Long shifts and few chances to rest may make for a nursing staff that has serious doubts about the quality of its own care, a new study finds, as tired nurses stationed in the critical care units of various hospitals have reported regretting the decisions of their patient care on multiple occasions.

Like doctors, who must begin their careers with intensive residencies to prepare, sometimes, for overnight shifts, registered nurses often report to the call of their patients. This sacrifice, however, may come at the expense of caring for those patients, as a cohort of 600 nurses who filled out questionnaires on personal- and work-related data, sleep quality, daytime sleepiness, sleep quantity, clinical-decision self-efficacy, and decision regret couldn’t recall whether they had performed their job to the best of their ability.

Sleep deprivation actually begins to erode the body’s various processes alarmingly quickly. After only a week of insufficient sleep, the body’s genes begin to activate in different ways, altering the state of a person’s immune system, stress hormone response, and ability to attack inflammation. The natural circadian rhythms we develop — the sleep patterns that tell us to rise, more or less, with the sun and to sleep when it’s dark out — become disjointed. As a result, our white blood cell function diminishes, our worsening lethargy turning to sickness.

We also lose our ability to think, an aspect of the present study that gave researchers alarm because in order to assess patient health, professionals must be capable of catching the subtle fluctuations they’ve been trained to spot — a spike here, a low cell count there. The briefest of missteps may mean the difference between one treatment route and another.

“Registered nurses play a pivotal role as members of the healthcare team, but fatigued and sleep deprived critical care nurses put their patients and themselves at serious risk,” lead author and RN, Dr. Linda Scott, said in the study. “Proactive intervention is required to ensure that critical care nurses are fit for duty and can make decisions that are critical for patients’ safety.”

The team suggests a three-pronged approach. First and foremost, nurses must be scheduled according to a strategically designed plan, one that maximizes fatigue management. In other words, it has to minimize the number of sleepy nurses on-duty. Next, hospitals must ensure these nurses aren’t working alone. While a nurse may have worked a long shift, yet claims to feel alert, the sheer number of hours he’s put in necessitates a second set of eyes. And if an otherwise routine shift overwhelms him, researchers argue hospitals should offer strategically planned nap times and relief staff to assist him.

“By working together to manage fatigue, critical care nurses and employers can ensure patients receive care from alert, vigilant, and safe employees,” Scott said.

Nurses comprising the study were largely male and worked shifts in excess of 12 hours, and to the surprise of the researchers, seldom made up the lost sleep during non-working hours. This signaled not only a work/life imbalance, but a larger systemic illness plaguing the specific hospitals. As the authors write, coming to a workable solution regarding nurse fatigue may be in part a simple awareness issue.

“In addition,” they concluded, “education on how to manage fatigue and incorporation of fatigue countermeasures should be routine practices in healthcare organizations.”

 

Source: Scott L, Arslanian-Engoren C, Engoren M. Association of Sleep and Fatigue With Decision Regret Among Critical Care Nurses. American Journal of Critical Care. 2014.