Worker fatigue is part of a costly and dangerous cycle that results when workload–staffing imbalances exist: understaffing leads to increased overtime, fatigue, staff burnout, and turnover. When health care workers are fatigued, the safety of both patients and staff is compromised. In a recent Webinar, the Joint Commission distilled current research on fatigue, discussing its causes and symptoms and the various means of addressing this challenging issue. (The topic was also recently discussed in AJN; see In the News, March.)
Leading the discussion was Ann Scott Blouin, a nurse and the executive vice president of customer relations at the Joint Commission. According to the American College of Occupational and Environmental Medicine, fatigue is “the body's response to sleep loss or to prolonged physical or mental exertion.” Factors contributing to staff fatigue fall into three categories: organization and management issues, such as overtime requirements; the nature of the work, such as shift work (particularly shift work that doesn't rotate “forward” from day to evening to night); and personal challenges, such as moonlighting and family responsibilities. Fatigue has emotional, physical, and behavioral consequences, including lapses in attention, diminished reaction time, and reduced motivation. As a result, workers make more errors.
Blouin cited alarming statistics on the effects of fatigue on safety. For instance, the risk of medication and other errors increases significantly after eight hours of work and is even higher after 12.5 hours. The rate of employee accidents increases after nine hours of work and doubles after 12 hours. One study has also shown that critical care nurses who experienced fatigue were more likely to report “decision regret,” a concern that they might have made the wrong decision for a patient.
A comprehensive Joint Commission monograph, Improving Patient and Worker Safety, outlines interventions that organizations and health care workers can use to improve worker well-being and patient safety. Among these is the development of evidence-based risk-reduction strategies, flexible staffing strategies, and staff education regarding sleep hygiene and the effects of fatigue on safety. The monograph is available at http://bit.ly/1gnuszm. Another useful resource, the Fatigue Risk Management System Resource Pack, produced by the government of Queensland, Australia, is also available online, at http://bit.ly/1lDkF4B.—Karen Rosenberg