On 6/15/2009 r/b/moorehead.jr. m/d/ said:

Clearly nurses do not work until they stumble out of zeal for better care,but because they are short staffed and work cheaper when on long shifts,and feel morally obligated not to abandon their patients and no systematic way has been found to improve their handoffs of patients. Blame and punishment and harassement and denigration haunt them and shades of this cloud the first 30-45 minutes of their next shift as they explain and reexplain how they tried to manage a patent admitted at change of shift who was incidentally found to be hypertensive, but was in pain, agitated and hungry and soiled. There was no experienced supervisor nurse, they no longer exist, the "nurse manager" was in a 6 hour meeting, can't supervise from the meeting only distribute blame over many days and many more meetings and blast a "care partner"(what is that) out of a job. There are four offices on a floor of 13 patient beds. Cut costs there JACHO or Mr. Pres.

On 3/23/2009 Mario Vittone said:

I am waiting for the Joint Commission to institute the same crew rest requirements for perioperative teams as the FAA has for flight crews. I am always a little dismayed when hearing about surgeries that "took 14 hours" - as if anyone can effectively manage fatigue that long. Also very concerning to me is the way interns are worked for hours over any reasonable fatigue levels in the name of "learning." Great post.

On 3/18/2009 Staff Nurse said:

At my hospital the philosophy is that if you are too impaired to drive safely, you are too impaired to work safely. There have been days that I haven't slept well (I work nights) and I have called in to get coverage for the first 4 hours of my 12-hour shift in order to catch up on sleep. Thank heavens for float pool nurses!

On 3/17/2009 Jim Parker, Senior Editor said:

Thanks for raising that question. Currently, we do offer the ability for readers to subscribe to individual posts to keep up-to-date with a particular discussion that stems from a blog entry. It's the "bookmark and share" feature shown just under the title, author, etc. Also, we are in the process of adding an RSS feature to the blog itself so that readers can see when new posts are made.

On 3/17/2009 Don Martelli said:

Valid points on fatigue. Also, great work on the tips thus far. One small suggestion...utilize an RSS feed so folks can easily subscribe to your content.

On 3/17/2009 Maryanne Burakoff said:

As a long term night shift Respiratory Therapist, the best thing my Director recently did for us was to let us make our own schedule so we could realistically work the long hour shifts with adequate time to rest in between.

On 3/16/2009 Resident in Training said:

However, a number of studies have shown that work-hour limits have no ill effects on patient outcomes. Yet a bunch of residents seem to believe hand-offs *do* lead to patient harm: A 2006 survey of resident physicians at Massachusetts General Hospital found that handoffs commonly lead to patient harm, according to an article in The Joint Commission Journal on Quality and Patient Safety. More than half of the 161 medical or surgical residents who responded to the anonymous survey said they recalled at least one occasion in their last month-long rotation when a patient suffered from flawed handoffs. About one in nine said the harm that resulted was significant. And there's no work hour restrictions for attendings, or nurses, or techs, or RTs, or anyone else. How are we, as residents, to learn how to care for patients from admission to discharge, seeing our mistakes, complications, and side effects from medications and procedures without following a patient through their hospital course? And when we're out on our own in the community, practicing medicine alone?

On 3/13/2009 norma tucker said:

Dear Safety Awareness Council Your topic today was fatigue. I am not an RN, but have worked on the floor with RN's for years. How can our nurses not be exhausted when they work 12 hour shifts, sometimes 3 days or more in a row. The 12 hour day turns into 13 or more by the time they get report at the beginning of their shift and give report at the end. Then they are expected to go and rest to start the long day over again. Our nurses have a case load of approximately 5 patients on a shift. This equates to 12 minutes per hour per patient. Of that 12 minutes the nurse has to chart activities, collect medications and get medical supplies. If we are truely concerned about patient care, shouldn't we be concerning ourselves with the health and welfare of our nursing staff? Just an observation from the non-medical staff. Thank you for listening.

On 3/13/2009 JoAnn Wood said:

Very important not to call people in to work extra shifts when they are already maxed out! We are setting ourselves up for failure when we do this, no to mention putting our emploees at risk as well. I don't think those people who call in frequently or come in late frequently are thinking about the effects this has on their coworkers.

On 3/13/2009 Scott Wallask said:

This is pretty thought-provoking topic from the environment of care side of the house, too. I imagine there is an OSHA hook to this somewhere, too, in terms of the safety of workers who are fatigued while on the job, though I have never seen an OSHA standard directly address this concern. Thanks, Scott Wallask, Briefings on Hospital Safety

On 3/13/2009 Audrie Bretl, JCR Senior Editor said:

Well put, my colleague.

Health care worker fatigue has been on my mind since I worked in a hospital way back when. I always made myself feel better when I made a mistake by thinking, "at least I'm not doing brain surgery." I remember seeing doctors walking around the hallways looking like zombies after an 18- or 24-hour shift and feeling so bad for them. We expect them to do their jobs safely and save lives but so much pressure is put on them to run on empty, if you will. It put my job into perspective.

I'd like to point out a resource that might be helpful to the readers of this blog. Late in 2008, I edited a book called Strategies for Addressing Health Care Worker Fatigue that offered some really good information on this very topic. Readers can check it out by clicking here.