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HealthNovember 16, 2021

Nurse fatigue: Exploring self-perception and effective countermeasures

By: Sarah Handzel, BSN, RN
According to several studies, up to 80% of nurses in the United States experience high levels of fatigue. Unfortunately, fatigue is linked to a decrease in the quality of patient care.

Errors in medication administration, reduced cognitive and physical abilities, and fatigue’s impact on a nurse’s quality of life all affect patient care activities.

Many factors contribute to nurse fatigue. Other industries, such as the aviation and transportation industries, have developed strategies to combat excessive fatigue among employees and promote the safety of the public. But no such policies exist in the healthcare industry.

The American Nurses Association (ANA) has taken the position that each nurse is responsible for managing their fatigue. This includes the ability to recognize and self-assess excessive fatigue, as well as rejecting unsafe work assignments when excessive fatigue is evident. However, it is unknown how well nurses self-assess fatigue levels. Also, little evidence exists on methods that effectively help reduce fatigue.

A recent study in JONA: Journal of Nursing Administration explored these issues. The researchers aim was to describe nurses’ self-perceptions of fatigue and determine how well specific fatigue countermeasures were accepted.

Surveys, fatigue assessment scale used to collect data

In total, the study analyzed data from 279 surveys collected from nurses working in a large hospital system in the southeast. The mean age of all participants was 41 years, and the mean years of professional nursing experience was 13.5 years. 12-hour shifts were most common among survey respondents, as was working day shift instead of nights.

Each nurse rated his or her fatigue level on a scale ranging from “no fatigue” to “extreme fatigue.” They were also asked to complete the Fatigue Assessment Scale (FAS) to help quantify fatigue levels. This 10-item instrument measures fatigue similarly to a Likert scale, with higher scores suggesting higher levels of fatigue.

Additionally, each nurse was asked to indicate their level of acceptance of participation in several fatigue reduction strategies, each of which was guided by recommendations from the ANA, American Academy of Nursing, and National Institute for Occupational Safety & Health.

Survey results show high fatigue levels, which fatigue remedies nurses prefer

The data collected showed that only 54.3% of nurses rated themselves as having high fatigue matching FAS measurements. A full 38.3% underestimated their level of fatigue, while 7.1% overestimated fatigue levels when compared with the established fatigue instrument.

Several fatigue reduction strategies were accepted among the participating nurses, including:

  • Handing over patient care for a duty-free break
  • Working nine-hour shifts
  • Working no more than two consecutive shifts
  • Not working beyond the scheduled shift
  • Not adding additional shifts to the nurse’s schedule

Even though the results suggest acceptance of several fatigue-reducing strategies, many nurses work in right-to-work states. They have no protections from being fired if work is refused, which obviously affects the adoption of such strategies.

But nurse leaders can still help combat fatigue by accepting and implementing the fatigue-reduction strategies most accepted by the study respondents. Even though many of the respondents indicated acceptance for fatigue-reduction strategies, they may also give in to pressure from managers, peers, and work circumstances which negate any effect those strategies might have.

Considering today’s patients and standards of care, it is important for nurse leaders to help create a work environment that is supportive of nurse well-being and patient safety. Actively taking steps to reduce fatigue can help improve patient outcomes, increase nurse retention, and prevent employee injuries.

Sarah Handzel, BSN, RN
Freelance Health and Medical Content Writer, Wolters Kluwer Health
Sarah has over nine years’ experience in various clinical areas, including surgery, endocrinology, family practice, and pharmaceuticals. She began writing professionally in 2016 as a way to use her medical knowledge beyond the bedside to help educate and inform healthcare consumers and providers.
  1. Cochran, K 2021: Can Nurses Self-Assess Fatigue? Implications for Nurse Leaders. JONA: The Journal of Nursing Administration 2021;51(10):507. doi: 10.1097/NNA.0000000000001055
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