A Pilot Study of the Safety Implications of Australian Nurses' Sleep and Work Hours

Abstract

The frequency and severity of adverse events in Australian healthcare is under increasing scrutiny. A recent state government report identified 31 events involving "death or serious [patient] harm" and 452 "very high risk" incidents. Australia-wide, a previous study identified 2,324 adverse medical events (AME) in a single year, with more than half considered preventable. Despite the recognized link between fatigue and error in other industries, to date, few studies of medical errors have assessed the fatigue of the healthcare professionals involved. Nurses work extended and unpredictable hours with a lack of regular breaks and are therefore likely to experience elevated fatigue. Currently, there is very little available information on Australian nurses' sleep or fatigue levels, nor is there any information about whether this affects their performance. This study therefore aims to examine work hours, sleep, fatigue and error occurrence in Australian nurses. Using logbooks, 23 full-time nurses in a metropolitan hospital completed daily recordings for one month (644 days, 377 shifts) of their scheduled and actual work hours, sleep length and quality, sleepiness, and fatigue levels. Frequency and type of nursing errors, near errors, and observed errors (made by others) were recorded. Nurses reported struggling to remain awake during 36% of shifts. Moderate to high levels of stress, physical exhaustion, and mental exhaustion were reported on 23%, 40%, and 36% of shifts, respectively. Extreme drowsiness while driving or cycling home was reported on 45 occasions (11.5%), with three reports of near accidents. Overall, 20 errors, 13 near errors, and 22 observed errors were reported. The perceived potential consequences for the majority of errors were minor; however, 11 errors were associated with moderate and four with potentially severe consequences. Nurses reported that they had trouble falling asleep on 26.8% of days, had frequent arousals on 34.0% of days, and that work-related concerns were either partially or fully responsible for their sleep disruption on 12.5% of occasions. Fourteen out of the 23 nurses reported using a sleep aid. The most commonly reported sleep aids were prescription medications (62.7%), followed by alcohol (26.9%). Total sleep duration was significantly shorter on workdays than days off (p < 0.01). In comparison to other workdays, sleep was significantly shorter on days when an error (p < 0.05) or a near error (p < 0.01) was recorded. In contrast, sleep was higher on workdays when someone else's error was recorded (p = 0.08). Logistic regression analysis indicated that sleep duration was a significant predictor of error occurrence (chi2 = 6.739, p = 0.009, e beta = 0.727). The findings of this pilot study suggest that Australian nurses experience sleepiness and related physical symptoms at work and during their trip home. Further, a measurable number of errors occur of various types and severity. Less sleep may lead to the increased likelihood of making an error, and importantly, the decreased...

Napping During Night Shift: Practices, Preferences, and Perceptions of Critical Care and Emergency Department Nurses

“…Participants in our study identified impairments in cognitive functioning and decision making when naps were desired but not possible, experiences congruent with findings that nurses were at increased risk for making and not catching errors during periods of sleep deprivation. 5 Similar to findings reported by Dorrian et al 5 and Scott et al, 8 nurses in our study reported risk for personal injury related to fatigue and specifically associated with the drive home after working the night shift.…”

“…Nurses working nights are less alert and more likely to struggle to stay awake during the latter half of the shift than are nurses working permanent day or evening shifts. 39,40 In a study 5 …”

“…1 Data from the United States indicate that of the 2 421 351 registered nurses employed in nursing in 2004, the I n Canada, of the close to 258 000 registered nurses employed in nursing, approximately 34 500 (13%) work on units that regularly, if not injuries on shift and while driving home. [5][6][7][8][9] Sleep deprivation, sleep disturbance, and fatigue also are significant contributing factors to impaired personal health. [10][11][12] Restorative napping, defined as a purposeful, brief sleep period, has been identified as a potential strategy to improve performance, reduce fatigue, and increase vigilance for individuals working extended hours or during night shift.…”

Aspectos cronobiológicos do sono de enfermeiras de um hospital universitário

“…O exposto é reiterado em estudos, os quais demonstraram que a qualidade do sono noturno dos trabalhadores nas folgas é melhor do que a do sono diurno nos dias de trabalho e que a quantidade de horas de sono noturno nos dias das folgas é maior do que a quantidade de horas de sono diurno nos dias pós trabalho noturno (10)(11)(12) . Durante a pesquisa verificou-se que duas enfermeiras (Polaris e Hamal), trabalhadoras há mais de cinco anos do turno da noite e que são definitivamente vespertinas, desenvolveram hábitos de sono peculiares, isto é, na noite posterior ao seu plantão elas não conseguem dormir em horário dito "normal".…”

Identifying Work-Family Conflict among Nurses: A Qualitative Study

“…Working overtime has been associated with an increase of work-family conflict and stress if the shift is longer than 12.5 hours (Rogers, et al, 2004). Nurses on night shifts have reported high levels of stress, physical and mental exhaustion (Dorrian, et al, 2006). Another study among nurses reported that the nurses used http: //dx.doi.org/10.15405/epsbs.2016.11.02.11 eISSN: 2357-1330 responsibility of the Organizing Committee of the conference 110 their half an hour of break during the shifts to take a rest or meals (Rogers, et al, 2004).…”