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When I was a young nurse, I sometimes worked double shifts, usually pairing day and evening so I could sleep at night. Only a few times did I "double" evening and night.
On one such occasion, after getting up early with my children, I started my shift at 3 p.m. in a medical/surgical unit at a small hospital. Late in the shift, the nursing supervisor asked-no, begged-me to stay for another. They needed help and the hourly rate was too good to refuse.
The LPNs coming on duty knew I'd be the only RN working overnight and volunteered to cover for me if I needed to lie down during break. Thanking them, I insisted I'd be fine. Midway through the shift, I took a break. The next thing I remember was waking up in a panic. With my head still foggy, I darted around checking patients, making sure they'd received their medications and that their I.V. lines were working properly. As promised, the other nurses had everything under control.
But that episode convinced me: no more evening-and-night for me. I'd been too exhausted to provide safe patient care and was fortunate to have a great team backing me up.
In 2004, Ann Rogers and other sleep experts published results of their study on nurses and fatigue in Health Affairs journal. They found that nurses who worked more than 121/2 hours were three times more likely to make an error than those working less than 81/2 hours and that unplanned overtime at the end of any shift increased risk.
Pressured by nursing organizations that recognize the dangers of working tired, many states are taking steps to eliminate mandatory overtime. On an individual basis, though, are nurses acting as wisely? We like 12-hour shifts because they allow longer stretches of time off. But face it: Most "12-hour" shifts last longer, increasing the error risk.
The allure of great pay, the desire to help colleagues, or the fear of abandoning patients may tempt you to work when you're tired. But objective self-assessment is difficult and you may not recognize when you're low on energy. Before you sign on for extended hours, consider how fatigue affects your performance. If you're compromising patient safety, you're also jeopardizing your career. Is putting in those extra hours really worth the risk?
Cheryl L. Mee, RN, BC, CMSRN, MSN
Rogers AE, et al. The working hours of hospital staff nurses and patient safety. Health Affairs. 23(4):202-212, July/August 2004.
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