¶ … working of operating room nurses as a result of the nursing shortage and the general strain and intensity of the health care arena in general. Nurses in general fulfill a truly crucial role within the arena of patient care, these are the individuals who engage with patients and their relatives for the longest amounts of time, and are the ones who detect and evaluate all changes in their health status: this means that nurses are generally the ones who are the first to react to such changes and the first to initiate dialogue with other medical team members on the necessary intervention that needs to be made. The nurses are the ones who are capable of delivering the bulk of the pharmacological, physical and emotional interventions: thus, if they're fatigued or unable to work at the highest level of their abilities because of exhaustion, in the integrity of the healthcare facility is completely compromised. After assessing and scrutinizing this issue in its entirety, the diagnosis developed was essentially that the over-working of nurses and the accompanying fatigue that they ensue and have to work through is incredibly dangerous: it poses a threat to them, a threat to patients and it compromises the integrity of the medical field as a whole. The diagnosis was stated as follows: "Full time operating room nurses who are called back after hours for emergency cases are at increase risk of injury, fatigue and potential to make errors. This surgical team has indicated from the data that nurses working after hours pose safety risks for themselves and patients. Planning with management needs to occur to address some of their issues and risks." One aspect of the diagnosis which was incredibly wise was that in order to properly gather real-time data on the issues that nurses face in the field and working on the front lines of care, a questionnaire would be developed and administered to these nurses. This is an essential part of the correction process. In order, to create the most specific program to address this hazardous situation, there needs to be the most accurate and precise evaluation of this population, their needs and shortcomings. For example, as a part of the diagnosis issued, the following questionnaire was proposed.

Questionnaire

"How many years of operating room experience do you have?

How often are you scheduled to take call after hours in your schedule?

How many extra shifts of call do you pick up?

What is your comfort level coming back to work after hours for emergency cases?

Do you feel obligated to come back for emergency cases?

Have you experienced injury at work? If so, how many and what area was affected?

Have you experience injury at work after hours? If so, how many and what area was affected.

Have you ever made an error (medication, charting, or other) after coming back for emergency cases?

What is your age?

What is your gender?"

Thus, the program which is developed needs to proactively address the needs of this population in conjunction with the vagaries and issues which abound in their field. The answers that the nurses provide in direct response to these questions need to be used and directly referenced in regards to the nuances and details of the program created.

Program Outline

One pillar of the program will revolve around a strategic napping program that will be effective immediately in each nursing unit. As a result of the fact that delivering sufficient nursing care warrants vigilance, complex cognitive functioning, superior dexterity and technical skills along with the ability and willingness to engage with patients on a mental, social and emotional level (McMillan, 2011). When nurses have achieved a higher level of rest and awareness, patient care is generally a challenge that can be met with a certain amount of ease and planning; however, because most nurses work with patients when they're exhausted, they enter a truly hazardous arena of caring for patients (McMillan, 2011). Because this is so commonplace for nurses to be working while exhausted, more and more healthcare facilities need to make sleep promotion a priority. "Most adults appear to need seven to eight hours of sleep per night, with fewer than seven and more than nine or more hours associated with increased morbidity and mortality (Bonnet and Arand, 2011). For people such as night shift workers, who sleep during the day, the amount of sleep obtained is frequently below recommended levels and its quality is poorer than in those who are able to sleep at night (Gold et al., 1992)" (McMillan, 2011). For nurses, factors like the demands and immediacies...

Though the consistent nature of reports of sleep disturbance do demonstrate the aggravated need for strategic sleep promotion by hospitals and how they need to more vocally emphasize to nurses that it is their duty to engage in sleep and health and wellness (McMillan, 2011).
Thus strategic napping in the form of restorative napping needs to be emphasized by the health care facility as a means of valuing and promoting the importance of sleep. Restorative napping is referred to as developing purposeful sleep over brief periods and is something which has in fact been found to minimize exhaustion and to improve the performance and vigilance of healthcare workers (McMillan, 2011). In fact, a nursing study explored how when nurses were able to nap on breaks during their night shifts, 10 out of the 13 nurses who did so reported benefits such as improved energy and mood along with better overall decision-making (McMillan, 2011). However, despite the consistent benefits of napping during breaks, many facilities don't adopt it because of things like lack of facilities, interruptions, demanding caseloads and fear of inertia stemming from sleep (McMillan, 2011).

The strategic napping program needs to contain the following pillars as asserted by McMillan (2011):

Availability of nurses to engage in uninterrupted breaks where they can nap for at least 20 minutes.

Availability of time and a plan to recovery from sleep inertia post-nap so that they can successfully return to work.

Ability to create a nap room that is quiet, soothing, and close to the unit with a private area for each user and which is not used for multiple purposes.

Ability to furnish this room with things like beds, stretchers or chairs that recline.

Offer amenities like blankets and pillows or a locker so that team members can store their own.

Use of alarm clocks, timers or other devices that will allow nurses to know when their nap period is over.

Ability to create an atmosphere characterized by dim lighting.

Educational Program

Making sleep a priority will be one component of the overall program, as one reason that nurses don't get enough sleep is often because they don't value it adequately or don't acknowledge its importance sufficiently enough. Employees thus need to receive information about "circadian rhythms, sleep hygiene measures, shift work and its adverse effects, and a variety of strategies that can be used to reduce fatigue (e.g., judicious use of caffeine and napping during night shifts)" (Rogers, 2008). Thus, one component of the educational pillar involves asking managers to consider altering the starting times of shifts when possible in order to make schedules more compatible with the circadian rhythms of all employees and to make sure that no single employee is schedule for no more than two night shifts in a row (Rogers, 2008). In fact, managers need to be educated about the important nuances of sleep so that they will be able to adequately educate their team members about their specific sleep needs so that nurses can prioritize sleep in a meaningful way.

Stimulants

While coffee and caffeinated beverages are a staple of any nursing unit and can be used to combat the pervasive fatigue that so often afflicts nurses, just because nursing units have coffee readily available, doesn't mean that caffeine is being effectively used as a stimulant. Just like napping, caffeine needs to be treated as the tool that it actually is. "Generally, caffeine's onset of action occurs approximately 15 -- 30 minutes after ingestion and its effects last 3 -- 4 hours. Although tolerance can develop, significant increases in alertness and performance can be obtained with 200 mg of caffeine (approximately the amount of caffeine in one to two cups of coffee), with positive effects occurring with doses ranging from 100 mg to 600 mg" (Rogers, 2008). An additional benefit of caffeine is that studies have found that it works effectively on its own; it can work even more effectively when paired with napping. Another stimulant which has found to be of a certain amount of success is modafinil, which has had an impact on increasing the alertness of workers who suffer from a sleep disorder connected to shift work (Rogers, 2008). However, when supplying caffeine one should stock the kitchenettes and nursing stations in healthcare facilities with coffee beans infused with antioxidants, green teas and acai berries, so that each cup contains the most powerful amount of…