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A steep price to pay: fatigue compromises staff and patient safety.

1 A steep price to pay: Fatigue compromises staff and patient safety It’s not uncommon for nurses to work 3 12-hour shifts at 1 hospital and then work another 3 at a different hospital, yet anyone who works 12 hours is putting their patients in jeopardy, Sheryl A. Michelson, MS, RN-BC, said at the AORN Congress in March 2013. “This is not what nurses want to hear, but we need to think about this. We didn’t go into nursing to hurt people,” Michelson said during a compelling presentation on worker fatigue. “When we allow people to work 6 12-hour shifts in a row, we are pretty much signing their death certificate or maybe someone else’s in the community who gets hit by the person driving home,” Michelson told a packed audience. Having known 2 nurses who died from falling asleep at the wheel after working long shifts, Michelson is highly attuned to the dangers of auto accidents. “One was a very dear friend of mine. She left 3 young children, and it had a huge impact on me,” she said. As the manager of perioperative education at Stanford University Hospital in Stanford, California, Michelson is on call every fourth or fifth weekend, working from 3 pm Friday until Monday morning as the administrative manager. Over time, she has noticed an increase in complaints about staff behavior among people working long shifts, such as lack of teamwork, yet she also found more staff were requesting more hours. Michelson, a member of Stanford’s needlestick injury committee, sought to learn the association between injury incidence and length of shift. Through an extensive literature search, she learned some startling facts about the effects of fatigue: $18 billion per year is lost in productivity and accidents (among nurses and other shift workers such as fire fighters and the police), and there are at least 1,500 fatalities, 100,000 auto crashes, and 76,000 injuries annually. It’s important to know that fatigue constitutes overwhelming tiredness and impaired cognitive and physical function, she said. Nurses will admit to feeling exhausted, but they don’t know when they are dangerous. Often, it’s not until a major error occurs that people realize how much fatigue affects their performance. In one study, among 22,000 RNs who rotated shifts, 35.5% admitted to falling asleep while caring for patients. At Stanford, an academic institution with more than 600 beds that treats mainly adult patients, “we don’t force people to do 24-, 48-, or 72-hour call shifts, but many places do that,” she said. Some people take long hours voluntarily, and others are being mandated to do so because of how their hospital schedule is run. “They don’t feel that they have the ability to say ‘this is not safe,’” Michelson said.