The American Nurses Association called for stronger collaboration between RNs and their employers and evidence-based strategies to reduce the risk of nurse fatigue for patients and nurses associated with shift work and long hours. The ANA also emphasized strengthening the culture of safety in the work environment in a 2014 position statement that replaces two 2006 position statements on the topic.
“Research shows that prolonged work hours can hinder a nurse’s performance and have negative impacts on patients’ safety and outcomes,” ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, said in a news release. “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.”
Research links shift work and long hours to sleep disturbances, injuries, musculoskeletal disorders, gastrointestinal problems, mood disorders, obesity, diabetes mellitus, metabolic syndrome, cardiovascular disease, cancer and adverse reproductive outcomes, according to the news release.
The ANA offered numerous evidence-based recommendations for RNs and employers to enhance performance, safety and patient outcomes. They include:
Involving nurses in the design of a regular and predictable schedule so nurses can plan for work and personal responsibilities.
Limiting nurse work weeks to 40 hours and work shifts to 12 hours.
Eliminating the use of mandatory overtime as a staffing solution.
Promoting frequent, uninterrupted breaks during shifts.
Enacting a policy that confers RNs the right to accept or reject a work assignment based on preventing risk from fatigue. The policy should include that a rejected assignment does not constitute patient abandonment and that RNs should not suffer adverse consequences in retaliation for such a decision.
Encouraging nurses to manage their health and rest, including sleeping seven to nine hours a day; developing effective stress management, nutrition and exercise habits; and using naps in accordance with policy.
The position statement was developed by a professional issues panel, established by the ANA board. The panel was comprised of 15 ANA nurses, with additional input from an advisory committee of about 350 members. The statement was distributed for public comment to nursing organizations, federal agencies, employers, individual RNs, safety and risk assessment experts and others, whose suggestions were evaluated for incorporation in the statement.