Fatal fatigue 

by Candice Owley 

When a Madison, Wis., nurse made a fatal medical error recently, it occurred in the afternoon of her work shift, which had followed a day when she worked a double shift (16 hours), then slept overnight in the hospital so that she could be on duty the next morning. For years we have read about studies telling us that long hours and sleep deprivation significantly contribute to errors in care. Fatigue causes errors in medication administration, order transcription and in interpretation of lab results.

The hospitals know about these studies yet continue the dangerous practice of requiring forced overtime. Even beyond forced overtime, the healthcare system has for far too long hired too few staff and expected workers to “volunteer” to work far beyond their 40-hour workweek. Far too many hospitals also treat employees as good “team players” when they work hundreds and hundreds of hours of overtime and look negatively upon employees who turn down overtime.

In addition to the number of hours worked in a day, the number of hours off before returning to work can contribute to fatal fatigue. A recent study of bedside nurses found that a nurse with fewer than eight hours of sleep made more errors—7 percent more if they had only seven hours of sleep, and 14 percent more if they only had six hours of sleep. Employees themselves contribute to the fatigue problem by volunteering to work excessive amounts of overtime, and then coming to depend on the extra income from those hours.

The Wisconsin Board of Nursing has put a restriction on the Madison nurse’s license so that she is unable to work more than 12 hours a day or 60 hours a week. The Veterans Administration system has implemented that same standard. The Institute of Medicine has called on all hospitals and labor organizations to support the 12-hours-a-day/60-hours-a-week restriction.

The airline industry years ago realized that fatigue could be deadly and put restrictions on the number of hours pilots could work. No airline can schedule pilots beyond the legal maximum, and no pilot can volunteer to work more hours. As a union, the Wisconsin Federation of Nurses and Health Professionals will continue to press for legislation to end the dangerous practice of mandatory overtime, and will keep pushing for adequate numbers of staff. Perhaps it is also time to support adoption of standards that put limits on all hours worked by employees providing direct care service.

When I get on an airplane, I can feel safe in the knowledge that the pilots are not working beyond the safe hour standards established by the industry. Patients entering hospitals should feel just as safe. It’s time for the healthcare industry to follow the lead of the airlines and end scheduling practices that cause fatal fatigue. Our patients deserve no less.

Printed with permission from the WFNHP.