fatigued nurse

In recognition of the American Nurses Association (ANA) noting 2017 as the "Year of the Healthy Nurse," Stevenson University will be exploring the topics of nurse fatigue as well as balancing the mind, body, and spirit to combat the stresses within the nursing field. 

For 15 consecutive years, the Gallup poll has reported that nurses are rated as the most trusted professionals with the highest honesty and ethical standards. Those standards, however, may come at a cost. Perhaps to their own detriment, nurses are known to go above and beyond to serve, protect, and care for their patients and community. Additionally, nurses are routinely scheduled to work 12-hour shifts, and usually work over those hours due to staffing shortages. Per two studies referenced in Patient Safety and Quality: An Evidence-Based Handbook for Nurses, “…the majority of hospital staff nurses (75 percent) now work 12-hour shifts, some nurses report being scheduled to work for periods as long as 20 consecutive hours.” While enduring these long shifts, nurses often do not take breaks or rest, which can be a key contributor to causing nurse fatigue. The American Nurses Association (ANA) notes that nurse fatigue is a serious issue by stating, “Inadequate sleep and resulting fatigue has major implications on the health and safety of registered nurses and can compromise patient care.” Lack of sleep is at times dismissed as a common problem and can be seen as a harmless matter, however it can cause severe issues. Per Patient Safety and Quality: An Evidence-Based Handbook for Nurses, “Sleep loss is cumulative and by the end of the workweek, the sleep debt (sleep loss) may be significant enough to impair decision making, initiative, integration of information, planning and plan execution, and vigilance.  The effects of sleep loss are insidious and until severe, are not usually recognized by the sleep-deprived individual.”

Health issues caused by continuous sleep deprivation are well-documented, however there is another danger that stems from working long shifts known as “drowsy driving.” Per a 2016 Forbes article, over 83 million people drive without sufficient sleep and in 2015 there were “an estimated 5,000 lives lost in drowsy driving related crashes.” After working a 12-plus hour shift or the night shift, nurses are absolutely at risk of drowsy driving. The most commonly known danger surrounding lack of sleep in the healthcare industry is medical errors. In 1999, the Institute of Medicine released their widely cited report, To Err is Human, which initially “shocked the medical establishment” and finally brought the national epidemic into the spotlight. Unfortunately almost 20 years later, medical errors are still plaguing the healthcare industry at an alarming rate. A 2016 study from the Johns Hopkins University School of Medicine noted that “’medical errors’ in hospitals and other health-care facilities are incredibly common and may now be the third-leading cause of death in the United States — claiming 251,000 lives every year, more than respiratory disease, accidents, stroke and Alzheimer’s.”

The fatigue caused by sleep deprivation is not only harmful to patients and the general public, but to nurses themselves. Without proper sleep, nurses are more likely to suffer a needlestick injury or risk potential health issues such as hypertension, obesity, diabetes, depression, and cardiovascular disease. Working long hours can also cause a different type of fatigue in nurses, known as compassion fatigue. According to a 2014 Journal of Emergency Nursing article, “Compassion fatigue is described as ‘the cost of caring’ and “an extreme state of tension and preoccupation with individual or cumulative traumas of clients,” whereby persons present a ‘state of exhaustion and dysfunction, biologically, physiology and emotionally due to prolonged exposure to compassion stress.’” Due to staffing shortages, the nurse to patient ratio is routinely unbalanced, causing nurses to exert themselves far beyond their capacities. These stresses can lead to more shortages, as compassion fatigue has been linked to, “an increase in absenteeism and staff turnover, decrease in quality of patient care, decreased patient satisfaction, decrease in patient safety, and difficulty recruiting and retaining staff.” It is a vicious cycle that has yet to be resolved in the healthcare industry.

Although there are factors out of a nurse’s control that can contribute to nurse fatigue, there are steps that can still be taken to combat the associated stress and exhaustion. Check back later this week for our next Nurses Week installment dedicated to avoiding nurse fatigue titled, “Mind, Body, and Spirit: How Nurses Stay Healthy through Stress.”