What is the Quality of the Evidence on Nurse Fatigue, Hours Worked, and Patient Safety?

Thursday, 16 July 2009: 8:30 AM

Linda. L. Coy, MSN, Ed
Patient Care Services, Kaiser Permanente, Pasadena, CA

Learning Objective 1: analyze the effect of nurse fatigue on patient safety.

Learning Objective 2: evaluate the need for Registered Nurses to work extended hours either voluntary or mandatory.

Purpose: The purpose of the August 2008 integrative review was to evaluate the quality of evidence on Nurse Fatigue, Hours Worked, and Patient Safety and provide recommendations from the experts to Nurse Executives and Ambulatory Care Directors, Nurse Managers and Staff Nurses.

Methods: An integrative review provided the quality of evidence on nurse fatigue, hours worked, and patient safety. The search found 28 relevant publications of the 483 reviewed from research studies, national organizations and expert opinion.

Results: Patients depend on healthcare providers to guarantee their safety. Nurses experiencing fatigue pose a serious threat to their patients that might cause harm or even death. A key relationship between hours worked and patient safety is the risk of error being three times higher when nurses work shifts greater than 12 hours, work overtime or work more than 40 hours per week. Nurses who work extended hours struggled to remain alert and were more likely to cause fatigue-related errors. Longer shift duration does increase the risk of making at least one error, regardless of the length of the original shift. Recommendations from the experts and national organizations suggest that extended work hours should be eliminated and that nurses should not work more than 12 consecutive hours during a 24 hour period. Education and awareness of the impact of nurse fatigue and its effect on patient safety is essential. It is clear that extended work hours are associated with errors and near errors.

Conclusion: A change in the nursing culture is needed to address the danger of fatigue and improve patient safety. Research efforts to gain additional knowledge regarding the impact of overall nursing hours worked on patient safety is needed as the culture of nursing encourages working to meet the needs of the patients without examining the consequences of nurse fatigue.