Nurses put safety first

The Scarborough Hospital takes initiative to reduce fatigue on the job

The Scarborough Hospital’s (TSH) nurses have launched a program addressing fatigue on the job in response to studies by the Canadian Nurses Association (CNA) that link overtired nurses to patient safety risks.

Following its research in the 2010 report Taking Action on Nurse Fatigue, the CNA urged hospitals to develop strategies to manage the problem. It says fatigue is “mentally penetrative,” making it much more serious than just a feeling of tiredness. It found that fatigued nurses are prone to making bad decisions that could lead to clinical errors and reduced patient safety.

Here are the numbers:

  • 55%: Of the 7,000 polled, the number of nurses who feel they are “almost always” tired at work.
  • Of the 7,000 nurses polled, 80% feel tired after work.
  • On average, nurses work more than 40 hours a week.
  • During a 28-day study, every nurse involved worked at least one overtime shift.
  • 2 out of 3 nurses work 10 or more overtime shifts in 28 days.
  • Nurses working 12.5 hours or longer are found to be 3 times more likely to make an error.

Source: Taking Action on Nurse Fatigue

Tanja Futter is a registered nurse helping to lead the nurse fatigue initiative at TSH. She explained that the project has two parts, one encouraging “safety huddles” and teamwork on units and the other focusing on addressing fatigue in the individual.

“I think professionally, literature indicates that for better patient care, with nurses that aren’t fatigued, there’s less personal injury, less patient safety concerns, and less medication errors,” says Futter.

The Nursing Practice Council at TSH will be organizing discussions, distributing self-assessment questionnaires and providing pamphlets to help nurses better identify and deal with fatigue in themselves and their co-workers.

Follow-up meetings will talk about how to identify fatigue in oneself and peers, how to confront stress in the moment and basic tips and self-care methods.

Futter emphasizes the importance of discussion as a strategy.

“Nurses know about fatigue, but the idea of identifying it within ourselves is not always something that we do,” she says.

Led by staff rather than by management, the program aims to empower nurses at an individual level to combat the issue of nurse fatigue.

They hope not only to improve the quality of care for patients, but also the quality of job life for nursing staff.

“What we’re hoping is to create awareness on an individual level,” Futter says.

According to the CNA, some of the symptoms of work-related fatigue are reduction of skillful anticipation and patient safety, diminished judgment, degraded decision-making, lack of concentration, and clinical errors. They attribute their statistics on nurse fatigue to a higher burden of responsibility on nurses, staff shortages and long shifts.

Futter also noted the prevalence of “short-shifting,” where nurses return to work within 10-or-so hours of finishing their last shift. Twelve-hour shifts are standard in the nursing community.

A profession-wide shortage of registered nurses has led to understaffing and longer shifts with more overtime.

Other changes in the hospital workplace, such as increased professional demands and workload, greater volume of patients, more complex methods of treatment and increased expectations from patients and their families are contributing factors in nurse fatigue.

The CNA and the Registered Nurses’ Association of Ontario issued recommendations for policies and programs in hospitals to manage the problem of nurse fatigue. According to Futter, TSH’s initiative is the only one of its kind in the Scarborough area.

“For our patients at the Scarborough Hospital, having nurses that are aware of fatigue and addressing fatigue within themselves makes a better patient care experience,” she says.

Futter said the initiative is starting with four of the hospital’s wards and the Nursing Practice Council plans to have all 1300 nursing staff involved over the course of this year.