Work Hours and Reducing Fatigue-Related Risk: Good Research vs Good Policy

Dawson, Drew; Zee, Phyllis C.

doi:10.1001/jama.294.9.1104

Cited by 51 publications

(35 citation statements)

References 7 publications

(2 reference statements)

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“…It has a significant effect on the levels of alertness, concentration, judgment, mood, and performance which might also be a reason for the increased risk of injury and medical errors. [6,7] Moreover, fatigue also impairs memory, problem solving, and decision making-abilities. [8,9] Fatigue problems are believed to cost the United States about 18 billion dollars in accidents and lost productivity, while 76,000 injuries among shift workers were reported.…”

Section: Introductionmentioning

confidence: 99%

The impact of 12-hour shifts on nurses’ health, wellbeing, and job satisfaction: A systematic review

Banakhar

2017

JNEP

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Objective: This review was conducted to investigate the impact of applying 12-hour shifts in comparison to 8-hour shifts on nurses' health wellbeing and job satisfaction. Methods: MEDLINE, CINHALE, PsycINFO, EMBASE, Web of Science, and SCOPUS databases were searched, covering the period between 1980 to 2017. Studies were included if they concerned nurses working for 12-hour shifts in comparison to 8-hour shifts in hospital settings, based on observational/surveys studies. Results: In the yielded 12 studies, 3 studies reported that 12-hour shifts had an impact on nurses' health and wellbeing, such as cognitive anxiety, musculo-skeletal disorders, sleep disturbance, and role stress; however, there was no significant difference between 12-and 8-hour shifts with digestive and cardiovascular disorders, psychological ill health, and somatic anxiety. Of the 4 studies measuring the impact of 12-hour shifts on fatigue, three studies showed that the nurses experienced more fatigue in the 12-hour shifts in comparison to 8-hour shifts; nevertheless, one study did not find a significant difference in fatigue and critical thinking performances between 12-and 8-hour shifts. Nine of the 12 studies measured job satisfaction in 12-and 8-hour shifts, 5 studies showed a greater dissatisfaction regarding 12-hour shifts, while 3 studies found that the nurses were more satisfied with 12-hour shifts than with 8-hour shifts; but one study pointed out that there was a difference between the two shifts considering pay and professional status. Conclusions: The findings of the review suggest that 12-hour shifts resulted in negative health concerns and job dissatisfaction; however, there is a need for more empirical evidence to support this.

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Section: Introductionmentioning

confidence: 99%

The impact of 12-hour shifts on nurses’ health, wellbeing, and job satisfaction: A systematic review

Banakhar

2017

JNEP

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“…Although workload plays a key role in staff and patient's wellbeing, few researches have been conducted on the evaluation of workload effects and impacts on healthcare (25). The present study aimed at determining the rate of patient safety events, evaluating nursing workload as well as identifying the main factors that affect the incidence rate of patient safety events among nurses.…”

Section: Introductionmentioning

confidence: 99%

The Association of Nursing Workloads, Organizational, and Individual Factors with Adverse Patient Outcome

