Addressing patient safety lapses caused by a tired nurse is not solely the responsibility of an individual healthcare worker, but also of an employer whose policies and culture can help protect nurses and patients alike, the American Nurses Association wrote in a recently shared position statement addressing fatigue.
The statement is the group’s first update on the issue since a 2014 publication. It urges workers and organizations to view nurse fatigue as a public health issue threatening patients and nurses alike, and looks to recast nurse fatigue as an issue requiring “collective ethical responsibility” rather than individual resilience alone.
“Fatigue isn’t a matter of willpower. It’s a systems problem, and it requires systemic solutions,” said Brad Goettl, D.N.P., chief nursing officer of the American Nurses Enterprise, said in a statement.
The position statement highlights research and surveys published since the 2014 statement outlining the prevalence of fatigue (75% to 80% of nurses reported moderate to high fatigue in 2021), contributing factors such as work hour scheduling and improper work-life balance and the various repercussions of nurse fatigue. On the latter, the statement’s authors cited studies describing:
- Increased medical errors
- Impaired cognitive function
- Reduced vigilance
- Compromised patient satisfaction
- Increased nurse burnout and turnover
- Increase risk of workplace injury, ranging from overexertion to needlesticks and drowsy driving accidents
- Increased susceptibility to chronic health issues and other illnesses
- Worsened mental health and well-being
- Poorer work-life harmony
- Higher risk of legal action, loss of employment or loss of nursing license
Some of these adverse effects come with clear financial costs, the statement’s authors note. Absenteeism forces employers to secure supplemental staff coverage, mistakes can lead to increased legal liability or penalties and workforce turnover can run a hospital tens to hundreds of thousands of dollars per worker, they wrote.
The position statement doesn’t shy away from individual nurses having their own responsibility to mitigate fatigue, and encourages them to adopt healthy lifestyle habits and prioritize sleep hygiene. Nurses must also remain aware of their rest, their hours and their ability to remain alert and responsive, the statement reads, while noting that some state boards consider voluntarily working over a certain number of additional hours grounds for charges.
Still, “while personal health behaviors are important, self-care cannot compensate for unsafe staffing, chronic overtime or misaligned scheduling systems,” the statement warns.
Here the ANA called for employers to implement a slew of policies and interventions that, per the cited research, mitigates the risk of nurse fatigue. These include limits on scheduling excessive and consecutive hours, allowing adequate recovery time between shifts, keeping schedules predictable—with the statement noting that AI-based scheduling tools appear to be “a promising solution … [that] can more effectively account for complex variables, such as fatigue, shift length limits and preference requests, compared with manual methods.”
Additionally, the position statement called on employers to promote open communication and a workplace culture in which employees feel safe to report fatigue-related concerns without fearing retaliation or penalty. This can include strategies such as peer support, the provision of designated break areas and, more broadly, consistently sufficient staffing levels.
“When nurses are routinely scheduled in ways that don’t allow for adequate rest and recovery, patients, nurses, and entire care teams bear the consequences,” Goettl said. “ANA’s position statement makes clear that addressing fatigue is a non-negotiable safety responsibility, and it provides a roadmap for employers to build safer schedules, stronger staffing practices, and a culture where raising fatigue concerns is supported, not penalized.”
ANA also noted that educators can play a role by including coursework on the impacts of fatigue or by emphasizing fatigue in nurse leadership programs.
The association noted that its position statement addresses and outlines evidence-based solutions to acute and chronic nurse fatigue stemming from work responsibilities. It does not directly address moral fatigue, compassion fatigue or burnout.