Fatigue is a complex problem that affects nursing in every field and it appears from research reviewed, every country. Carer acute clinical fatigue leads to burnout and loss of nurses from the field. It is also known from research that there is a higher level of fatigue in healthcare workers than in any other work population or in the general population (Gaba & Howard, 2002). Nurse clinical fatigue not only threatens the health of the nurse but threaten’ patient safety and health care quality. For these reasons the potential impact on healthcare fatigue is significant and indicates the need for more study (Fang & Kunaviktikul, 2008).
The nature of nursing work is becoming identified as one of the reasons for clinical fatigue among nurses. Carer fatigue is noted by Farrington (1997) as hemorrhaging of yourself for others.” Certainly nurses given everything of themselves to their careers. Clinical fatigue is related to emotional exhaustion, depersonalization, and the feeling of reduced personal accomplishment. It is a cognitive as well as emotional state. Clinical fatigue often causes an inefficient action pattern that causes declining interest in the field, reduced concentration, and negative emotions about the work that they do. There are many things that affect this clinical fatigue level and Fang et.al. (2008) has found that much of that belongs to what is called the Job, Demand, Control Model. This model includes such things as the demands placed on the nurse because of the job, the control the nurse has over the job, the support she/he gets in the work environment, whether shift work is involved, and the exposure that she/he may have to hazards in the work environment.
Each of the above mentioned things that affect the nurse on duty also affects her/his ability to sleep, anxiety level, depression and jobs satisfaction level. Many of these lead to acute clinical fatigue which then leads back to increasing anxiety and depression as well as the inability to sleep. It is noted that most fatigue studies have been done on the general population and the nursing population is wholly different and because of that previous studies do not apply to this clinical fatigue situation. Therefore there is good reason to study clinical fatigue specific to the nursing challenge. (Fang, 2008).
There are many nursing implication from study. Nursing fatigue is generally acute fatigue and therefore chronic fatigue treatment does not apply to this situation. Nursing recovery seems to be one of the major issues related to clinical nursing acute fatigue and that is affected by the amount of time that a nurse has between shifts. There is a need for joint research projects between administrations and nurses to help manage this problem as the possibility of affecting the general safety of patients continues to be a concern. Administrations must begin to realize that nurses are professionals and professionals have control over their jobs. Their training is unique and multifaceted and because of these reasons, they must be given more autonomy.
There is a need to study how job demands can be changed (Taylor & Barling, 2004). For example there may be ways to rearrange the work flow, allowing the demands of the day to be spread out better, relieving anxiety. The nurses need better control of how their jobs are done. There are many programs out there presently that are attempting to solve this problem. There is the Nurse Friendly Program and the Magnet Program. With each program there is the recognition that nurse satisfaction is increased and fatigue is decreased when the nurse has more control over how her job is done.
Acute clinical fatigue is very much influenced by nursing dissatisfaction with the job (Taylor, et.al. 2004). Dissatisfaction causes depression and anxiety as well as the unsettled feelings that come with trying to decide whether or not to change jobs or can I change jobs and still be able to support my family? Nurses say that there is not enough organizational commitment to what they do or professional commitment from their peers. Commitment to the nurses on our clinical units will reduce some of the acute fatigue that is felt by nursing. Commitment means providing them with ongoing support, time off between shifts, longer breaks, time to exercise, psychological support for difficult patients, more control over their jobs and reduction in role ambiguity. Until clinical units are able or willing to commit more resources to solving the acute fatigue issues related to nursing, there will continue to be an increase as stressors continue to increase. This will continue to cause problems with the health and safety of our nurses and their patients.
