The Concept of Fatigue Among Nurses, Essay Example

Abstract

This paper tackles the concept of fatigue among nurses and how it affects patient care and safety. In addition, this paper provides various recommendations that can be done in order to solve and combat the challenges of fatigue in the healthcare system.

Nursing Practice Problem

Nurses play an important role in the provision of health care not just in the hospital setting but as well as in the residential care facilities. The nurses in the United States of America have exerted their voice in relation to the challenges and issues that are prevalent in the health care system. One of these pressing challenges is the threat on the safety of the patients triggered by the extraordinary intensities of fatigue in the nurses. A deeper look into the situation reveals that the nursing personnel are also threatened as a result of unsafe scheduling practices and unhealthy work atmosphere. It is the goal of every nurse to provide quality and safe care to the patients and within the context of their job description (Ruggiero, 2002). Quality and safe care can be defined as the manner in which a nurse assist a patient to attain optimum health while providing a safe environment for the patients and guaranteeing that all necessary steps and actions are conducted to avert injury or harm to the patient. However, regardless of the collaborative effort of all health care professionals to ensure patient safety, the truth remains that it is threatened by fatigue among nurses. This is primarily due to the prevalent understaffing in the system that is putting the health of the nurses and patient safety in a very detrimental position. In addition, fatigue in the nursing staff is not just brought about working longer hours to accommodate understaffing but also the heavy workload that one less staff puts on the shoulder of the nurses working on shift. The workload becomes twice as heavy as the nurses try to accommodate shortage in staffing (Zboril-Benson, 2002).

In this regard, the national patient safety goals have identified nurses’ fatigue as a threat to the safety of the patients not just in the hospitals but as well as in residential and home care facilities.

Related Literature

Fatigue is defined as an overpowering feeling of tiredness that contributes to the exhaustion, sleepiness, and lack of energy and an impairment of the cognitive and physical function of a person. Also, fatigue is one of the major causes of burnout in nurses. Studies have shown that fatigue in nurses decreases the level of alertness and work efficiency, increases the incidents of errors in medications, and poor overall performance in the provision of healthcare to the patients (Lyndon, 2007).

Fatigue in nurses can be attributed to situations wherein there is a lack of staff on a night shift. Contrary to popular belief, working night shift is not a walk in the park. As a matter of fact, it is harder due to the fact that there is not as much nursing staff working at night as it is during the day. In residential care facilities with about 46 residents requiring care, a day shift requires 2 nurses to give medications and attend to the needs of 46 residents. At night time, most residential facilities only have 1 nurse and a care aide to take care of the same number of residents. There will be nights where it will be quiet and there will be nights where the workload will be too much for just 2 staff to handle. As a result, patients have to wait for longer time to be attended to. In these situations, falls among the residents and injury are inevitable. The frequency of nurses calling in sick is likewise increasing. Moreover, studies have shown that nurses who work 12 hours shift or longer are more prone to committing errors (Johnson, 2008). This is not to mention the changes in work attitudes. Nurses who are tired are showing signs of irritability, lack of motivation, and loss of empathy that are critical in supporting the patients’ attainment of optimum health. It has to be remembered that provision of health care to patients is not limited to making sure that they are physically healthy. The care extends to the emotional and mental aspect of the well-being of the patients. A fatigue nurse will not be able to address these aspects of care (Ross, 2008).

The gravity of the impact of fatigue among nurses to the safety of the patient can be measured by what happens to the patients. Take for example the case of a nurse who worked at St. Mary’s Hospital in Madison. The nurse worked an 8-hour shift on July 4^th, 2007 but also accepted an extra shift on the same day. She was also scheduled to work a 7 in the morning shift on the following day so at the end of her 2 shifts; she slept for 2 hours and worked the next day. However, during the second half of her July 5^th shift, she mistakenly administered the wrong medication to a patient. Instead of giving the patient IV penicillin for a streptococcal infection, she gave the patient IV bupivacaine to the 16 year old patient that is scheduled for an induced labor. The wrong medications resulted to a cardiac arrest that killed the patient, but the baby survived. A felony of criminal neglect of patient causing great bodily harm was filed against the nurse but she was allowed to plead guilty to two misdemeanors with no contest. Her license was suspended for nine month but has lost her job.

