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An Integrative Review: Fatigue Among Nurses in Acute Care Settings

Smith-Miller, Cheryl A. PhD, RN-BC; Shaw-Kokot, Julia MSLS, RN; Curro, Brooke BNS, RN; Jones, Cheryl B. PhD, RN, FAAN

JONA: The Journal of Nursing Administration: September 2014 - Volume 44 - Issue 9 - p 487–494
doi: 10.1097/NNA.0000000000000104

OBJECTIVE: The aim of this study was to examine current research related to nurse fatigue and identify effective prevention strategies.

BACKGROUND: Work-related fatigue negatively affects patient safety and nurses’ well-being and increases employer costs. Preventing fatigue and minimizing its negative consequences require knowledge of the contributing factors if effective interventions are to be designed and implemented.

METHODS: This review targeted original research (2002-2013) examining fatigue among nurses working in acute care settings.

RESULTS: Nurses experience high rates of fatigue. Shifts longer than 12 hours contribute to increased fatigue and errors, but the evidence was inconsistent with regard to age and fatigue level. Individual lifestyle, unit culture, and organization policies influence the prevalence and intensity of work-related fatigue.

CONCLUSIONS: Preventing work-related fatigue requires multifaceted approaches involving the organization, the clinical unit, and the individual.

Supplemental Digital Content is available in the text.

Author Affiliations: Nurse Researcher (Dr Smith-Miller), University of North Carolina Hospitals, and Adjunct Faculty, University of North Carolina at Chapel Hill; Education Librarian (Ms Shaw-Kokot), Health Sciences Library, University of North Carolina at Chapel Hill; Patient Services Manager (Ms Curro), University of North Carolina Hospitals, Chapel Hill; Associate Professor and Chair (Dr Jones), Health Care Environments School of Nursing; Director, Hillman Scholars Program in Nursing Innovation, University of North Carolina at Chapel Hill; and Research Program Consultant, University of North Carolina Hospitals Division of Nursing, Chapel Hill.

The authors declare no conflicts of interest.

Correspondence: Dr Smith-Miller, 3rd Floor Old Infirmary, University of North Carolina Hospitals, 101 Manning Drive, Chapel Hill, NC 27514 (

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