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Principles of fatigue and how it impacts nursing practice

Support/Funding

References

Bae, S., Brewer, C. S., & Kovner, C. T. (2012). State mandatory overtime regulations and newly licensed nurses’

mandatory and voluntary overtime and total work hours. Nursing Outlook, 60(2), 60-71.

Birmingham, S., Dent, R. L., & Ellerbe, S. (2013). Reducing the Impact of RN Fatigue on Patient and Nurse Safety. Nurse Leader, 11(6), 31-34.

Impact of Working Conditions on Patient Safety: Fact Sheet. October 2002. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/factsheets/errors-safety/workfact/index.html

Knudson, L. (2013). Nurse staffing levels linked to patient outcomes, nurse retention. AORN Journal, 97(1), C1-9.

Patient Safety Threatened by Insufficient Nurse Staffing, Fatigue. (2013). AACN Bold Voices, 5(8), 8.

Ranji SR, Wachter RM. Limiting Individual Providers' Hours of Service: Brief Update Review. In: Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 Mar. (Evidence Reports/Technology Assessments, No. 211.) Chapter 43. Available from: http://www.ncbi.nlm.nih.gov/books/NBK133396/.

Shekelle PG. Effect of Nurse-to-Patient Staffing Ratios on Patient Morbidity and Mortality. In: Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 Mar. (Evidence Reports/Technology Assessments, No. 211.) Chapter 34. Available from: http://www.ncbi.nlm.nih.gov/books/NBK133362/.

Shipman, D., Hooten, J. (2008). Without enough nurse educators there will be a continual decline in RNs and the quality of nursing care: Contending with the faculty shortage. Nurse Education Today, 28(5), 521-523.

  • Hold hospitals accountable for mandated safe staffing ratios
  • Medicare reimbursement
  • Public reporting of staffing ratios
  • Federal funds to facilitate higher education for nurses to pursue a degree in teaching

Policy Proposal

How Can We Ensure Patient Safety?

  • Enact laws or regulations to restrict mandatory overtime
  • Increase the number of nursing educational programs by increasing nursing faculty
  • Standardize and regulate nursing-patient ratios

  • Support the Registered Nurse Safe Staffing Act to establish minimum staffing ratios
  • Review Agency for Healthcare Research EBP studies aimed at improving the quality of US Healthcare and make appropriate recommended changes
  • Nurses' working conditions: effects on medication safety
  • Work environment for nurses and patient safety
  • Impacts of unit-level nurse workload on patient safety
  • The relation of hospital workload to patient safety
  • Staff nurse fatigue and patient safety
  • Hire more nursing faculty – expand nursing programs

Ages of RNs in US

Statement of the Problem

Effect of Nurse-to-Patient Staffing Ratios on

Patient Morbidity and Mortality

Who Are The Stakeholders?

Increased morbidity and mortality with decreased staffing

Fatigue in nursing

Patients

Healthcare providers

Healthcare establishments

Insurers

Payers

Pharmaceutical manufacturers

Mental and physical fatigue in nursing leads to multiple issues that include medication errors,

decreased endurance, decreased effective communication, and inability to perform fine motor tasks such as inserting an IV.

Luanne Cruz, RN

Causes

Long working hours

Increasing patient to nurse ratios

Higher level of acuity

Nursing shortage-Aging workforce

Acute and Chronic Fatigue Scores

Across Work Schedules

(higher = increased fatigue)

Correlation of fatigue and performance

Who Does This Policy

Proposal Affect?

  • Healthcare institutions and administrators
  • Hire more nurses to eliminate mandatory overtime
  • Educational institutions
  • Hire more faculty to expand quality nurse training programs
  • Lawmakers
  • Enact legislation to provide safe staffing in the hospital setting

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