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Grueling work schedules linked to higher patient mortality, says nursing study

A recent study published in Nursing Research has confirmed the longstanding suspicion that adverse work schedules are linked to increased rates of patient mortality. More patients die in hospitals where nurses work long hours and have only short periods of time away from work.

Previous studies have shown that nurses get less sleep working 12-hour shifts, especially those working night shifts. Nurses who are sleep-deprived or fatigued encounter problems with concentration, memory, reaction time, and decision-making. They make mistakes more often and in some cases these mistakes will cost lives.

Data for the study was used from a 2004 survey of over 600 nurses working in 71 hospitals in North Carolina and Illinois. The increased mortality rates were chiefly among patients who suffered from pneumonia, aortic aneurysms, congestive heart failure, and heart attacks; increased rates of each of these were found to correspond to various scheduling issues.

However, this does not mean that the 12-hour shift should be scrapped, says North Carolina Nurses Association (NCNA) CEO Tina Gordon. “Continuity of care is one of the benefits [of the 12-hour shift],” she says. “A lot of patients will tell you that they like seeing the same nurse as much as possible ... I also think that you’re going to find a lot of nurses with an individual preference for working a few 12-hour shifts versus working 5 eight-hour shifts a week.”

Gordon argues that the real world seldom offers simple solutions to complex problems, since job satisfaction and turnover rates also indirectly influence patient outcomes. “You want to be able to recruit and maintain the most experienced nurses ... and keeping that turnover rate in check is important to patient outcomes. I think there are going to be arguments on both sides of the fence, and I think there’s not going to be one Holy Grail of what you need in your nursing departments for patient outcomes.

“It’s going to be the total package, and recognizing that all of these factors come into play, and finding a balance that works well.”

The NCNA has been working to raise awareness about nurse fatigue and fitness for duty, and has unequivocally opposed the use of mandatory overtime. According to a recent study by NCNA, the rate of incidence for mandatory overtime in North Carolina is “very, very low,” says Gordon. Part of their organization’s mission is to educate nurses about determining their own levels of fitness and understanding the dangers of taking on additional shifts at other facilities/employers.

How can nurses try to ensure that they don’t get overworked? It’s important that you carefully consider whether you feel fit for work. Discuss problems with your manager or union representative. Be prepared to refuse to work overtime shifts if you feel that you are overly fatigued. In the long run, however, you need to open the lines of communication with your employer and keep them open.

“Communication is key,” says Gordon, “and making sure that everyone is communicating about balancing the needs of the patient with the needs of the nurse. Making sure that the nurses understand that in the long run their health and well-being, and their own management of their fatigue level, is going to be the very best thing that they can offer their patients. Having an employer that accepts that and encourages that self-assessment is going to be the best for everyone in the long run.”

With the aging nursing population, Gordon says, the need for flexible scheduling, sensitive to individual abilities, is greater than ever. “There are a lot of nurses that are very rapidly approaching retirement age and if a twelve-hour shift is the only option for them, they may choose to leave the workforce. But it could be the case where a six-hour shift would be perfect for them … Assessing that individual nurses’ fatigue level ... is going to change based on that nurse’s situation.”

Other provisions to fight fatigue may include instituting short naps to revitalize nurses in the middle of the workday and using fatigue risk-management software for scheduling.

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