- OUR INSIDE LOOK THIS WEEK FOCUSES ON A NEW PUSH TO
ACKNOWLEDGE FATIGUE AMONG NURSES.
THE AMERICAN ACADEMY OF NURSING HAS ISSUED RECOMMENDATIONS TO
PROMOTE A RESTED AND ALERT STAFF BECAUSE TIRED NURSES INCREASE
THE RISK OF MEDICAL MISTAKES AND PUTTING THEIR OWN HEALTH AT
RISK.
THE RISK OF ERRORS DOUBLES AFTER WORKING MORE THAN EIGHT HOURS
AND GO UP 3.5 TIMES FOR NURSES WORKING MORE THAN 12 HOURS.
LINDA SCOTT IS DEAN OF THE UW NURSING SCHOOL.
SHE JOINS US THIS WEEK TO TALK MORE ABOUT HER FINDINGS AND
RECOMMENDATIONS AS A MEMBER OF THE ACADEMY OF NURSING.
THANKS VERY MUCH FOR BEING HERE.
- THANK YOU.
I'M HAPPY TO BE HERE.
- SO INTERESTING.
YOU DID A NATIONAL STUDY OF NURSES' WORK HOURS.
WHAT DID YOU FIND?
- WE LOOKED AT OVER 11,000 SHIFTS AND WE FOUND JUST WHAT
YOU SAID, THAT RISKS FOR ERROR DOUBLES WITH OVERTIME, ANY HOURS
WORKED AFTER EIGHT, AND AFTER 12 HOURS THEY'RE 3.5 TIMES MORE
LIKELY.
BUT WHAT WE ALSO FOUND IS THAT ERRORS INCREASED WHEN THERE WAS
IN ADD QUITE SLEEP.
- WELL, SURE.
AND YET NURSES REGULARLY, I UNDERSTAND, WORK THESE 12-HOUR
SHIFTS.
HOW COMMON IS THAT IN THE PRACTICE?
- IT'S MORE COMMON.
IT STARTED OFF IN CRITICAL CARE, WITH THE GOAL TO TRY TO REDUCE
THE NUMBER OF HAND OFFS WITH A PATIENT.
BUT WHAT WE'RE FINDING IS EVEN THOUGH NURSES MAY WORK THREE
12-HOUR SHIFTS, THAT THEY MAY WORK ADDITIONAL SHIFTS
ELSEWHERE.
SO THERE'S LITTLE TIME FOR RESPITE.
AND WE ALSO FOUND THAT NURSES, EVEN THOUGH IT'S A 12-HOUR
SHIFT, THEY TEND TO WORK AN HOUR OR TWO BEYOND THAT.
WHEN YOU START THINKING ABOUT THE NUMBER OF CONSECUTIVE WAKE
HOURS, IT BECOMES VERY PROBLEMATIC.
AS ADULTS WE STILL NEED EIGHT HOURS OF SLEEP, AT LEAST, IN A
24-HOUR PERIOD.
AND WHEN YOU DON'T DO THAT AND WHEN YOU HAVE CONSECUTIVE WAKE
HOURS, YOU ALSO HAVE THAT SAME NEUROCOGNITIVE EFFECT THAT YOU
SEE WITH INTOXICATION.
- WOW.
WELL, SO IF THESE LONG SHIFTS ARE AN ISSUE, WHY DON'T
HOSPITALS JUST SHORTEN THE SHIFTS?
- WELL, THAT IS ONE OF THE RECOMMENDATIONS, IS TO BEGIN TO
LOOK AT NEW SHIFT WORK PATTERNS RATHER THAN 12-HOUR SHIFTS.
BUT THERE IS ALSO A CONCERN THAT IF THEY SHIFT TO A DIFFERENT
MODEL, THAT THEY COULD POTENTIALLY LOSE STAFF, BECAUSE
FROM A PERSONAL PREFERENCE, NURSES MAY ONLY WANT TO WORK
12-HOUR SHIFTS.
- SO WHAT ARE THE OTHER RECOMMENDATIONS?
- SO WHAT WE REALLY WANTED TO DO IS TO HAVE ORGANIZATIONS,
BOTH EMPLOYERS AS WELL AS EMPLOYEES, THE NURSES, TO REALLY
ENGAGE IN GOOD FATIGUE MANAGEMENT STRATEGIES.
