Reduce nurse fatigue with 40-hour workweeks, no forced overtime

Nurses shouldn't be required to work overtime to cover staffing shortages, the American Nurses Association (ANA) said in a position paper released last week that called for hospitals and nurses to work together to reduce nurse fatigue and possible harm to patients.

"Research shows that prolonged work hours can hinder a nurse's performance and have negative impacts on patients' safety and outcomes," ANA President Pamela F. Cipriano, Ph.D., R.N., said in a statement. "We're concerned not only with greater likelihood for errors, diminished problem solving, slower reaction time and other performance deficits related to fatigue, but also with dangers posed to nurses' own health."

Evidence-based recommendations in the position paper include:

  • Scheduling 40-hour work weeks with shifts of no more than 12 hours, including hours on call

  • Halting the use of forced overtime to cover staffing shortages

  • Formally giving registered nurses the right to accept or reject work assignments to prevent fatigue-based risk, with no adverse consequences including being accused of patient abandonment

  • Letting nurses be involved in designing regular, predictable work schedules

  • Promoting frequent, uninterrupted rest breaks during shifts

  • Encouraging nurses to be more proactive in managing their health and rest, including sleeping at least seven hours a day

In addition, the ANA called for an anonymous system for employees to report accidents, errors and near-misses. Incident investigators should look at factors that increase the risk for fatigue-related errors to determine if fatigue played a role.

Fatigued nurses are more likely to regret their clinical decisions than nurses who get plenty of sleep, researchers at the University of Illinois at Chicago College of Nursing found in a study that focused on critical care nurses. Those working at night and on 12-hour shifts were more likely to regret their decisions.

Nurse fatigue also can cost hospitals more money, as well as hinder patient and employee satisfaction, according to a separate report issued last year. In the accompanying survey, more than a quarter of the nurses surveyed reported making a fatigue-related error, with two-thirds saying fatigue caused a near-error on their part.

For more information:
- see the position paper
- here's the statement