Fatigue in Healthcare Workers

In the current healthcare environment, healthcare workers and job-related fatigue go hand in hand. While the need for 24-hour care in hospitals and skilled nursing facilities is not new, the pace and demands of patient care are. Medical care is more complex. In-hospital patients are more acutely ill, and nursing patients often have a variety of medical conditions that must be constantly monitored—patients with life-threatening conditions who once would have died now survive because of medical innovations, new drugs, and advanced technologies (MacDonald et al.). New treatment modalities and rapidly changing technologies, especially computerized and interconnected high-technology devices, require a new level of mental and physical alertness on the part of healthcare workers, and everywhere, staffing shortages and economic pressures mean extended work shifts and, in many states, mandatory nurse overtime. While workers in many other industries must also cope with work-related fatigue, constant contact with ill and suffering patients distinguishes healthcare workers’ experiences of fatigue.

Legislators, accrediting agencies, professional groups, and the general public are all well aware of the effects of fatigue in healthcare, in part due to media coverage of Institute of Medicine (IOM) reports such as Resident Duty Hours: Enhancing Sleep, Supervision, and Safety, which addresses concerns about medical residents’ fatigue;Keeping Patients Safe: Transforming the Work Environment of Nurses, which found a direct link between overworked nursing staff and patient deaths; and the eye-opening, and still frequently cited, To Err Is Human: Building a Safer Health System,which reported that as many as 98,000 patients die each year as a result of medical errors. The Joint Commission has issued a Sentinel Event Alert on the topic, the Accreditation Council for Graduate Medical Education (ACGME) has regulated the number of hours that medical residents may work, at least 17 states have passed laws or regulations limiting or banning mandatory overtime for nurses (“Many States”), and professional groups have called for work hour regulation.

Although the impact of fatigue on patient safety is a key area of concern, its effect on healthcare workers is also important, as fatigue and sleep deprivation have been associated with a number of physical and psychological problems. Fatigue also affects the safety of the general public; the National Highway Traffic Safety Administration estimates that at least 100,000 police-reported motor vehicle crashes annually are due to driver fatigue (Lerman et al.). In addition, worker fatigue may also raise a variety of legal liability issues for hospitals and other healthcare facilities, as fatigued workers make more medical errors. Finally, fatigue is also associated with lost workdays and an increase in occupational injuries, such as needlesticks, and is a factor cited by many nurses for leaving the hospital setting.

While people often use the term “fatigue” interchangeably with “sleepiness,” the two are actually different, although related, states, both of which are affected by sleep deprivation—a not uncommon fact of life for many healthcare workers. Sleepiness is, quite simply, the tendency to fall asleep. Fatigue, on the other hand, is a broader sense of weariness and depleted energy and is the result of the body's complex response to sleep loss and/or prolonged physical or mental exertion (Lerman et al.). * Fatigue is multidimensional in both its causes and manifestations; it is influenced by many factors: physiological (e.g., circadian rhythms), psychological (e.g., stress), behavioral (e.g., sleep habits), and environmental (e.g., work demand). Fatigue is experienced both physically (e.g., sleepiness) and psychologically (e.g., emotional exhaustion) and may persist despite periods of rest (CNA and RNAO).

_______________ * Fatigue is also associated with certain physical and psychological disorders not addressed in this Risk Analysis. ...