There was one big theme for me today at AONE – Fatigue Management.
When you go to conferences, there are usually multiple concurrent sessions to attend and I try to pick the ones that seem most interesting to me and ones that are on current topics. First up for me today was a session with Joe Tye who does motivational speaking on leadership. Apparently Joe has been working a lot with hospitals helping them establish a positive culture of ownership and engagement. I’m excited to read a copy of his book The Florence Prescription and came away excited and pumped about life in general. (He is a motivational speaker!)
Then I found myself in a session being presented by a representative of the Joint Commission who talked about fatigue management. That’s not a topic I hear a lot about in healthcare. I know that my counterparts at Axsium have told me that other industries (like the petroleum industry) have industry recommended practices to avoid consecutive and long shifts, but in healthcare, there are no industry standards.
To that point, the Joint Commission session spoke effectively to the very negative impacts of fatigue in hospitals, how it has been categorized as a Sentinel event, and strategies that hospitals can have to counter it. It seemed very clear that the solution needs to be a combination of practical action plans and a cultural change. That topic in general held my interest enough that I followed it up with a session by a group from Northwestern Memorial Hospital in Chicago who spoke about how the practically attacked the problem fatigue in their organization.
In both sessions, I found it interesting that one of the sacred cows of nursing was brought up as a problem topic, although no one was quite willing to call it out as THE problem. I’m talking about 12 hour shifts. These long shifts are common in every hospital I’ve ever worked with and the reality is, it’s never just 12 hours. It’s always at least an extra 30 minutes and usually more.
There are a number of studies (don’t have details at my fingertips, but if you’re curious, I can hunt them down) which speak to the negative consequences of consecutive and long shifts. However, my observation in hospitals is that 12 hour shifts are a sacred structure of scheduling. I’m not sure if it is traditional, or if it is a function of convenience for work/life balance, or if it is simply an expression of the “we are helping people which is more important than…whatever” culture in healthcare. It’s probably a combination of all of those. What I do know is that if you talk about taking away 12 hour shifts from a unit or a hospital, the nursing staff will immediately be up in arms over why you are making their lives miserable.
Back to Fatigue Management: The basic tenant of fatigue is that when you are exhausted, you don’t perform as well. In nursing, that means you make mistakes. Mistakes mean patient safety is compromised. Therefore, nursing fatigue negatively impacts patient safety.
How is this not a bigger issue in healthcare in America?! I find it peculiar that the petroleum industry has recognized how important it is and has defined and instituted recommended practices (“RP-755” – Google it!) but healthcare, which is responsible for people’s lives on a daily basis, has not gotten themselves together and established standards.
Recall the call to courageous action by Captain Sully yesterday at AONE to healthcare in America to take the example of the airline industry and institute patient safety measures to eliminate, not just reduce, people dying due to errors. Is this a good place to start? I don’t know that I’m in a position to arbitrarily say, without going through more data and studies, “we need to end 12 hour shifts.” But what I will say is: We need to be rethinking and evaluating every assumption to affect change.
AONE is a conference for nursing leaders. Call me crazy, but if innovative positive cultural change in healthcare nursing is going to start anywhere, it’s going to start here!