Lack of sleep and on-the-job fatigue are taking a toll on nurses, leaving them at greater risk of making errors or regretting decisions while caring for critically ill patients, according to a new study published in the American Journal of Critical Care.
Nearly 30% of nurses surveyed said they had regrets about decisions they made while caring for patients in critical care units (CCUs). The study showed that those nurses were more likely to work night shifts or shifts of 12 hours or more. They also reported significantly more daytime sleepiness and acute fatigue.
About 75% of respondents said they had lost at least eight hours of sleep within a five-day period, increasing the likelihood that they would make errors. Male nurses were more likely than their female counterparts to say they regretted making poor decisions when tired.
According to the study, patients, particularly those who are critically ill, are at heightened risk for errors, or near-errors, when nurses are sleep deprived. About 19% of drug-related errors in CCUs are potentially life-threatening and 42% require “additional life-sustaining intervention.”
The study, Association of Sleep and Fatigue with Decision Regret Among Critical Care Nurses, was published in January 2014 by authors Linda D. Scott, an associate dean at the University of Illinois at Chicago College of Nursing, and Cynthia Arslanian-Engoren, an associate professor of nursing, and Milo C. Engoren, a clinical professor, both at the University of Michigan.
As part of the study, the authors analyzed more than 600 questionnaires completed by randomly selected critical care nurses. The respondents were asked about sleep quality, daytime sleepiness, sleep loss, fatigue and ability to recover during days off work.
Sleep deprivation can affect memory, alertness, attention, vigilance and decision making, according to the study.
“Because critical care nurses provide most of the care in the CCU, they must remain alert to provide safe care and recognize subtle changes in a patient’s condition,” the authors wrote.
The study comes on the heels of an annual survey by Nursing Times that found that more than 80% of nurses in the United Kingdom report short-staffing at work at least once a week, and that almost 73% said job stress increased their likelihood of illness, either physical or mental.
The survey, released in September 2013, also found that 74% of respondents had felt pressured to go to work even when they felt sick.
The co-authors of the study of critical care nurses in the United States called on healthcare employers to introduce work schedules that reduce the likelihood of fatigue and also to provide relief staff to cover for nurses during breaks.
“Proactive intervention is required to ensure that critical care nurses are fit for duty and can make decisions that are critical for patients’ safety,” Scott said in a statement.
