Fatigue: Implications for Nursing Practice

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The issue of fatigue has become a popular topic for discussion most recently as it relates to patient safety and nurse well-being.  Given our aging nursing professionals and the ensuing nursing shortage, recruiting and retaining nurses has become a key focus for most institutions.  Providing a supportive care environment has included many components for promoting the health and safety of patients as well as staff.  Components such as adequate staffing, no mandatory overtime, coverage for breaks, expansion in the use of safety checklists, nationally standardized processes such as same color patient ID bands and code names for such events as cardiac arrest and fire, no interruptions for the healthcare provider standing in the medication room or at a medication-dispensing station, are frequently items of discussion and emerging key focus areas.  And, many of these components have an element related to the concept of fatigue.

As nursing professionals we are obligated to explore these components, and where possible, to create environments where we can study the implications of these various care delivery strategies.  Additionally, where there is evidence to support making changes in practice, we as professionals are obligated to pay attention to such evidence and make decisions accordingly – in administrative practice, clinical practice, as well as individual professional practice.

The Washington State Nurses Association has prioritized the issue of fatigue as an area of practice needing serious attention.  Accordingly, we have commissioned the development of a document:  Quality of Care, Nurses’ Work Schedules, and Fatigue: A White Paper

• Download and read the new WSNA White Paper on Fatigue, by Jan Ellis, PhD, RN, ANEF

Additionally WSNA, in collaboration with the Northwest Organization of Nurse Executives, co-sponsored a workshop on June 20, 2008.  The keynote speaker for the program was Ann Rogers, PhD, RN, FAAN, Associate Professor at the University of Pennsylvania.  Dr. Rogers holds a joint appointment with the School of Nursing and the School of Medicine’s Division of Sleep and Respiratory Neurobiology.  Her research has focused exclusively on sleep and sleep disorders.  Her recent work has focused on the effects of fatigue and patient and nurse safety.

Resources from the June 20, 2008 Workshop on Fatigue:

• Ann Roger's On-screen Slides (PDF; 1.8MB)
• Scoring Handout (PDF; 131 KB)
• What Do We Know About Sleep - Or the Lack of Sleep? (PDF; 212 KB)
• Epworth Sleepiness Scale (ESS) assessment tool (PDF; 189 KB)
• Pittsburg Sleep Quality Index (PSQI) tool (PDF; 152 KB)

Numerous practice recommendations were developed collaboratively by workshop participants including staff nurses, nurse managers, nurse educators, and chief nursing officers:

• Practice Recommendations (PDF; 35KB)

Additional References:

• [Refer to White Paper References]
• Lorenz, Susan G. (2008) 12-Hour shifts: An ethical dilemma for the nurse executive. Journal of Nursing Administration. 38 (6), 297-301.
• Nurse Fatigue - The Human Factor (Alabama Nurse, Sep-Nov 2005)
• Patient Safety: Fatigue, Stress and Work Schedule Effects  (American Association of Nurse Anesthetists, Advisory Opinion 5.1)
• Long Shifts, Sleep Deficits Raise Nurses' Risk for Drowsy Driving, Motor Vehicle Accidents (Sleep Journal, December 2007)
• Study Finds Nurses Need Their Naps (NurseZone.com)

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