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Trinkoff AM, Baldwin CM, Chasens ER, et al. CE: Nurses Are More Exhausted Than Ever: What Should We Do About It?. Am J Nurs. 2021;121(12):18-28doi: 10.1097/01.NAJ.0000802688.16426.8d.
Trinkoff, A. M., Baldwin, C. M., Chasens, E. R., Dunbar-Jacob, J., Geiger-Brown, J., Imes, C. C., Landis, C. A., Patrician, P. A., Redeker, N. S., Rogers, A. E., Scott, L. D., Todero, C. M., Tucker, S. J., Weinstein, S. M. (2021). CE: Nurses Are More Exhausted Than Ever: What Should We Do About It?. The American journal of nursing, 121(12), 18-28. https://doi.org/10.1097/01.NAJ.0000802688.16426.8d
Trinkoff, Alison M, et al. "CE: Nurses Are More Exhausted Than Ever: What Should We Do About It?." The American journal of nursing vol. 121,12 (2021): 18-28. doi: https://doi.org/10.1097/01.NAJ.0000802688.16426.8d
Trinkoff AM, Baldwin CM, Chasens ER, Dunbar-Jacob J, Geiger-Brown J, Imes CC, Landis CA, Patrician PA, Redeker NS, Rogers AE, Scott LD, Todero CM, Tucker SJ, Weinstein SM. CE: Nurses Are More Exhausted Than Ever: What Should We Do About It?. Am J Nurs. 2021 Dec 01;121(12):18-28. doi: 10.1097/01.NAJ.0000802688.16426.8d. PMID: 34743129.
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Am J Nurs. 2021 Dec 01;121(12):18-28. doi: 10.1097/01.NAJ.0000802688.16426.8d.

CE: Nurses Are More Exhausted Than Ever: What Should We Do About It?.

The American journal of nursing

Alison M Trinkoff, Carol M Baldwin, Eileen R Chasens, Jacqueline Dunbar-Jacob, Jeanne Geiger-Brown, Christopher C Imes, Carol A Landis, Patricia A Patrician, Nancy S Redeker, Ann E Rogers, Linda D Scott, Catherine M Todero, Sharon J Tucker, Sharon M Weinstein,

Affiliations

  1. Alison M. Trinkoff is a professor at the University of Maryland School of Nursing, Baltimore. Carol M. Baldwin is professor emeritus and a Southwest Borderlands Scholar at Arizona State University's Edson College of Nursing and Health Innovation, Phoenix. Eileen R. Chasens is a professor and chair of the Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, where Jacqueline Dunbar-Jacob is dean and a distinguished service professor and Christopher C. Imes is an assistant professor. Now retired, at the time of this writing Jeanne Geiger-Brown was a professor and associate dean for research at the George Washington University School of Nursing, Washington, DC. Carol A. Landis is a professor emeritus at the University of Washington School of Nursing, Seattle. Patricia A. Patrician is a professor and the Rachel Z. Booth Endowed Chair at the University of Alabama at Birmingham School of Nursing, and a retired U.S. Army colonel. Nancy S. Redeker is the Beatrice Renfield Term Professor of Nursing at the Yale University School of Nursing, New Haven, CT. Ann E. Rogers is a professor at the Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta. Linda D. Scott is a professor and dean of the University of Wisconsin-Madison School of Nursing. Catherine M. Todero is dean of the College of Nursing and vice provost of Health Sciences at Creighton University, Omaha, NE, and Phoenix, AZ. Sharon J. Tucker is the Grayce Sills Endowed Professor in Psychiatric-Mental Health Nursing and director of the Translational/Implementation Research Core at the Ohio State University College of Nursing, Columbus. Sharon M. Weinstein is chief executive officer of the Global Education Development Institute, and SMW Group LLC, North Bethesda, MD, and a clinical assistant professor at the College of Nursing, University of Illinois, Chicago. This article was a collaborative effort by the Fatigue Subgroup of the Health Behavior Expert Panel, American Academy of Nursing. The authors acknowledge Claire C. Caruso, PhD, RN, a research health scientist at the National Institute for Occupational Safety and Health, for her help in reviewing the manuscript. Contact author: Alison M. Trinkoff, [email protected]. The authors and planners have disclosed no potential conflicts of interest, financial or otherwise. A podcast with the authors is available at www.ajnonline.com.

PMID: 34743129 DOI: 10.1097/01.NAJ.0000802688.16426.8d

Abstract

ABSTRACT: For nurses, the challenges posed by demanding work environments and schedules often lead to fatigue, and this can be exacerbated during crises like the COVID-19 pandemic. In this article, the authors discuss causes and challenges of nurse fatigue and consider several evidence-based strategies and solutions for individual nurses and organizations. Barriers to implementation, including a negative workplace culture and inadequate staffing, are also described, and several resources are presented.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

