According to the National Sleep Foundation, adults need seven to nine hours of sleep for health and well-being. However, many shift workers such as nurses struggle to meet these recommended hours of sleep due to long work hours, shift work, and a highly demanding and complex work environment.
A study led by Dr. Amany Farag, associate professor in the UI College of Nursing, surveyed 1,137 nurses from eight hospitals in Iowa. It found that 79% of night-shift nurses reported poor sleep quality and 55.4% reported daytime sleepiness.
“Lack of sleep is associated with negative outcomes to nurses and their patients, such as injuries, cognitive failure, slow reaction time, lost productivity, burnout, and medication errors,” she said. “It is also associated with nurses’ drowsy driving, a major risk factor for car accidents and near accidents when driving home after extended work hours.”
Farag said that currently there is no evidence-based intervention to mitigate and manage nurse fatigue.
“Other industries such as commercial truck driving and aviation have federally regulated their working hours and implemented naps and work breaks as fatigue management strategies. However, our study participants shared that they cannot leave their patients to their equally fatigued colleagues to take a break,” she said.
Here, Farag talks about how fatigue impacts nurses and injuries, how technology may help detect sleepiness, and why addressing fatigue is critical to supporting nurses and lessening the national nursing shortage.
Q & A: Why can’t sleep behavior be captured by the hours of sleep or duration of sleep alone?
Sleep is a complex, multi-dimensional behavior that cannot be fully understood by considering only its quantity or duration. It involves multiple interrelated factors, including sleep quality, amount of sleep, timing of sleep, and sleep-wake cycle. Therefore, no single measure can capture it. For example, two people may sleep the same number of hours per night but have very different sleep quality. One person wakes feeling refreshed and well-rested, while the other feels tired. Understanding sleep requires a holistic approach that evaluates all dimensions.
Q & A: What do we need to know about nurse fatigue and interventions to manage it?
Nurse fatigue is a critical issue in healthcare due to its implications for patient safety, nurse well-being, and overall healthcare system outcomes. Our study showed that nurses experience more acute fatigue than chronic fatigue and more mental fatigue than physical fatigue. One might expect that night shift nurses are more fatigued than day shift nurses; however, our study showed the opposite. Day shift nurses were more fatigued than night shift nurses. Nightshift nurses, however, suffered from worse sleep quality than dayshift nurses.
There are general recommendations that can help with fatigue management. They include exercise, good sleep, naps, light therapy, and taking minibreaks during shift work.
Investing in fatigue management in health care systems is essential. Fatigued nurses suffer from impaired judgment, reduced coordination, and slow reaction time, which can increase the risk of errors and injuries and compromise patients’ safety. Fatigue-related errors can lead to high healthcare costs due to additional treatments (increasing patients length of stay), legal actions, and insurance claims.
More importantly, given the national nursing shortage, addressing nurse fatigue is critical for retaining experienced nursing staff and ensuring a sustainable healthcare workforce. Examples of fatigue management at hospitals include encouraging nurses to take breaks, having rest areas, and offering counseling services.
Q & A: How can technology help us learn about nurse fatigue or how to detect it?
Technology has the potential to significantly advance our understanding of nurse fatigue as well as aid in its detection and management. Here are a few examples:
Wearable Devices: Fitness trackers and smartwatches can monitor physiological parameters indicative of fatigue, such as heart rate variability, activity levels, and sleep patterns. These devices can alert nurses to signs of fatigue before it affects their performance.
Mobile Applications: Apps can be developed to track self-reported measures of fatigue, mood, and cognitive function. They can also be used to deliver mindfulness and relaxation exercises, which are designed to mitigate stress and improve sleep quality.
Artificial Intelligence (AI) and Machine Learning (ML): AI algorithms can analyze complex and large datasets, including work schedules, sleep patterns, and performance metrics to predict time periods at high risk for fatigue. This can help with more effective staff scheduling that minimizes fatigue.
Simulation and Training Tools: Virtual reality (VR), for example, can be used to train nurses to recognize and manage fatigue, including how to communicate about fatigue and its potential effects on patient care. These tools can also deliver relaxation/meditation sessions.
Telemedicine and Telehealth (Virtual nursing): These platforms can facilitate flexible work arrangements for nurses, reducing the need for travel and allowing for more restful off-duty periods, which can help reduce fatigue.
The use of any technology must be guided by ethical considerations to ensure data security and participants’ privacy.
Q & A: How can we better support nurses?
Adequate Staffing: Ensure that staffing levels are sufficient to manage the patient load, thereby reducing excessive workloads on individual nurses. We found that adequate staffing and resources were significantly associated with low fatigue scores.
Rest Areas: Provide quiet, comfortable, and designated rest areas for staff to take breaks during their shifts. These areas should be away from clinical areas and allow nurses to relax and recharge.
Break Management: Encourage regular breaks and ensure that nurses take these breaks. Discourage a culture of skipping breaks due to workload.
Mental Health Support: Offer access to counseling services, stress management programs, and mental health resources to help nurses cope with job-related stressors that can worsen fatigue.
Ergonomic Design: Design workspaces that reduce physical strain, such as adjustable patient beds and patient lifts, which can decrease physical fatigue.
Monitoring Workloads: Regularly review and monitor nurse workloads and patient acuity to ensure a fair and safe distribution of work that does not overburden individuals.
Transportation Options: Provide transportation options or accommodations for nurses who work night shifts or extended hours to prevent car crashes caused by drowsy driving.
Q & A: What studies are you working on now about nurse fatigue?
I am building off my studies that evaluate predictors of nurse fatigue, sleep, and recovery patterns. I am currently collaborating with two engineering teams to use artificial intelligence (AI) to develop predictive algorithms that can be used to 1) quantify nurses’ workload, 2) understand patterns of nurses sleep, fatigue, and recovery throughout work and non-work days, and 3) use the generated data to develop a scheduling dashboard that can help nurse managers with optimal staffing that helps nurses adequately recover between shifts.
Although our algorithms will use a sample of acute care nurses, they can be modified and used with other shift workers such as first responders and firefighters.
Published December 11, 2023
Some resources:
UI IPRC blog post: Nursing & injury prevention: Q & A with Professor McCarthy