Linking Medical Errors, Nurses' 12-Hour Shifts
It's well known that caregiver fatigue is a huge cause of medical errors, whether the caregiver involved is a new resident coming off a marathon week or an overworked nurse pulling back-to-back shifts.
A few months ago, the Accreditation Council for Graduate Medical Education placed new restrictions on the hours residents can work and the supervision they receive. This follows years of research into new physicians' training and the effect long hours and tiredness play in performance and contribute to poor quality care. A 2004 study found that first-year residents working all night were responsible for more than half of preventable adverse events.
Nurses don't have the same extraordinarily-long work requirements as residents—and they clearly perform very different tasks—but like residents, they work long shifts and suffer from fatigue. Studies have linked nurse fatigue with medical errors, poor quality care, stress, and burnout.
There are many reasons for nurse fatigue, but one stands out as pretty easy to fix: shift length. It's no wonder that nurses are fatigued when 12-hour shifts are the norm. Despite the fact the Institute of Medicine has recommended limiting use of 12-hour shifts, it's standard practice throughout the profession. Nurses routinely work back-to-back-to-back 12-hour shifts.
At the recent Nursing Management Congress in Grapevine, TX, held September 23-25, I attended a presentation by Cole Edmonson, CNO/vice president of patient care services at Texas Health Presbyterian Hospital in Dallas. Edmonson noted that research is helping us understand the dangers nurse fatigue presents to patients and to nurses themselves. He called 12-hours shifts a dead idea whose time has passed and suggested they may cause more problems than they solve. He asked attendees whether it is time to declare the end of 12-hour shifts.
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