This is an update of an earlier blog.

Hospitals in which nurses work long hours have higher rates of patients deaths from pneumonia and acute myocardial infarction, according to a study.

Fatigue harms patients

Researchers at the University of Maryland School of Nursing and Johns Hopkins School of Medicine conducted a study of nurses’ work schedules, staffing and patient outcomes as part of ongoing research funded by the National Council of State Boards of Nursing.

In the study — “Nurses’ Work Schedule Characteristics, Nurse Staffing, and Patient Mortality,” which appears in the January/February issue of Nursing Research — the authors examined patient outcomes and staffing information from 71 acute care hospitals in Illinois and North Carolina. They compared the data with survey responses of 633 randomly selected nurses who worked at the hospitals.

Long work hours and lack of time off were the components most frequently linked to patient mortality. Co-author Alison Trinkoff, RN, ScD, MPH, FAAN, professor at the Maryland School of Nursing, said nurses need time off to rest and recuperate for their own health and to ensure a high level of performance on the job. Read more.

Comments: Fatigued, distracted, and exhausted nurses are working 12 hour shifts or longer. Some are working these hours by choice because it provides more days off. Some have no choice since 12 hour shifts are the only possible staffing pattern. And patients are paying the price. What may be good for an organization, in terms of staffing, may not be good for nurses. Ultimately patient safety depends on clear thinking, critically thinking, and clear communicating nurses. Fatigue from being on one’s feet for 12 hours interferes with these abilities. One study from 2004 showed that nurses who work shifts of 12.5 hours or longer are three times more likely to make an error in patient care. Here it is 6 years later and we still have 12 hour shifts.

In December 2011, The Joint Commission published a Sentinel Event Alert about healthcare worker fatigue and patient safety. This is the impact of fatigue:

• lapses in attention and inability to stay focused
• impaired communication
• memory lapses
• irritability
• confusion
• compromised problem solving
• slowed or faulty information processing and judgment
• diminished reaction time
• reduced motivation
• indifference and loss of empathy

It is time we look at the evidence and rethink long, intense, and exhausting shifts. When a poor outcome occurs, medical malpractice attorneys should be asking for the staff records of the nursing unit, and delve into how many shifts in a row and how many hours in a row the nurses were working. With the publication of the Sentinel Event Alert, pressure increases on hospitals to address the fatigue-related risks.