When I speak about nurse staffing issues at conferences, one question consistently comes up. Nurses ask, “If I am not scheduled to work, and work calls, what responsibility do I have to come in?” While there is no legal requirement in this situation, it does present a moral dilemma. Nurses want to help their colleagues, and know that better staffing equals better patient outcomes. Yet, nurses also need to balance their personal lives and family needs. This dilemma can lead to nurses experiencing moral distress.
Several studies, including one published in 2002 by Linda Aiken, PhD, RN, FAAN, FRCN, and another published in 2007 by Robert L. Kane, MD and colleagues, have demonstrated that better staffing does improve patient care. Research also shows that fatigue can impact patient outcomes. For instance, one study by Marianne E. Weiss, DNSC, RN, and colleagues noted that in units with higher RN nonovertime staffing, the odds of patient readmission were lower compared with units that included RNs working overtime. RN overtime was positively associated with post-discharge utilization, which means when RN overtime staffing was higher, the odds of ED use also were higher, resulting in 1.7 times higher odds of an ED visit.
What is the answer to this dilemma? While working on my private pilot’s license, I have learned many useful mnemonics. One example is the IMSAFE checklist. As noted in the Federal Aviation Regulations Aeronautical Information Manual, Chapter 8-1-1, commercial and private pilots should use a checklist to assess their ability to fly safely. To prevent human injury or loss of life, the Federal Aviation Administration expects pilots to identify, assess and satisfactorily mitigate risk through a safety-risk management process, which includes using checklists.
The IMSAFE checklist is very easy to apply as an objective measure of your ability to work an additional shift if you’re asked.
I — Illness — Are you suffering from any illness or symptom of an illness that might affect ability/performance?
M — Medication — Are you currently taking any prescription or over-the-counter drugs?
S — Stress — Are you overly worried about other factors in your life? Psychological, environmental and physiological stress can be a powerful distraction and affect ability.
A — Alcohol — Legal limits vary. State boards of nursing have position statements on this subject.
F — Fatigue — Have you had sufficient sleep and adequate nutrition?
E — Emotion — Have you fully recovered from any extremely upsetting events?
While nurses are not flying a plane, we are taking care of lives. As such, we can routinely look to the safety record of aviation and ask what we can apply to make healthcare safer. There is no single answer for the question, “Should I go into work on a day off?” However, understanding the research, noting valuable risk management lessons from aviation, and performing a self-assessment can help you decide.
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