Here & Now

Nursing Fatigue and Medical Errors

FREDERICA FREYBERG:

Our inside look this week focuses on a new push to acknowledge fatigue among nurses. The American Academy of Nursing has issued recommendations to promote a rested and alert staff because tired nurses increase the risk of medical mistakes. Not to mention putting their own health at risk. According to our next guest, the risk of errors doubles after working more than eight hours. And go up 3.5 times for nurses working more than 12 hours. Linda Scott is Dean of the UW Nursing School. She joins us this week to talk more about her findings and recommendations as a member of the Academy of Nursing. Thanks very much for being here.

LINDA SCOTT:

Thank you. I’m happy to be here.

FREDERICA FREYBERG:

So I understand you did a national study of nurses’ work hours. What did you find?

LINDA SCOTT:

In that initial study, we looked at over 11,000 shifts and we found just what you said, that risks for error doubles with overtime, any hours worked after eight. And after 12 hours, they’re 3.5 times more likely. But what we also found is that errors increased when there was inadequate sleep.

FREDERICA FREYBERG:

Well, sure. And yet nurses regularly, I understand, work these 12-hour shifts. How common is that in the practice?

LINDA SCOTT:

Its more common. It started off in critical care, with the goal to try to reduce the number of handoffs with a patient. But what we’re finding is even though nurses may work three 12-hour shifts, that they may work additional shifts elsewhere. So there’s little time for respite. And we also found that nurses, even though it’s a 12-hour shift, they tend to work an hour or two beyond that. When you start thinking about the number of consecutive wake hours, it becomes very problematic. As adults we still need eight hours of sleep, at least, in a 24-hour period. And when you don’t do that and when you have consecutive wake hours, you also have that same neurocognitive effects that you see with intoxication.

FREDERICA FREYBERG:

Wow. Well, so if these long shifts are an issue, why don’t hospitals just shorten the shifts?

LINDA SCOTT:

Well, that is one of the recommendations, is to begin to look at new shift work patterns rather than 12-hour shifts. But there is also a concern that if they shift to a different model, that they could potentially lose staff, because from a personal preference, nurses may only want to work 12-hour shifts.

FREDERICA FREYBERG:

So what are the other recommendations?

LINDA SCOTT:

So what we really wanted to do is to have organizations, both employers as well as employees, the nurses, to really engage in good fatigue management strategies. So, you know, when we’re talking about 12-hour shifts, so if you’re going to do a 12-hour shift, how do you incorporate fatigue management strategies within that? As an individual, do I come to work fit for duty? Have I had enough sleep prior to that work shift so that I can be alert and vigilant? So it’s really looking at our current practices and modifying them. A very good and effective fatigue management strategy is strategic naps. You know, and really taking a 20-minute nap will increase your level of alertness and allow you to be awake and it will break those consecutive wake hours.

FREDERICA FREYBERG:

Well, that sounds great, but how willing are employers to allowing their nursing staff to take catnaps during the day?

LINDA SCOTT:

Unfortunately they’re not. Most institutions still have human resource policies on the books that says if an individual is caught napping or sleeping on the job, it’s grounds for termination. But yet, like I said, there’s evidence that really supports that if you give someone a respite from the job, if you allow them to take a short nap, it actually improves patient safety as well as nurse safety.

FREDERICA FREYBERG:

I would think so. You know, the idea that tired nurses, you know, are more prone to medical mistakes doesn’t instill a lot of confidence on the part of patients. Is this kind of a touchy subject for hospital administrators?

LINDA SCOTT:

Well, I think it is, but I think it’s one that we can no longer ignore. When you think about nurses are human. All of us have the same issue. Whether you’re, you know, in academia, you’re in a hospital. So we really need to look at how we can do healthy practices. How we can increase the quality and quantity of sleep so that we function. Just the loss of an hour or two can — and you do that a few days in a row, you actually can develop what’s called a cumulative sleep debt. You can’t get that back.

FREDERICA FREYBERG:

Briefly, the idea — well, we all know that nurses are the backbone of the operation. How well is that acknowledged by hospitals making policy decisions on their behalf?

LINDA SCOTT:

Well, nurses, I think everyone knows that nurses are indeed critical to health care delivery. And as an employer, you also really need to make sure that you have a healthy work environment. So what I really hope that the academy’s position paper will do will be a call to action for all employers to really look at their current practices and make this truly a year of the healthy nurse and beyond.

FREDERICA FREYBERG:

All right. Linda Scott, thanks very much.

LINDA SCOTT:

Thank you.