Abadi¹,

Akbari²,

Akbari³

et al. 2016

Iran Red Crescent Med J

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Introduction: Adverse patient outcomes have become a big concern in the quality of healthcare. Different factors can have an impact on the variety and rate of adverse patient outcomes. Objectives: The present study aimed at determining the rate of patient safety during events and evaluating nursing workloads as well as identifying the main factors that affect the incidence rate of patient safety events among nurses. Methods: This cross-sectional study was conducted on 293 nurses working in 24 wards of Baqiyatallah hospital in Tehran, Iran, in 2016. The sampling method was stratified random sampling. Data were collected using a self-administered questionnaire, which was classified into 4 subtitles: Individual and organizational characteristics, perceived subjective, objective workloads, and some patient safety events during the past 6 months. Binary and multiple regressions were used to survey the relationship between variables using the SPSS Version 23 software. Results: Bloodstream infection, pressure ulcer, and patient falls were the most reported adverse outcomes during the past 6 months with 76.1%, 66.2%, and 59%, respectively. At least one of the 6 adverse outcomes was reported by nurses within the range of 45%-77%. Of all individual characteristics, the only significant relationship occurred between work experience and bloodstream infection (P value = 0.28 and 0.32). No significant relationship was detected between adverse patient outcomes and objective workloads. Regression models revealed that the subjective workload of adverse patient outcomes increased with making adjustments in the individual and organizational characteristics. The incidence rates of adverse outcomes were 5.69-9.78 times more than the fixed shifts in all rotational shift works. Conclusions: The nurses reported a high incidence rate of all patient safety events, and the results revealed that the objective workload could not be a predictor for patient adverse events. According to the findings, subjective workload and work shift were significantly related to the incidence rate of adverse patient events. In conclusion, good regulation of sleep-wake cycles can be an important factor for decreasing the rate of adverse patient events.

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“…7,26 Examining the effects of a change to a shift-work system is warranted. Increasing autonomy and support 27 and decreasing workload might also decrease stress levels.…”

Section: Discussionmentioning

confidence: 99%

“…Increased resident work hours are associated with sleep deprivation. 7,8 For some, sleepiness is a near daily occurrence. 9 Resident sleep deprivation has been associated with diminished well-being and objectively measured worsened educational performance.…”

Section: Introductionmentioning

confidence: 99%

“…4 Indirect evidence has also linked fatigue to impaired medical decision-making and decreased patient safety. 7 Although duty hour reduction is associated with decreased in-hospital mortality and potential improvements of patient care, 10,[14][15][16] data suggest that these mandates may not have solved the problem of sleep deprivation 17 or fatigue 18 for medical trainees. Studies to date have not identified the workplace factors associated with fatigue.…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated with Intern Fatigue

et al. 2008

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BACKGROUND: Prior data suggest that fatigue adversely affects patient safety and resident well-being. ACGME duty hour limitations were intended, in part, to reduce resident fatigue, but the factors that affect intern fatigue are unknown. OBJECTIVE:To identify factors associated with intern fatigue following implementation of duty hour limitations. DESIGN:Cross-sectional confidential survey of validated questions related to fatigue, sleep, and stress, as well as author-developed teamwork questions.SUBJECTS: Interns in cognitive specialties at the University of California, San Francisco. MEASUREMENTS:Univariate statistics characterized the distribution of responses. Pearson correlations elucidated bivariate relationships between fatigue and other variables. Multivariate linear regression models identified factors independently associated with fatigue, sleep, and stress. RESULTS:Of 111 eligible interns, 66 responded (59%). In a regression analysis including gender, hours worked in the previous week, sleep quality, perceived stress, and teamwork, only poorer quality of sleep and greater perceived stress were significantly associated with fatigue (p<0.001 and p=0.02, respectively). To identify factors that may affect sleep, specifically duty hours and stress, a secondary model was constructed. Only greater perceived stress was significantly associated with diminished sleep quality (p=0.04), and only poorer teamwork was significantly associated with perceived stress (p<0.001). Working >80 h was not significantly associated with perceived stress, quality of sleep, or fatigue. CONCLUSIONS:Simply decreasing the number of duty hours may be insufficient to reduce intern fatigue. Residency programs may need to incorporate programmatic changes to reduce stress, improve sleep quality, and foster teamwork in order to decrease intern fatigue and its deleterious consequences.

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Work Hours and Reducing Fatigue-Related Risk: Good Research vs Good Policy

Cited by 51 publications

References 7 publications

The impact of 12-hour shifts on nurses’ health, wellbeing, and job satisfaction: A systematic review

The impact of 12-hour shifts on nurses’ health, wellbeing, and job satisfaction: A systematic review

The Association of Nursing Workloads, Organizational, and Individual Factors with Adverse Patient Outcome

Factors Associated with Intern Fatigue

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