Nurses in health care facilities may perform better through harm reduction strategies: Researchers

University of Maryland School of NursingOct 22 2010

University of Maryland School of Nursing researchers say nurses in hospitals and other health care facilities may perform better by following the lead of airlines, trucking, and nuclear plants, by limiting hours of service, ensuring prompt and definite breaks during shifts, and other scheduling strategies.

In the third of a series of reports, "Is It Time to Pull the Plug on 12-Hour Shifts?" Jeanne Geiger-Brown, PhD, RN, associate professor, and Alison Trinkoff, professor, ScD, RN, FAAN, recommend harm reduction strategies to institutions that use 12-hour nursing shifts.

The researchers acknowledge that some nurses prefer working a compressed series of 12-hour shifts and then having more time off. The trend for 12-hour shifts started in the 1970s and 1980s when there were nursing shortages.

Geiger-Brown says that despite many areas of the country today having a sufficient supply of nurses, the common practice of successive 12-hour shifts continues and many nurses suffer serious sleep deprivation, higher risk of health problems, and greater odds of making patient errors. The researchers say it is time to consider alternatives

"There is now a well-developed science of scheduling to reduce fatigue risk, along with commercially available fatigue risk-management software" to help industries identify schedules that lead to dangerous fatigue, the authors wrote in the Journal of Nursing Administration.

Circadian rhythm specialists have shown that federally regulated limits on truck driving shifts have reduced accident rates, says Geiger-Brown.

But scheduling in nursing is still self-regulated, they note. Due to the health care responsibility to their patients, Trinkoff says, "Nurses may be expected to stay until the job is done. It may never be done."

In the first part of their series, the authors summarized research evidence to challenge the 12-hour shift paradigm. In the second part, they described barriers to nursing executives moving away from the practice. In the newest paper, the professors offer strategies they developed from their extensive research, surveying, and traveling in the nursing profession.

"It became clear to me that even if [institutions] don't like the 12-hour shifts, they will not get rid of them," especially, Geiger-Brown says, because hospital budgets often leave hospitals with no "wiggle room" to hire more nurses.

The authors' suggestions to help mitigate the possible negative effects of the 12 hour shifts include:

•Eliminate all overtime (voluntary and mandatory) for 12-hour nurses.
•Leaving on time must become a guarantee rather than an unlikely occurrence.
•Don't call a nurse back to work after a 12-hour shift because it disrupts their sleep and implies that time off is a luxury, as opposed to necessary for practice and performance.
•Corporate napping, also called power napping. Both laboratory and workplace studies have confirmed (by electroencephalogram) that a brief 15- to 20-minute nap during a work shift confers additional alertness.
•Completely relieved breaks, where nurses are relieved of their responsibilities are important for performance, and need to be part of the cultural norm.
•Schedule easier tasks at the end of the shift, more difficult tasks at the beginning.
• Provide nutritious healthy food on night shifts so that workers can eat and refuel properly.

Trinkoff emphasizes, "Calling the nurse back in from home is a big one. We have data to show that when you are called back to work without enough sleep, you don't do as well, that you are more likely to be injured."

Geiger-Brown adds, "In many studies, results show that nurses don't get their breaks. We need the ability to ensure that Occupational Safety & Health Administration-mandated completely relieved breaks occur, and to do this, we may need others [nurses] to fill in."

She said the industry should use available technology to measure risk for schedule-related fatigue because research has shown that sleep-deprived individuals cannot accurately assess their own sleepiness.

"That way we should get away from scheduling regulations and more on fatigue prevention," says Geiger-Brown.