Accreditation

Beat fatigue and improve patient safety

Accreditation Connection, February 23, 2004

Whether brought on by mandatory overtime, voluntary extra hours, or a desire for flexible schedules, health care professionals sometimes find themselves on the wrong end of fatigue.

A growing number of registered nurses are either asked or told to work more hours, a danger that poses “one of the most serious threats to patient safety,” according to a new report published by the Institute of Medicine (IOM), a private, nonprofit group that provides health policy advice under a congressional charter. Long hours also whittle down the on-the-job safety of the workers themselves.

The report offers several examples of how hospitals appear to “emphasize efficiency over patient safety.” Offering time-and-a-half pay to entice nurses to work overtime is one example, since it’s cheaper than hiring and training new staff to work the open shifts, says the IOM.

Further, “unless specified in collective bargaining agreements, there are no federal (and only a few state) regulations restricting the number of hours a nurse can work in a 24-hour period or over a period of seven days,” the report says.

Try this pop quiz
Can you guess whether the following statements are true or false?

• Brushing your hair will help you stay awake
• Eating peanuts will make you sleepy
• It’s possible to feel refreshed after a 90-second nap

Believe it or not, they’re all true, and they offer easy ideas that can help nurses and others stay awake.

There are other simple steps to consider, too. For example, sipping hot mint tea with lemon is a better way to counteract fatigue than chugging a cup of coffee with lots of sugar, according to Kirsty Kerin, PhD, a consultant with Circadian Technologies, Inc., in Lexington, MA. She specializes in preventing fatigue-related hazards associated with long-shift work.

If you tell nurses that fatigue threatens their well-being and that of their patients, they’ll all nod approvingly.

However, recognizing sleeplessness when it occurs is a more difficult chore because people often don’t recognize how tired they are until they begin dozing off.

Recognize the problem
It helps to identify the following signs of fatigue, as noted by the IOM:

• A weakened capacity to do work
• Slower reaction time
• Omission errors
• Compromised problem solving
• Reduced motivation
• Impaired hand-eye coordination, accuracy, speed, decision-making, and memory
• Struggling to stay awake
• Seeking physical support while standing, such as by leaning against chairs or beds

You can imagine how uncomfortable patients or fellow staff members would feel if they saw a nurse or physician exhibiting any of the above signs while responding to a clinical alarm or handling a needle.

Here’s another warning: Just after lunchtime and during the pre-dawn hours between 3 a.m. and 5 a.m. are particularly dangerous times for nurses, regardless of how long they’ve worked.

That’s because the body’s normal sleep rhythms want to shut the body down during those periods so that it can get rest.

“If you’re tired during those times, it’s not because you’re being lazy or disrespectful to patients; it’s because you’re struggling against a biological phenomenon,” Kerin says.

Five ways to beat fatigue
Sleep is the best way to counteract fatigue. A study published in 2002 in the Journal of Sleep Research suggests short naps can increase alertness. Kerin explains this and other ideas in the following tips for staying awake and alert:

1. Take a power nap—Five minutes or less will do the trick and is by far the best way to counteract the harmful effects of fatigue, she says. Go somewhere quiet during a break and wear sunglasses or a baseball hat over your eyes to block out the light. If you sit quietly and are tired enough, you’ll likely fall asleep. And don’t worry about waking up groggy. Your body isn’t able to slip into a deep enough sleep in five minutes to cause you to wake up dazed and disoriented, Kerin says.

2. Chew on ice or mint-flavored gum—The coolness of the ice stimulates your brain while mint naturally has properties that help keep you alert.

3. Eat citrus—Snack on an orange or put lemon in your tea if they agree with your palate. While it won’t give you the jolt that caffeine does, it will help stimulate your brain and increase your alertness.

Caffeine has its fans, but the stimulant prevents some people from sleeping restfully once they finally go to bed. This, in turn, may cause them to feel sleepy when they wake up to begin their next shifts.

4. Brush your hair—This helps stimulate your scalp and promotes blood flow to the brain. It won’t work miracles, but every little bit helps.

5. Avoid sugar—Otherwise, you’ll feel sleepier once your body hits that infamous sugar low, says Kerin. You should also avoid eating peanuts, milk, tuna, and turkey, since each of them has substances that promote sleep—just think of the aftermath of that turkey dinner each Thanksgiving.

If you hanker for a vending machine treat, choose pretzels rather than chips or sugary food. If you like citrus fruit, bring that in to snack on, and consider drinking hot apple cider rather than coffee, since apples also help the body stay awake, Kerin says.

That’s a long shift
An eight- to 12-hour shift is the norm for many nurses, but some work as many as 22.5 hours straight, according to the IOM’s report.

One study found that 27% of full-time hospital and nursing home nurses reported working more than 13 hours at a time, one or more times each week.

And in some cases, nurses don’t have a choice. One study conducted by the American Nurses Association found that employers forced six out of 10 registered nurses to work overtime.

Generally, nurses are unaware of how sleep-deprived they are and often don’t realize it until the problem is dangerously severe. Some nurses report falling asleep during their shift at least once a week.

Editor’s note: The IOM’s full report—Keeping Patients Safe: Transforming the Work Environment of Nurses—is available online at www.nap.edu/catalog/10851.html.



IOM: Limit overtime hours

Following are some of the recommendations from the Institute of Medicine’s (IOM) recent report on nurses and patient safety:

• States should prohibit nurses from providing patient care in excess of 12 hours in any given 24-hour period and in excess of 60 hours per seven-day period
• Health care organizations and unions should adopt similar restrictions through their policies
• Nursing schools, boards of nursing, and health care organizations should educate nurses about the patient safety threats caused by fatigue

Source: Keeping Patients Safe: Transforming the Work Environment of Nurses, published by the IOM.  

Most Popular

Related Articles