Nursing Fatigue, Nursing Shortage, and Patient Harm: It's Time to Break the Vicious Cycle

What if someone told you that you could save someone's life tomorrow by going to bed early, sleeping eight hours, and waking up refreshed? Would you do it (assuming you believed this to be true)? What if you knew this same person would die should you fail to follow this pleasurable protocol? Would you make sleep a priority then? Statistically speaking, this is a real dilemma nurses face many working days of their lives. Only, often times, the choice to sleep is either not made or not even offered as a choice! With the state of the dangerous relationship between nurses and fatigue today, nurses as a whole are in desperate need for someone to remind them that sleep is not a luxury, but a life-saving measure. Equally important, nurses must rise up and demand the right to their own self-care, for their own sake and the sake of the people in their care.

The relationship between fatigue, the nursing shortage, and quality of patient care is caught in a vicious cycle. First, the rising shortage of nurses has led to unstable coping mechanisms within the health care system such as mandatory overtime, increased length of shifts for nurses, loss of breaks during nursing shifts (50%) of the time (Ellis, 2008), and erratic, unreliable scheduling based on facility census. Such unstable coping mechanisms have led to dangerous levels of fatigue among nurses, which has severely detrimental effects on quality of patient care as well as the health of the nurses themselves. Nurses are often becoming burned out and stressed out, not to mention too ill to work, and either dropping out of the workforce or temporarily checking out, which brings us back to the beginning of the cycle: a nursing shortage that persists.

Fatigue harms the health of nurses and puts patients who go to health care facilities to get better at a significant danger of getting worse. Studies show a direct causal relationship between a rising level of fatigue and a decreasing level of alertness, concentration, judgment, mood, and performance in health care workers (Ellis 2008, p.1). It is shown to impair cognitive and psychomotor performance in working clinicians (Ellis, 2008, p.1). Working overtime is associated with a 61% increase in injury on the job, including needlestick and musculoskeletal injury. Night shift nurses commonly report incidents of drowsy driving, increasing the risk for auto accidents (Ellis, 2008). Fatigue has been related to increased risk for cancer, increased use of sick leave and decreased job satisfaction (Ellis 2008, p.2). Additionally, fatigue is directly linked to the disturbingly high incidence of patient safety error currently being rigorously scrutinized by the Joint Health Commission.

Ironically, the environment set up for nurses to work in does not support alertness and good judgment, but instead fosters the