ADDRESSING NURSE FATIGUE TO PROMOTE SAFETY AND HEALTH: A JOINT RESPONSIBILTY BARBARA B. HOBBS, PHD, RN SOUTH DAKOTA NURSES ASSOCIATION OCTOBER 5, 2015
PREVAILING MESSAGES Little acceptance by nurses We all worked nights and shiftwork; Expected as part of the job. New RNs need to “get over it” Iam safe even when I tired. RNs should be fired for napping; it is patient abandonment Patients come first; meal breaks are a luxury
PURPOSE Articulates the ANA’s position of the joint responsibility of RNs and Employers to: Reduce risks r/t sleepiness and fatigue Create and sustain a culture of safety Healthy work environment Work-life balance
DEFINITIONS Fatigue – impaired function resulting from physical labor or mental exertion. Physical – reduces physical capacity Objective – reduced productivity Subjective – weary, unmotivated Sleepiness – Inc. propensity to fall asleep resulting from an imbalance of the sleep/wake cycle. Decreased sleep quality and quantity
REVIEW OF THE EVIDENCE
SHIFTWORK & LONG WORKING HOURS Growing body of evidence on the effect inadequate sleep and resulting fatigue Inability to provide optimal patient care Risk of error; reduced job performance Health and safety issue Safety, drowsy driving Direct costs and financial impact
JOINT RESPONSIBILITIES OF RNS AND EMPLOYERS Collaboration to achieve safe, quality care for patients. Supports AACN Standards for Establishing and Sustaining Healthy Work Environments (AACN, 2005) Recommendations to adopt evidence-based strategies to reduce health and safety risks (JCAHO, 2001& 2012)
IOM (2004) recommendations not exceed 12 Hrs. in 24 Hrs. or 60 total Hrs. / 7 days Best Evidence more than 40 Hrs. per 7 days linked patient safety and nurse health. ANA Recommendation ≤ 40 Hrs.- (paid + unpaid) work in 7 days
RNS’ ETHICAL RESPONSIBILITY Address fatigue and sleepiness in the workplace leading to harm or prevent optional care; Practice healthy behaviors; Take meals, rest breaks; Implement fatigue countermeasures naps, caffeine, exercise, etc.;
may refuse an assignment that compromises availability of sufficient time to sleep; Implement fatigue countermeasures 11 evidence-based strategies seek health care provider input when fatigue or health symptoms are unresolved.
EMPLOYERS’ RESPONSIBILITY Establish a culture of safety Adopt policy that allow RN to accept or reject assignments to prevent risks from fatigue. Limit work hours to 40 Hrs. / 7 days Including meetings, in-service, on-call hours Regularly audit scheduling practices
Verify nurses get breaks and meals; Support minute naps; Limit extra shifts scheduled; Adopt and implement ANA’s key (7) and additional workforce and scheduling strategies.
TAKE HOME MESSAGE: Reflect on your own habits sleep/wake; meal breaks, exercise Know and follow the evidence Role model healthy work behaviors Communicate & support implementation of the ANA recommendations.