SO, YOU KNOW, WHEN WE'RE TALKING ABOUT 12-HOUR SHIFTS, SO IF
YOU'RE GOING TO DO A 12-HOUR SHIFT, HOW DO YOU INCORPORATE
FATIGUE MANAGEMENT STRATEGIES WITHIN THAT?
AS AN INDIVIDUAL, DO I COME TO WORK FIT FOR DUTY?
HAVE I HAD ENOUGH SLEEP PRIOR TO THAT WORK SHIFT SO THAT I CAN BE
ALERT AND VIGILANT?
SO IT'S REALLY LOOKING AT OUR CURRENT PRACTICES AND MODIFYING
THEM.
A VERY GOOD AND EFFECTIVE FATIGUE MANAGEMENT STRATEGY IS
STRATEGIC NAPS, YOU KNOW, AND REALLY TAKING A 20-MINUTE NAP
WILL INCREASE YOUR LEVEL OF ALERTNESS AND ALLOW YOU TO BE
AWAKE AND IT WILL BREAK THOSE CONSECUTIVE WAKE HOURS.
- WELL, WITH THAT, HOW WILLING ARE EMPLOYERS IN
ALLOWING THEIR WORKERS TO TAKE CATNAPS DURING THE DAY?
- UNFORTUNATELY THEY'RE NOT.
MOST HAVE HUMAN RESOURCE POLICIES ON THE BOOKS THAT SAY
IF AN INDIVIDUAL IS CAUGHT NAPPING OR SLEEPING ON THE JOB,
IT'S GROUNDS FOR TERMINATION.
BUT YET THERE'S EVIDENCE THAT REALLY SUPPORTS THAT IF YOU GIVE
SOMEONE A RESPITE FROM THE JOB, IF YOU ALLOW THEM TO TAKE A
SHORT NAP, IT ACTUALLY IMPROVES PATIENT SAFETY AS WELL AS NURSE
SAFETY.
- I WOULD THINK SO.
YOU KNOW, THE IDEA THAT TIRED NURSES, YOU KNOW, ARE MORE PRONE
TO MEDICAL MISTAKES DOESN'T INSTILL A LOT OF CONFIDENCE ON
THE PART OF PATIENTS.
IS THIS KIND OF A TOUCHY SUBJECT FOR HOSPITAL ADMINISTRATORS?
- WELL, I THINK IT IS, BUT I THINK IT'S ONE THAT WE CAN NO
LONGER IGNORE.
WHEN YOU THINK ABOUT NURSES ARE HUMAN.
ALL OF US HAVE THE SAME ISSUE, WHETHER YOU'RE, YOU KNOW, IN
ACADEMIA, YOU'RE IN A HOSPITAL.
SO WE REALLY NEED TO LOOK AT HOW WE CAN DO HEALTHY PRACTICES, HOW
WE CAN INCREASE THE QUALITY AND QUANTITY OF SLEEP SO THAT WE
FUNCTION.
JUST THE LOSS OF AN HOUR OR TWO CAN -- AND YOU DO THAT A FEW
DAYS IN A ROW, YOU ACTUALLY CAN DEVELOP WHAT'S CALLED A
CUMULATIVE SLEEP DEBT.
YOU CAN'T GET THAT BACK.
- BRIEFLY, THE IDEA -- WELL, WE ALL KNOW THAT NURSES ARE THE
BACKBONE OF THE OPERATION.
HOW WELL IS THAT ACKNOWLEDGED BY HOSPITALS MAKING POLICY
DECISIONS ON THEIR BEHALF?
- WELL, NURSES, I THINK EVERYONE KNOWS THAT NURSES ARE
INDEED CRITICAL TO HEALTH CARE DELIVERY.
AND AS AN EMPLOYER, YOU ALSO REALLY NEED TO MAKE SURE THAT
YOU HAVE A HEALTHY WORK ENVIRONMENT.
SO WHAT I REALLY HOPE THAT THE ACADEMY'S POSITION PAPER WILL DO
WILL BE A CALL TO ACTION FOR ALL EMPLOYERS TO REALLY LOOK AT
THEIR CURRENT PRACTICES AND MAKE THIS TRULY A YEAR OF THE HEALTHY
NURSE AND BEYOND.
- ALL RIGHT.
LINDA SCOTT, THANKS VERY MUCH.
- THANK YOU.