underestimated. This article reviews basic information about fatigue and sleep and includes examples drawn from data provided by 6 NICU nurses who participated in a recent study to highlight the relationship between fatigue and error. These case studies reinforce the concept that NICU nurses need to be alert enough to provide safe care for their patients, as well as alert enough to detect and correct the errors made by others. Employing good sleep habits, minimizing shift rotations and excessive work hours, and using strategic naps can reduce the adverse effects of fatigue that could potentially put patients, especially the most vulnerable ones, at risk.
1Center for Sleep and Respiratory Neurobiology, School of Medicine, University of Pennsylvania, Philadelphia, Pa
2Bio-behavioral Research Center, School of Nursing, University of Pennsylvania, Philadelphia, Pa
3Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, Mich
Address reprint requests to Ann E. Rogers, RN, PhD, FAAN, University of Pennsylvania School of Nursing, 420 Guardian Drive, Philadelphia, PA 1910–46096. E-mail: firstname.lastname@example.org
Financial support for this study was provided by the Agency for Healthcare Research and Quality (R01 HS1196301), and an American Nurses Foundation Grant (Dr. Scott).