Nurse fatigue and patient safety

A disturbing report highlighting the extent to which nurses across the country are experiencing fatigue on the job points to the need for changes in the workplace to ensure patient safety isn't compromised.

The research report, Nurse Fatigue and Patient Safety, was prepared by the Canadian Nurses Association (CNA) and the Registered Nurses' Association of Ontario (RNAO).

In a survey of more than 7,000 registered nurses across all sectors of health care, more than 55 per cent reported feeling almost always fatigued during work, while 80 per cent indicated they always felt fatigued after finishing work. In addition to depleting their physical energy levels, nurses said fatigue interfered with their ability to make good judgments and sound decisions. Nurses point to relentless and excessive workloads, ongoing staffing issues and sicker patients as the key reasons for their fatigue. Coupled with the cognitive, physical and emotional strains of working in high-stress environments, the report concludes that fatigue is taking a heavy toll on nurses.

Both CNA and RNAO say the research, which included a broad environmental scan, interviews, a national survey and literature reviews, highlights a serious issue that must be addressed immediately through policy decisions at all levels of the health-care system. CNA and RNAO say a call to action to governments, health-care organizations, nursing associations, regulatory bodies, unions, educators and nurses themselves, is urgently needed.

Key recommendations in the report include: - ensuring governments at all levels provide adequate funding to increase the number of RNs to ensure safe care for all patients, in particular, sicker, complex or unstable patients; - requiring organizations to make public annually, their overtime, absenteeism and disability statistics, as part of their Quality Improvement Programs and accountability agreements with funding bodies; and - supporting nurses to assume more responsibility for mitigating and managing fatigue while at work, including using professional approaches to decline additional work assignments

"Although those in the profession know the risks of working when fatigued, many tend to pay more attention to the needs of their patients and colleagues than to their own," said RNAO president David McNeil. "Change at the system and organizational levels are urgently needed to mitigate and manage fatigue in the nursing profession."

"Nurse fatigue is just one of the negative consequences that can be linked to Canada's RN shortage," said CNA president Kaaren Neufeld. "The imperative for the Canadian Nurses Association and RNAO in spotlighting this crucial problem and identifying specific solutions is to guard against unsafe patient situations and stop a potential exodus of nurses from the profession, which would further compound patient safety."