In 2014, the National Patient Safety Goals have also included alarm fatigue as one of the threats to the safety of the patients. This type of fatigue points to process wherein nurses have are becoming more and more desensitized with the bells ringing and alarms going-off. It cannot be denied that nurses face hundreds of alarms on a daily basis from a patient needing some assistance or from IV units needing replacement. As a result, nurses are having problems prioritizing alarms and bells to the extent of ignoring the alarms or silence it. This does not include the situation wherein patients have to wait long time to get the assistance they need as the nurses become busy with other patients. Hence, it is increasing the risk of falls and other safety hazards for the patients.

Positions or Viewpoints

According to the American Nurses Association (n.d), fatigue and inadequate sleep among the nurses can have major negative implications not just on the health of the nurses but it can also greatly compromise patient care. It is also associated with early retirement, disability, increased employer’s cost, worker’s compensation claims and cost for training and recruitment activities. The American Nurses Association is calling for the collaboration of employers and nurses to reduce the nurse fatigue and the implications that come with it. The organization also calls for nurses to be proactive in addressing fatigue and sleepiness. On the other hand, the National League for Nursing has been supporting studies on work-related fatigue and how to improve and promote the health of the nurses to better provide a safe and quality patient care. The New York State Nurses Association made their position regarding fatigue in nurses clear by fighting to ban mandatory overtime for nurses. Before the 1^st of July 2009, registered nurses are being forced to work longer hours and overtime despite exhaustion. The New York State Nurses Association, together with 14 other states in America, condemned such work practice and won. The government, however, still allows voluntary overtime (New York State Nurses Association, n.d).  The National Patient Safety Goals are extending the context of fatigue among nurses and other health care workers by considering alarm fatigue as threat to patients’ safety.  Studies are being conducted to explore the devastating effects of alarm fatigue to patients to strengthen the evidence of its existence and to map out a plan of addressing the problem.

Clearly, all the nurses association and commissions are working hand in hand and incessantly to ensure that nurses are healthy and well enough to do their job. It must be noted that this is not just a one way street. The protection is not just meant for nurses but more importantly, it is for the protection of the patients. A healthy nurse means healthy patients. They will be able to provide the optimum care that the patients need to attain optimum health. It has to be remembered that while nurses take care of the patients and ensuring their safety, the welfare of the nurses must also be protected and taken-cared off.

Management Plan

The following recommendations are geared towards managing fatigue in nurses:

1. Government must provide a standard for numbers of staff in a health care facility. In this way, short-staffing can be prevented and the workload will not be as heavy. Additional funding must also be provided to address the problems in short staffing and to promote safe work practices.
2. Employers and management must establish safe and effective scheduling practices to limit the working hours of nurses to a maximum of 12 hours per shift (Ellis, 2008).
3. Policies regarding meal breaks and periods of rest must be developed. The management and employers must make sure that nurses are getting their meal breaks without interference.
4. Education classes regarding managing fatigue at workplace must also be provided. In this way, nurses can be encouraged to be proactive in taking care of themselves and how important it is in the context of patient safety.
5. A review of the ethical responsibility of the nurses must be updated and discussed quarterly to ensure that nurses are reminded of their duties and their role in the promotion of patient safety.
6. Increase communication among the staff members.
7. Map out plans to address alarm fatigue to include further studies, additional staff and updated alarm system.

References

American Nurses Association. (n.d). Nurse Fatigue. Retrieved from http://www.nursingworld.org/fatigue

Ellis, J.R. (2008). Quality of care, nurse’s work schedules, and fatigue: A white paper. Seattle, WA: Washington State Nurses Association.

Johnson, J. (2008). The increased incidence of anesthetic adverse events in late afternoon surgeries. AORN Journal, 88(1): 79-87.

Lyndon, A. (2007). Agency for safety in perinatal nursing practice. San Francisco: University of California.

New York State Nurses Association. (n.d). Mandatory Overtime. Retrieved from http://www.nysna.org/mandatory-overtime#.VmfS2b-hpiZ

Ross, J. (2008). Fatigue: Do you understand the risks to safety? Journal of PeriAnesthesia Nursing, 23(1): 57-59.

Ruggiero, J. (2002). Correlates of fatigue in critical care nurses. Newark, NJ: Rutgers, the State University of New Jersey.

Zboril-Benson, L.R. (2002). Why nurses are calling in sick: The impact of health-care restructuring. Canadian Journal of Nursing Research, 33(4): 89-107.