1. Section Editor(s): Stewart-Amidei, Chris

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That yawn you find yourself trying to stifle while in a mid-afternoon patient care conference may not be as simple a phenomenon as you think. It may signal a more serious problem for nursing-fatigue.

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With 10- and 12-hour shifts, fewer nurses are working the more traditional 8-hour shift, and many nurses work beyond their scheduled shifts to complete their work. Optional or mandated overtime may have nurses working 16 hours or longer. Those nurses who work "doubles" have less time in between shifts to recuperate. Hospital hours also tend to be very early or very late, and the need to switch shifts-and subsequently, sleep patterns-is common. Even nurses who are salaried often work more than a 40-hour workweek. Further, females often get less sleep than males; this is of particular importance since nursing is traditionally a femaledominated occupation. Nurses come to work sick or tired without a second thought. That is one of the characteristics of being a nurse-we put our patients first. As a consequence, nurses are fatigued.


Nurse fatigue is an underrecognized problem with serious implications for patient care. Medication and patient-care errors are often blamed on nurse fatigue. Medication may be forgotten, or the wrong medication may be given. Patient vigilance may be lessened as fatigued nurses find it difficult to pay attention. Being tired simply puts our patients at risk. Fatigue places our colleagues at risk as well; decisions that are made while fatigued affect the entire team. Of course, the fatigued nurse may also have an increased risk for injury at work.


In spite of the known prevalence of nurse fatigue, little research has been done to identify the depth of the problem. Surveys of critical care and on-call perioperative nurses indicate that fatigue is frighteningly common. Many nurses report "near miss" events that can be blamed on fatigue. Yet most workplaces do little to preventively address the issue.


Perhaps it is time for us to seriously consider ways to prevent nurse fatigue. Some states have begun to consider mandates to limit the workday to 12 hours and the workweek to 60 hours for nurses involved in direct patient care. Other professions charged with public safety have been reducing employee hours for some time. Pilots and flight attendants have strict work hour limitations. Even residents have an 80-hour workweek limit. Another approach is to mandate rest periods while at work. A recent study indicated that most nurses, although afforded several breaks at work throughout the day, ended up working right through their breaks, thus adding to their fatigue.


Mandating limited work hours and breaks represent a cultural change in nursing, primarily because we try to put our patients first. It is time, though, to put ourselves first, so that we have enough energy to give our patients. It is the only way to keep us all safe and to prevent the errors from our ways. Please write to let our readers know what you think about this problem and share any solutions you have to offer.