Clinical Fatigue #2
The ANA has noted in several recent articles the recognition of clinical fatigue among nurses and the effects that it has on nurse retention in the field as well as patient safety (ANA, 2010). The analysis of the problem by the ANA leads to the fact that nursing is basically a relationship job. The nurse patient relationship is very important to the job and although there are stressors there, the relationships with other members of the health care team can make their shift, their day or their week, especially if they are not going well. If you aren’t able to take a break, you aren’t able to develop workplace relationships. You don’t develop peer friendships that lead to support and it is easier to leave a job if you have not developed friendships while there.
Smaha, Lal, And Smaha et.al. (2007), conducted a study related to the psychological support, lifestyle and coping mechanisms that nurses need to prevent clinical nurse fatigue. Those predictors that stand out are relationships among fatigue and psychological variables, including anxiety, mood and locus of control and well as the relationships among acute fatigue and a number of lifestyle factors such as shift work, sleep and exercise as well as various coping behaviors that affect acute fatigue.
The affects of acute clinical fatigue are somewhat different than those of chronic fatigue. In acute clinical fatigue, the nurse may have slower brain functioning which causes delays in reaction times, memory deficits and a decrease in cognitive abilities such as logical reasoning and concentrations which are really important in making nursing judgments. (Samaha,et.al., 2007). Nursing has regular exposure to psychological, emotional and physical stress and when you combine those with long shifts or with shift work, acute fatigue often happens. There has recently been concern as to whether nurses who have acute fatigue can deliver safe healthcare.
Nurses often avoid things such as exercise because of lack of time, or an already fatigued body. They then replace the exercise with things such as coffee and cigarettes. There are many situations of stress for nursing, each of which contribute to acute fatigue on the clinical units Employment insecurity is often a problem as well as the casualization that has occurred in the work force (Samaha, 2007). Many nurses now work contract and often do not know whether they will be working in the next however many weeks. However, working agency relieves the problem of having to be involved in hospital politics. In the casualization nurses are expected not to complain if they want their next contract.
The system in general is described by nurses as being the reason for acute fatigue. The culture of the system and the inability for others to understand what they do as well as the lack of commitment by administration to make it better is often listed by nurses. The biggest complaint that nurses have though is that the nature of the job is draining both physically and mentally and role activities, lack of time, nature of chronicity, concern for the safety of patients, expectations, concerns for their license, lack of continuity and the thanklessness nature of the work contribute to this fatigue in such a way that they feel burnt out and want to leave the profession all together (Samaha, 2007).
This research is not new. Nationally the effects of acute fatigue are what the nurses in these studies have stated. However, with the shortage of nurses throughout the world and the fact that many more will retire in the next 5 years stimulates a need to keep those nurses that are available in the profession. Acute fatigue and burnout drives nurses out of the field and to another profession with less stressors. It appears that these long standing issues are entrenched in the nature of nursing and stress in the work place, however, there must be a way found to discover how to change this pattern.
Job satisfaction is acutely important in assuring that nursing is not acutely fatigued. There are many job satisfaction surveys done all over the country and they are done often. Many of the same things that are noted in this paper are noted regularly on those job satisfaction surveys. Administrations must begin to solve the issues that are noted on those surveys. To say how important the nursing department is, one thing, while actually is changing the issues is another. Nurses will find something else to do if they remain unhappy and there are already far too many nurses. The changes that should occur need to occur soon or it will be too late.
Resources
ANA Clinical nurse fatigue and patient safety. ANA RN Information Nevada. May June.
2010
Fang, J., Wipada, K. Olson, K. (2008). Factors influencing clinical fatigue in Chinese
nurses. Nursing and Health Sciences. 10. 291-299.
Gaba DM, Howard SK. (2002). Fatigue among clinicians and the safety of patients. New
England Journal of Medicine. 347. 1249-1255.
Farrington, A. (1997). Strategies for reducing stress and burnout in nursing. British
Journal of Nursing 6 44-50.
Smaha, E., Lal, S., Smaha, N. (2007). Psychological, lifestyle and coping contributors to
chronic fatigue in shift-worker nurses. Journal of Advanced Nursing. 59(3). 221-
232.
