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An Interventional Approach for Patient and Nurse Safety: A Fatigue Countermeasures Feasibility Study

Scott, Linda D.; Hofmeister, Nancee; Rogness, Neal; Rogers, Ann E.

doi: 10.1097/NNR.0b013e3181de9116

Background: Studies indicate that extended shifts worked by hospital staff nurses are associated with higher risk of errors. Long work hours coupled with insufficient sleep and fatigue are even riskier. Although other industries have developed programs to reduce fatigue-related errors and injury, fatigue countermeasures program for nurses (FCMPN) are lacking.

Objectives: The objective of this study was to evaluate the feasibility of an FCMPN for improving sleep duration and quality while reducing daytime sleepiness and patient care errors. Selected sleep variables, errors and drowsy driving, were evaluated among hospital staff nurses (n = 47) before and after FCMPN implementation.

Method: A one-group pretest-posttest repeated-measures approach was used. Participants provided data 2 weeks before the FCMPN, 4 weeks after receiving the intervention, and again at 3 months after intervention.

Results: Most of the nurses experienced poor sleep quality, severe daytime sleepiness, and decreased alertness at work and while operating a motor vehicle. After the FCMPN, significant improvements were noted in sleep duration, sleep quality, alertness, and error prevention. Although significant improvements were not found in daytime sleepiness scores, severity of daytime sleepiness appeared to decrease. Despite improvements in fatigue management, nurses reported feelings of guilt when engaging in FCMPN activities, especially strategic naps and relieved breaks.

Conclusions: Initial findings support the feasibility of using an FCMPN for mitigating fatigue, improving sleep, and reducing errors among hospital staff nurses. In future investigations, the acceptability, efficacy, and effectiveness of FCMPNs can be examined.

Linda D. Scott, PhD, RN, NEA-BC, FAAN, is Professor and Associate Dean for Graduate Programs, Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, Michigan.

Nancee Hofmeister, MSN, RN, NE-BC, is Director of Nursing and Professional Practice, Bronson Methodist Hospital, Kalamazoo, Michigan.

Neal Rogness, PhD, is Associate Professor, Science & Mathematics, Grand Valley State University, Allendale, Michigan.

Ann E. Rogers, PhD, RN, FAAN, is Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia.

Editor's Note Materials documenting the review process for this article are posted at

Accepted for publication March 9, 2010.

The Blue Cross Blue Shield of Michigan Foundation provided financial support for this study (1142.RFP.ME5).

Corresponding author: Linda D. Scott, PhD, RN, NEA-BC, FAAN, Kirkhof College of Nursing, Grand Valley State University, 312 Cook-Devos Center for Health Sciences, 301 Michigan Avenue NE, Grand Rapids, MI 49503 (e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.