The Business Case for Ensuring Nurses Get Some Rest
“Exhausting” is the word Kathleen Colduvell, RN BSN BA CBC, uses in an article to describe what it’s like to work a 12-hour shift. “Utterly exhausting,” in fact.
Nurses across the United States likely would echo this sentiment. Being among the most dedicated of healthcare professionals, nurses routinely set aside fatigue to deliver patient care even though nurse exhaustion actually can put patients at risk. Nurse fatigue has been directly correlated to negative outcomes like medication errors. Savvy healthcare systems will proactively address the issue of nurse fatigue to show their commitment to nurse well-being and patient care.
The high price of nurse exhaustion
No one would consider allowing a nurse to work while intoxicated, and yet fatigue can have a very similar effect to alcohol on a person’s cognitive abilities. One study cited in this Medscape article concluded “when an individual has been awake for as few as 17 hours straight, their cognitive and psychomotor performance deteriorates to equal that of someone with a blood alcohol level of .05% (about 1-2 alcoholic drinks, depending on body weight and speed of consumption).”
This level of nurse fatigue can lead directly to poor decision-making, including medication errors. In fact, sleep-deprived nurses may be twice as likely as their well-rested peers to report a medication error, according to a 1992 study of inpatient nurses who worked rotating shifts. Not only can medication errors lead to adverse patient outcomes, but the Network for Excellence in Health Innovation (NEHI) has pegged inpatient and outpatient medication errors as a $21 billion problem that leads to approximately 7,000 patient deaths each year.
And medication errors represent only a fraction of the financial impact nurse fatigue can exert on an organization. Overtime costs related to nurses working double shifts and high turnover rates due to overworked nurses seeking better schedules elsewhere also can negatively impact the bottom line.
How nurse fatigue happens
Many occupational factors can lead to nurse exhaustion or sleep deprivation. Working the night shift, for example, disrupts natural circadian rhythms and can make it difficult for nurses to get a good rest on their days off.
However, one major cause of nurse fatigue might relate simply to the systems used to schedule staff on individual units. Outdated scheduling systems like paper-and-pencil, first-come-first-served or electronic spreadsheets make it difficult to equitably distribute the nursing workload among the staff population. These outdated systems can make it nearly impossible for supervisors to visualize their staffing needs and distribute shifts equally among available nurses. This situation may lead, in turn, to some nurses working frequent double shifts while others don’t get the number of shifts they desire, despite their availability. This workload imbalance leaves a certain portion of the nursing population without adequate rest, while fresh staff nurses go underutilized.
The case for making sure nurses rest
Healthcare systems, ACOs and others can approach the issue of nursing fatigue from both a humane and a business perspective. As valued members of the healthcare team, nurses deserve to be provided with every opportunity to rest and restore their physical and mental energy between shifts. As well, patients deserve to be served by nurses who not only possess excellent professional skills but the well-rested cognitive ability to make good decisions and communicate with patience and compassion.
On the business side, addressing nurse fatigue may help reduce costly medication errors and improve patient safety. One way to ensure nurses get adequate rest between shifts is to balance the workload equitably within the available staffing population. Software-based scheduling can reduce the number of double shifts that lead to fatigue while ensuring underutilized nurses obtain the number of shifts they desire. Balancing the nursing workload in this way demonstrates an organization’s commitment to patient care and nurse well-being while simultaneously reducing costs related to nurse fatigue.