Ever since I attended the AONE conference this year, I have been puzzling over why fatigue management seems to be an elephant in the room among nursing. Everyone will agree that, in the theory, there is a problem, but there is very little being done from a practical or formal perspective, at least that I can see.
Quick level set: What is fatigue management? I would define it simply as the policies and processes for avoiding employee fatigue caused by working too much.
As I’ve researched this, I’ve found that in other industries there are regulations in place to prevent overwork by employees. Motivations for these regulations could be employee protection or safety or risk mitigation – it does not matter. They are there and commonly adhered to by the companies in that industry.
As a result of an investigation into a 2005 incident by the U.S. Chemical Safety and Hazard Investigation Board, the petroleum industry has adopted RP-755 (stands for “Recommended Practice”) with specific guidelines around shift durations and other related factors. Seem straightforward enough, right?
In healthcare, the Joint Commission has recognized the link between nurse fatigue and adverse events. In 2011, a new Sentinel Event Alert was published that calls attention to the negative patient safety impacts that can result from healthcare worker fatigue. This can simply be boiled down to a concise statement:
FATIGUED NURSES = PATIENT SAFETY RISK
So, why do I see so little happening around fatigue management? There are no formal guidelines in the healthcare industry to prevent fatigue, like the petroleum industry published. Even the Joint Commission has not given rules or policies for hospitals to follow. Instead, hospitals are managing as minimally as they can so as not to disrupt their normal staffing operations.
I mention “staffing” because that’s really where the rubber meets the road on preventing fatigue. At Axsium Group, we work with a cross section of hospitals around the world and, while everyone has general policies around consecutive shifts and long shifts, most of those policies are along the lines of “How to pay a premium when it happens” not “It must be prevented at all costs!”.
As a part of my research, I have been musing over why fatigue management does not have a bigger presence in healthcare. I think the answer lies parallel to tobacco smoking.
We reached a point in our culture a few years back in that everyone knows that smoking is bad for your health. But people chose to continue to smoke because (1) they think it is cool and (2) it only impacts them. So the health advocates tackling this issue changed their research and their targeted marketing about smoking. Instead of focusing on “it’s bad for you!” (as are so many other things that we all do at one point or another like overeating!), they started focusing on the impacts of secondhand smoke. This was intended to attack the reasons people continued to smoke: Now (1) it is not just bad for you, it’s bad for others around you. And (2) because you are hurting the people around you, it’s selfish not cool.
Here is the parallel in healthcare:
Hospital staff work hard, work long, and work too much because they want to be self-sacrificing in their commitment to patient care. Yes, it is exhausting but it only impacts them. As a result, hospital policies have evolved to provide corresponding benefits to working long and hard like having just three 12-hour shifts in a week and assorted pay premiums. That makes it cool to work long too.
For the healthcare industry to take fatigue management seriously, the focus needs to change from the staff to the patients. Remember the statement above? Fatigued Nurses = Patient Safety Risk. Healthcare needs to understand that when staff works long and hard, it doesn’t just impact the self-sacrificing nurse, it impacts the patient as well. And because patient safety is impacted, it is no longer cool to get pay premiums for it, it is selfish.
I know that is not a message you hear every day, but it is the kind of mindset shift that needs to happen for healthcare to take fatigue management seriously. It starts at the top, of course, but the bottom has to buy as well. Nurses have to want to NOT overwork themselves specifically because they are self-sacrificing and it is in the greatest good of the patient to have fresh, rested care staff.
In upcoming blog articles, I’m going to drill into this subject a little more and talk about turning the theory of fatigue management into practice. If you have any fatigue management related stories or feedback on this topic, email me at cflanders@axsiumgroup.com or put it in the comments section below.