Relationship between Nurse Fatigue and Errors

¶ … Thomas (2005) analyzes the responses of nurses who were reported to the National Council of State Boards of Nursing for nursing errors. The responses were given to questionnaires delivered to both the reported nurses and their employers. The focus of the questionnaires was to identify any relationship (if one existed) between the number of working hours of the reported nurses, the incidents and nursing fatigue. 117 employers responded and 122 nurses responded.

The responses indicated that almost all nurses who were reported for incidents worked 40 or fewer hours per week total (that is taking into account any and all jobs a nurse might hold) and that "the vast majority of nurses denied experiencing fatigue" (Thomas, 2005, p. 2). The responses of the questionnaires thus indicated that there was no relation between nursing incidents/errors and nursing fatigue -- mainly because nearly 70% of the nurses who responded reported working only 40 hours or fewer per week. 20% reported working between 40 and 50 hours per week.

7% reported working between 50 and 60 hours per week, and 5% reported working more than 60 hours per week. That means that only about a third of the respondents actually worked more than what is considered a full work week's load. However, this is not actually a fair assessment of whether a nurse feels fatigued -- and the fact that (as Thomas points out) many nurses may have felt pressure to respond that they did not feel fatigued in the questionnaire's open-ended section could add a measure of unreliability to the study overall.

In short, the study is helpful in seeing how many nurses reported for errors worked overtime -- yet it is not necessarily helpful in determining if fatigue is or is not a variable in the errors committed. The research's methodology was based on the use of the National Council of State Board's of Nursing Taxonomy of Error Reporting and Root Cause Analysis (TERCAP). TERCAP served as method of collecting data on the nursing errors and the variables of working hours and nursing fatigue (self-reported).

The questionnaires that were sent out were not random but were based on the names in the errors report. The method involved sending the questionnaires to the nurses and to their managers so as to obtain information on whether nurses were actually being overworked and whether or not they actually felt fatigued. The questionnaire was written in a way so that there was space for the nurses to make comments regarding their "feelings of fatigue" (Thomas, 2005, p. 2).

Findings showed that expressions of feeling fatigued were made and the cause cited by nurses as workload, job frustration, job stress, illness, illness of their children, pregnancy, and education. The study also found that nurses likewise expressed not feeling fatigued so much as "overwhelmed and rushed" (Thomas, 2005, p. 3). The findings suggested that most nurses who were reported for practice errors did not actually feel fatigued and neither did they work more than forty hours per week when the practice error was committed.

Thus the study found that there was no significant relation between practice errors and fatigue. However, with that said, the study also noted its own limitations -- namely, that the findings might be misleading since respondents could very likely feel that they were expected to give a "right" answer and state that they were not feeling fatigued at work. Likewise, employers might have different ideas about what constitutes "overtime" and so the questionnaire cannot be taken as definitive evidence that there is no relation between fatigue and errors.

Moreover, the fact that several respondents did identify feeling overworked, rushed, overwhelmed and stressed can all be ways of indicating fatigue without actually expressing it using that specific term. In other words, the qualitative responses within the questionnaire indicate that there may be some relation between fatigue and practice error. What needs to be considered for future research is how well these terms are defined and definitions can be given in the questionnaire to assist respondents in making accurate assessments.

Moreover, the number of hours worked per week may be insignificant, for as the findings show, "a large percentage of nurses in the study were working 12-hour shifts at the time of the nursing practice error" -- which means that fatigue could be reached on shift basis rather than on a weekly workload basis. The study shows that other researchers have found that the majority of errors committed by nurses occur during 12-hour shifts.

The study also notes that 80% of nurses stay on at work past their shift concluding, so even the 12-hour mark is an inaccurate gauge of how long a nurse is actually at work. Thus, the study concludes that "this type of 'overtime'" maybe a "silent contributor to nursing practice errors" (Thomas, 2005, p. 3). The implications of this study for practice are that nurses should be kept from working 12-hour shifts as this is when the majority of errors occur.

Nurses should work 8-hour days and anything over that should be considered overtime. Likewise, nurses and employers should consider defining fatigue so that it can be better recognized. Nurses should be educated about the different forms that fatigue can take -- from feeling overwhelmed to stressed to rushed, and so on. Employers too should take note.