By Shawn Kennedy, AJN editor-in-chief
Just about every nurse I know has been “asked” (or “guilted” or “mandated”) to work an additional shift on top of a grueling one. The worst such experience I ever had was having to work from midnight to 8 am after working a straight week of 4 pm to midnight shifts. I was exhausted, but someone had called in sick, leaving only two RNs and one aide for the 11-bed ED trauma unit.
I was so tired that at one point I found myself falling asleep while I was standing by a patient’s bed charting vital signs. I couldn’t remember the blood pressure reading I had obtained just moments before. It was good luck that I didn’t make an error—and had the good sense to have a colleague double-check medications I was readying (these were the old days, before unit dosing).
“We’re concerned not only with greater likelihood for errors, diminished problem solving, slower reaction time and other performance deficits related to fatigue, but also with dangers posed to nurses’ own health.”
The statement summarizes research into working long hours and its association with errors, reduced alertness, and job performance as well as its effects on nurses’ health—manifested perhaps most dramatically in the dangers of drowsy driving, which has been implicated in deaths of nurses and others. (See our report about one case, “Can a Nurse Be Worked to Death?”).
Key recommendations from the ANA include:
- “…that registered nurses not exceed 40 hours of professional nursing work (paid or unpaid) in a seven-day period.”
- “…that employers should limit shifts (including mandatory training and meetings) to a maximum of 12 hours in 24 hours. (Those limitations include on-call hours worked in addition to actual work hours.)”
- “…that employers adopt—as official policy—the position that registered nurses have the right to accept or reject a work assignment on the basis of preventing risks from fatigue.”
Of course, staffing is a key factor in nurse fatigue and one that seems too often to get swept under the rug. Even within the recommended work times noted above, we’ve seen too many errors occur at the end of a long shift after several consecutive days. Twelve-hour shifts are problematic in themselves—see this previous blog post about that issue.
But kudos to the ANA—its statement is a good rallying point to support change. The next step: These recommendations should be developed into accreditation criteria for hospitals seeking Magnet status. I wonder, though: do most RNs see long hours and risk for errors as a real issue that might be addressed or just a fact of life that nurses must continue to deal with?