The Joint Commission Noticed We’re Tired After Long Shifts
The Joint Commission just issued one of their reports (available here with a free Medscape account), and this one states they’ve noticed we make mistakes when we’re tired and this is bad for patients. It is interesting that rules exist for physicians and medical residents regarding how many hours per week and how many hours in a row they can work, but to my knowledge none exist for nurses. Also interestingly, in this report the physicians chafed at the rules, indicating that they prevent needed continuity of care. I wonder how nurses would react if similar rules were handed down for our profession.
At least in my area of the United States, nurses work 12-hour shifts for the most part. For floor nurses, that generally means 14-hour shifts by the time you include report and tasks that have run over and have to be done. Anecdotally I would say that younger nurses complain bitterly about the fatigue after these long shifts but react srongly negatively at the idea of shorter shifts and working more than three shifts a week, whereas older nurses are more open to the idea of returning to five 8-hour shifts. All nursing opinions I have personally heard revolve around the shifts’ effects on us and not on the patients, although they are related: the article notes “a pivotal 2004 study of 393 nurses on more than 5300 shifts showing that those who worked shifts of 12.5 hours or longer were 3 times more likely to make an error in patient care.”
Three times more likely. That worries me. Nurses, how many times do you spend less than 12.5 hours at work for your 12-hour shift? Not very many, if you’re like the nurses I have worked with. A factor ignored in all the studies I’ve read on this subject is commuting time, too. Many nurses drive up to an hour to get to work. That adds 2 hours of awake time to every shift worked, and I know from the one job I had for which I commuted that that time does make a noticeable difference in fatigue.
The alert quotes a nurse from Atlanta:
“‘We have been slow to accept that we have physical limits and biologically we are not built to do the things we are trying to do.’
According to the Joint Commission alert, exceeding those physical limits can result in an extensive array of problems that can compromise one’s ability to provide optimal care, including memory lapses, an inability to stay focused, compromised problem solving, confusion, impaired communication, slowed or faulty information processing and judgment, diminished reaction time, and indifference and lack of empathy.”
When I started reading this alert, I assumed it was yet another report on how night shift was bad for you, but it doesn’t distinguish night from day shift—just lengths of shifts. As a veteran nightshifter who experiences more fatigue during the day, I find that refreshing. Dayshifters, you are not immune. We all need to pay attention to how we are faring during our shifts and take action if needed. The Joint Commission alert suggests things like naps, which are not going to happen, but usually we can arrange to go outside for a few minutes and just escape from the unit and swing our arms around to get our blood moving. A change of scene and some movement can really make a difference. Each nurse seems to have his or her own tricks for perking up, and it seems we need to be using them more. I don’t want to make three times more mistakes because I’m not alert…do you?
About MegenMegen Duffy, RN, BA, BSN, CEN, works in an ED at a community hospital in the Midwest. She serves as a local board member of the Kansas State Nurses Association and is a contributing editor to the American Journal of Nursing. Before her nursing career, she was a freelance medical editor and writer.
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