A Meassure of Perceived Fatigue among Nurses in Western North Carolina

Background/ Significance:  Managed health care and reduced reimbursement together with the nursing shortage is leading hospitals to rely on nursing overtime to meet staffing needs.  We are anticipating a heightened shortage of nurses as our aging population retires.  Other industries such as airline, trucking, and railroads have put policies into place to limit the hours employees can work in a week to circumvent fatigue in workers because fatigue contributes to worker errors.  Previous research has demonstrated a link between working long hours, fatigue, and decreased performance among nurses.  Fatigue has specifically been linked to on the job injuries and poorer patient outcomes.  The current trend in nursing is working 12-hour shifts.  This shift is popular among nurses and most think they fully recover from the long day on subsequent days off; however, research shows fatigue has more impact on a nurse working a 12-hour shift than one working an eight hour shift.  Evidence shows numerous negative effects of nurse fatigue on work performance.  It is well established that fatigue leads to decreased alertness, slowed reaction time, impaired communication, reduced motivation, lower productivity, lapses of attention to detail, compromised problem solving, increased risk of injury, and loss of empathy.

 Purpose:  This research study examined perceived fatigue among nurses.  The objectives were to measure the level of fatigue present, distinguish acute from chronic fatigue, determine the nurses’ ability to recover between worked shifts, and compare differences in fatigue across the various demographic groups within the study.

 Study Design/Methodology:   An anonymous survey was conducted to measure fatigue following a descriptive, correlational study design.  The survey instrument used in this study incorporated both the Fatigue Assessment Scale and the Occupational Fatigue Exhaustion Recovery Scale. These two survey instruments have proven reliability and validity and were combined to capture a more comprehensive depiction of fatigue than use of just one survey instrument may have offered.  The survey was distributed through email to nurses in direct patient care roles.  It was explained that participation was voluntary.  The email contained a link to an online survey where nurses could anonymously complete the survey.  There was no contact between the participants and the researcher.  Surveys were de-identified; IP addresses were not tracked.

 Setting/Sample:  The study was conducted in a large hospital system comprising five acute care facilities.  The hospitals are located in both urban and rural settings.  A convenience sampling method was utilized.  The total number of nurses in the study population was 2,764.  Study participants totaled 610 and represented a widely heterogeneous group of nurses.  All registered nurses who provide direct patient care in the hospitals were included in the study.  Nurses not working in direct patient care roles were excluded from the study.  All five hospitals were represented among the participants.

 Results:   When looking at the entire group of study participants, results from the Fatigue Assessment Scale indicated an overall presence of fatigue with a mean score of 23.5 utilizing descriptive statistics in SPSS.  When analyzing the Occupational Fatigue Exhaustion Recovery Scale, the study participants indicated an overall high level of acute fatigue with a mean score of 67.2.  The Occupational Fatigue Exhaustion Recovery Scale also revealed that participants, as a group, reported a medium or moderate amount of chronic fatigue with the mean score of 47.1 and a moderate ability to recover between worked shifts represented by a mean of 52.1.  A comparison of shift lengths revealed that nurses working a 12-hour shift reported a statistically significant higher level of acute fatigue with a mean score of 68.8, (p < .001), than nurses working ≤ 9 hours and nurses working 10 hours.  This is consistent with other studies of fatigue among nurses. When comparing day, evening and night shift nurses, nurses working night shift scored statistically significant higher on the Fatigue Assessment Scale with a mean of 24.9, (p < .001), than nurses’ working day or evening shifts.  Additionally, nurses in the study working night shift report the least ability to recover between shifts.  These results raise concerns regarding safe, high quality patient care since so many nurses are working 12-hour shifts in hospitals today.  There was not a statistically significant difference in reported fatigue between nurses who are required to take call and those who are not required to take call.  Moreover, there was no difference between nurses working in a trauma center and nurses working in community hospitals.  Although nurses working greater than 40 hours per week reported more chronic fatigue, mean 52.1, than nurses working less than 40 hours per week, mean 46.7, when compared there was not a statistically significant difference between the two groups (p = 0.08).  There was also no difference in reported fatigue among the various age groups.  .  The departments reporting statistically significant higher levels of acute fatigue compared to the other departments were labor and delivery and medical surgical inpatient units with mean scores of 72.9 and 72.3 respectively, (p < 0.5).  These mean scores represent a high level of acute fatigue.  The behavioral health department reported a statistically significant low capability of inter-shift recovery with a mean score of 37.9 (p < .05). 

 Conclusion:  Considering the increased acuity of patients today, the desire for quality patient care and the growing nursing shortage, the retention of experienced nurses should be a top priority.  This study and many others illustrate that 12-hour shifts result in a fatigued workforce.  Fatigue leads to exhaustion and burnout, which has shown to be a factor in nurses deciding to leave the profession.  Such a scheduling pattern is incompatible with goals for safe, high quality patient care; therefore the use of 12-hour shifts should be limited.  Healthcare leaders must provide healthy work environments to retain experienced nurses and to provide patients with safe experiences.  Shorter work shifts should be implemented in efforts to reduce the incidence of fatigue and burnout among nurses.  Hospital leaders must recognize that fatigued nurses present a risk to patients.  The number of hours that are required between worked shifts should also be well-defined to allow for adequate recovery.  Lastly, hospital leadership should change staffing patterns as well as their expectations of overtime and call duties, and view a fatigued nurse as incongruent with goals of patient safety.