1. ADDRESSING NURSE FATIGUE TO PROMOTE SAFETY AND HEALTH: A JOINT RESPONSIBILTY BARBARA B. HOBBS, PHD, RN SOUTH DAKOTA NURSES ASSOCIATION OCTOBER 5, 2015

2. PREVAILING MESSAGES  Little acceptance by nurses  We all worked nights and shiftwork;  Expected as part of the job.  New RNs need to “get over it”  Iam safe even when I tired.  RNs should be fired for napping; it is patient abandonment  Patients come first; meal breaks are a luxury

3. PURPOSE  Articulates the ANA’s position of the joint responsibility of RNs and Employers to:  Reduce risks r/t sleepiness and fatigue  Create and sustain a culture of safety  Healthy work environment  Work-life balance

4. DEFINITIONS  Fatigue – impaired function resulting from physical labor or mental exertion.  Physical – reduces physical capacity  Objective – reduced productivity  Subjective – weary, unmotivated  Sleepiness – Inc. propensity to fall asleep resulting from an imbalance of the sleep/wake cycle.  Decreased sleep quality and quantity

5. REVIEW OF THE EVIDENCE

6. SHIFTWORK & LONG WORKING HOURS  Growing body of evidence on the effect inadequate sleep and resulting fatigue  Inability to provide optimal patient care  Risk of error; reduced job performance  Health and safety issue  Safety, drowsy driving  Direct costs and financial impact

7. JOINT RESPONSIBILITIES OF RNS AND EMPLOYERS  Collaboration to achieve safe, quality care for patients.  Supports AACN Standards for Establishing and Sustaining Healthy Work Environments (AACN, 2005)  Recommendations to adopt evidence-based strategies to reduce health and safety risks (JCAHO, 2001& 2012)

8.  IOM (2004) recommendations  not exceed 12 Hrs. in 24 Hrs. or  60 total Hrs. / 7 days  Best Evidence  more than 40 Hrs. per 7 days linked patient safety and nurse health.  ANA Recommendation  ≤ 40 Hrs.- (paid + unpaid) work in 7 days

9. RNS’ ETHICAL RESPONSIBILITY  Address fatigue and sleepiness in the workplace leading to harm or prevent optional care;  Practice healthy behaviors;  Take meals, rest breaks;  Implement fatigue countermeasures  naps, caffeine, exercise, etc.;

10.  may refuse an assignment that compromises availability of sufficient time to sleep;  Implement fatigue countermeasures  11 evidence-based strategies  seek health care provider input when fatigue or health symptoms are unresolved.

11. EMPLOYERS’ RESPONSIBILITY  Establish a culture of safety  Adopt policy that allow RN to accept or reject assignments to prevent risks from fatigue.  Limit work hours to 40 Hrs. / 7 days  Including meetings, in-service, on-call hours  Regularly audit scheduling practices

12.  Verify nurses get breaks and meals;  Support 20-30 minute naps;  Limit extra shifts scheduled;  Adopt and implement ANA’s key (7) and additional workforce and scheduling strategies.

13. TAKE HOME MESSAGE:  Reflect on your own habits  sleep/wake; meal breaks, exercise  Know and follow the evidence  Role model healthy work behaviors  Communicate & support implementation of the ANA recommendations.