Tired nurses may regret clinical decisions

Study finds male nurses, those who work 12-hour shifts, most likely to second guess care choices
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Nurses who are tired, don't get enough sleep or don't have time to recover between shifts are more likely than unimpaired nurses to regret clinical decisions they make during their shifts, according to a new study in the American Journal of Critical Care.

The research team, led by Linda D. Scott, R.N., Ph.D., associate dean for academic affairs at the University of Illinois at Chicago College of Nursing, analyzed the responses of 605 critical care nurses to personal and work-related questions on fatigue, sleep quality and quantity, daytime sleepiness, clinical-decision self-efficacy and decision regret.

Twenty-nine percent reported decision regret. These nurses were more likely to work nights and 12-hour shifts than nurses who didn't regret their decisions. They also reported significantly more acute fatigue and less time to recover between shifts, according to the study. Furthermore, they found that male nurses were more likely to regret decisions than female nurses.

"Registered nurses play a pivotal role as members of the healthcare team, but fatigued and sleep-deprived critical care nurses put their patients and themselves at serious risk," Scott writes. "In our study, the majority of nurses reported moderately high fatigue, significant sleep deprivation and daytime sleepiness, all of which affect their ability to be alert, vigilant and safe. Furthermore, the nurses were not likely to sufficiently recover from their fatigue-related states."

The findings indicate that healthcare organizations must take steps to ensure their critical care nurses are well rested. Researchers suggest organizations implement scheduling models that maximize management of fatigue, provide support resources for clinical decisions and have relief staff available to provide coverage for work breaks and strategic naps. They also recommend organizations provide routine education for staff on how to manage fatigue and incorporate fatigue countermeasures.

Furthermore, critical care nurses should also take individual steps to prevent fatigue, the authors write. They suggest nurses follow good sleep practices, take naps to decrease the number of consecutive hours awake and avoid accepting extended work shifts, excessive consecutive workdays and shifts that interfere with circadian sleep cycles.

A March 2013 survey conducted by Kronos reported that two-thirds of nurses had nearly made a mistake at work because of fatigue and more than a quarter had made a fatigue-related error.

However, a November 2013 study published in the Journal of the American Medical Association found a lack of sleep among surgeons does not increase the risk of adverse patient outcomes, FierceHealthcare previously reported.

To learn more:
- here's the study abstract

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