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The Effect of Staff Nurses' Shift Length and Fatigue on Patient Safety and Nurses' Health: From the National Association of Neonatal Nurses

Samra, Haifa A. PhD, RN-NIC-CNL; Smith, Barbara A. BSN, RNC-NIC

doi: 10.1097/ANC.0000000000000230
NANN Position Statement

University of South Dakota, Sioux Falls (Dr Samra); and UnityPoint Health Des Moines, Blank Children's Hospital, Des Moines, Iowa (Ms Smith).

Correspondence: Haifa A. Samra, PhD, RN-NIC-CNL, University of South Dakota, 1525 S. Euclid, Sioux Falls, SD 57105 (

The authors declare no conflicts of interest.

The National Association of Neonatal Nurses (NANN) is committed to efficient, equitable, safe, accountable, and high-quality patient care. As the professional voice of neonatal nurses, NANN recognizes the limitations of current evidence regarding staff nurses' shift length and fatigue and patient outcomes as well as the vulnerability of neonatal nurses to the potential risks of fatigue and sleep disturbances. The revised statement recommends that neonatal nurses and their employers implement a combination of countermeasures to minimize personal and patient safety risks as they relate to fatigue, shift length, and overtime.

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The relationship between working long shifts and safety outcomes is complex and may be influenced by several factors, including patient acuity, workload, type of shift, and how effectively fatigue is managed. Current evidence regarding effects of working long shifts on nurse performance, cognitive functioning, and patient outcomes is inconclusive. However, evidence points to a link between long shifts and suboptimal patient outcomes and healthcare errors.1–3 Currently, there are no effective measures that can completely eliminate the negative effects of working long shifts and there are no clear guidelines to inform neonatal nurse administrators and staff nurses about how to manage shift length and overtime.

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Research on nursing work-related fatigue clearly identifies the need to protect both patients and nurses from work-related fatigue and sleep deprivation. This position statement is aimed at highlighting risk-reduction strategies to address nurses' work-related fatigue and mitigate risks that are associated with working long shifts. Strategies include:

  • Working no more than 12 hours per day (12 hours plus 30 minutes for lunch break) and working no more than 48 hours per week
  • Limiting the number of consecutive 12-hour shifts to three per week
  • Having a minimum of two rest days after three consecutive 12-hour shifts, four 10-hour shifts, or five 8-hour shifts
  • Encouraging staff to take a minimum of one 10- to 15-minute break for every 4 hours worked and at least a 20-minute meal or rest break when working 6 hours or more
  • Incorporating education about fatigue into nursing curricula/orientation

Several factors at the system, unit, and individual levels influence the prevalence and intensity of work-related fatigue. Preventing work-related fatigue and consequences require a multifaceted approach toward individual lifestyle changes, workplace culture, and organizational policies. Employers must implement guidelines to minimize work-related fatigue and promote a culture that recognizes nursing fatigue as an unacceptable risk. It should also be recognized that there may be exceptions that necessitate a staff nurse to remain on duty for longer hours (eg, severe weather).

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Nurses are responsible for independent judgment related to patient care and treatment. It is imperative that nurses monitor their own fatigue levels. Nurses must be aware of factors that influence prevalence and intensity of work-related fatigue and take actions to modify those factors. Employers must create a culture that recognizes the effect of nursing fatigue on patient outcomes and nursing performance.

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1. Chen J, Davis KG, Daraiseh NM, Pan W, Davis LS. Fatigue and recovery in 12- hour dayshift hospital nurses. J Nurs Manag. 2014;22(5):593–603.
2. Griffiths P, Ball J, Drennan J, Jones J, Reccio-Saucedo A, Simon M. The Association Between Patient Outcomes and Nurse/Healthcare Assistant Skill Mix and Staffing Levels and Factors That May Influence Staffing Requirements. South Hampton, GB: University of South Hampton; 2014.
3. Rogers AE, Hwang WT, Scott LD, Aiken LH, Dinges DF. The working hours of hospital staff nurses and patient safety. Health Affairs. 2004;23(4):202–212.
© 2015 by The National Association of Neonatal Nurses