Nurse Fatigue Employers' Responsibility, Too

A revised position statement from the American Nurses Association calls for stronger collaboration between nurses and their employers to curb nurse fatigue and its clinical consequences.

Nurse fatigue is frequently linked to patient safety issues, from decision regret to poor hand hygiene compliance. Now, the American Nurses Association has released a revised position statement on the topic that calls for stronger collaboration between nurses and their employers to reduce fatigue.

It statement outlines evidence-based strategies for doing so and makes these recommendations:

• Involve nurses in the design of work schedules
• Use regular and predictable schedules
• Limit work weeks to 40 hours within seven days
• Limit work shifts to 12 hours
• Eliminate the use of mandatory overtime
• Promote frequent, uninterrupted rest breaks during shifts
• Enact official policy allowing nurses to accept or reject a work assignment based on preventing risks from fatigue. It should include the conditions that a rejected assignment does not constitute patient abandonment, and that RNs should not suffer adverse consequences in retaliation for refusing the assignment.
• Encourage nurses to manage their health and rest

The position paper was developed by a 15-member Professional Issues Panel on Nurse Fatigue, as well as an advisory committee made up of about 350 additional ANA members.

Among the people on the Professional Issues Panel was Linda D. Scott, PhD, RN, NEA-BC, FAAN, Associate Dean for Academic Affairs at the University of Illinois at Chicago College of Nursing. Scott and I spoke last year about her research linking decision regret with nurse fatigue. I caught up with her via email this week to hear about her experience developing the new position statement and its notable changes.

HealthLeaders Media: Why is this new position paper exciting?

Linda Scott: In 2006, the ANA published 2 separate position papers on the need to manage nurse fatigue. While each of these position papers spoke to the responsibilities of nurses and employer[s], the 2014 position paper emphasizes the collaborative and reciprocal responsibilities that each have in ensuring a safe, well-rested and vigilant nursing workforce.

HLM: What are some of the most important new additions, changes, and/or differences in the new position statement?

Scott: The rationale and strategies that are included are strongly grounded in research evidence that supports the need for fatigue management in health care.

There is an emphasis on the ethical responsibilit[ies] of both registered nurses and employers to consider the need for adequate rest and sleep when deciding to offer or accept work assignments, including on-call, voluntary, or mandatory overtime.

It recognizes the importance of inadequate sleep and the impact that sleep impairment and fatigue can have on the ability of nurses to deliver optimal patient care, all of which can have adverse effects on patient outcomes.

HLM: You were one of 15 people tasked with contributing to the position paper. Where can we see your influence?

Scott: My influence can be seen in the evidence for nurse fatigue, the need for fatigue management, and the impact on nurse and patient safety.

HLM: Is there anywhere that the position paper doesn't go far enough?

Scott: The position paper speaks to the importance of fatigue management, and the risks associated with long work hours. Without adequate sleep and intershift recovery, shiftwork will always be problematic.

The position paper emphasizes the need to address all aspects, makes recommendations for maximum work hours, and reiterates the need for nurses to be fit for duty…that is, they are accountable for getting enough sleep before starting a work shift. I think that there will still be nurses who think that they are immune to the impact of sleep loss and fatigue.

HLM: Now that the position paper is released, what are the next steps for implementation?

Scott: Next steps include dissemination, dialogue, and hopefully policy and practice changes.