References

  1. Mira JJ, et al. Acute stress of the healthcare workforce during the COVID-19 pandemic evolution: a cross-sectional study in Spain. BMJ Open 2020;10(11):e042555. - PubMed
  2. Ricci JA, et al. Fatigue in the U.S. workforce: prevalence and implications for lost productive work time. J Occup Environ Med 2007;49(1):1–10. - PubMed
  3. Steege LM, Dykstra JG. A macroergonomic perspective on fatigue and coping in the hospital nurse work system. Appl Ergon 2016;54:19–26. - PubMed
  4. Trinkoff A, et al. How long and how much are nurses now working. Am J Nurs 2006;106(4):60–71. - PubMed
  5. Witkoski A, Dickson VV. Hospital staff nurses' work hours, meal periods, and rest break: a review from an occupational health nurse perspective. AAOHN J 2010;58(11):489–97. - PubMed
  6. Geiger-Brown J, Trinkoff AM. Is it time to pull the plug on 12-hour shifts?: Part 1. The evidence. J Nurs Adm 2010;40(3):100–2. - PubMed
  7. Berney B, et al. Factors influencing the use of registered nurse overtime in hospitals, 1995-2000. J Nurs Scholarsh 2005;37(2):165–72. - PubMed
  8. Stokowski LA, et al. Medscape RN/LPN compensation report, 2020 [PowerPoint]. Medscape 2020 Oct 28. https://www.medscape.com/slideshow/2020-rn-lpn-compensation-report-6013278. - PubMed
  9. Caruso CC, et al. NIOSH training for nurses on shift work and long work hours. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health; 2015 Mar 31. DHHS (NIOSH) Publication No. 2015-115. https://www.cdc.gov/niosh/docs/2015-115. - PubMed
  10. Steege LM, Rainbow JG. Fatigue in hospital nurses—‘Supernurse’ culture is a barrier to addressing problems: a qualitative interview study. Int J Nurs Stud 2017;67:20–8. - PubMed
  11. Dor A, et al. Hospital nurses in comparison to community nurses: motivation, empathy, and the mediating role of burnout. Can J Nurs Res 2019;51(2):72–83. - PubMed
  12. Brewer CS, et al. A structural equation model of turnover for a longitudinal survey among early career registered nurses. Int J Nurs Stud 2015;52(11):1735–45. - PubMed
  13. Han K, et al. Work-related factors, job satisfaction and intent to leave the current job among United States nurses. J Clin Nurs 2015;24(21–22):3224–32. - PubMed
  14. International Council of Nurses. The global nursing shortage and nurse retention. Geneva, Switzerland; 2021 Mar 11. Policy brief; https://www.icn.ch/sites/default/files/inline-files/ICN%20Policy%20Brief_Nurse%20Shortage%20and%20Retention_0.pdf. - PubMed
  15. Trinkoff AM, et al. Nurses' work schedule characteristics, nurse staffing, and patient mortality. Nurs Res 2011;60(1):1–8. - PubMed
  16. Hittle BM, et al. Managing fatigue during times of crisis: guidance for nurses, managers, and other healthcare workers. NIOSH Science Blog 2020 Apr 2. https://blogs.cdc.gov/niosh-science-blog/2020/04/02/fatigue-crisis-hcw. - PubMed
  17. Delgado C, et al. Nurses' resilience and the emotional labour of nursing work: an integrative review of empirical literature. Int J Nurs Stud 2017;70:71–88. - PubMed
  18. Msiska G, et al. Emotional labour and compassionate care: what's the relationship. Nurse Educ Today 2014;34(9):1246–52. - PubMed
  19. Hu D, et al. Frontline nurses' burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: a large-scale cross-sectional study. EClinicalMedicine 2020;24:100424. - PubMed
  20. Cho H, et al. Hospital nursing staff perceptions of resources provided by their organizations during the COVID-19 pandemic. Workplace Health Saf 2021;69(4):174–81. - PubMed
  21. Lothschuetz Montgomery K, Geiger-Brown J. Is it time to pull the plug on 12-hour shifts?: Part 2. Barriers to change and executive leadership strategies. J Nurs Adm 2010;40(4):147–9. - PubMed
  22. Toh SG, et al. Systematic review on the relationship between the nursing shortage and job satisfaction, stress and burnout levels among nurses in oncology/haematology settings. Int J Evid Based Healthc 2012;10(2):126–41. - PubMed
  23. Gómez-García T, et al. Nurses' sleep quality, work environment and quality of care in the Spanish National Health System: observational study among different shifts. BMJ Open 2016;6(8):e012073. - PubMed
  24. Caruso CC. Negative impacts of shiftwork and long work hours. Rehabil Nurs 2014;39(1):16–25. - PubMed
  25. Besedovsky L, et al. Sleep and immune function. Pflugers Arch 2012;463(1):121–37. - PubMed
  26. Ftouni S, et al. Objective and subjective measures of sleepiness, and their associations with on-road driving events in shift workers. J Sleep Res 2013;22(1):58–69. - PubMed
  27. Shockey TM, Wheaton AG. Short sleep duration by occupation group—29 states, 2013-2014. MMWR Morb Mortal Wkly Rep 2017;66(8):207–13. - PubMed
  28. Akerstedt T, Wright KP Jr. Sleep loss and fatigue in shift work and shift work disorder. Sleep Med Clin 2009;4(2):257–71. - PubMed
  29. Geiger-Brown J, et al. Sleep, sleepiness, fatigue, and performance of 12-hour-shift nurses. Chronobiol Int 2012;29(2):211–9. - PubMed
  30. Molzof HE, et al. Misaligned core body temperature rhythms impact cognitive performance of hospital shift work nurses. Neurobiol Learn Mem 2019;160:151–9. - PubMed
  31. Thompson BJ, et al. The impact of a rigorous multiple work shift schedule and day versus night shift work on reaction time and balance performance in female nurses: a repeated measures study. J Occup Environ Med 2016;58(7):737–43. - PubMed
  32. González-Gil MT, et al. Nurses' perceptions and demands regarding COVID-19 care delivery in critical care units and hospital emergency services. Intensive Crit Care Nurs 2021;62:102966. - PubMed
  33. Trinkoff AM, et al. Longitudinal relationship of work hours, mandatory overtime, and on-call to musculoskeletal problems in nurses. Am J Ind Med 2006;49(11):964–71. - PubMed
  34. Imes CC, Chasens ER. Rotating shifts negatively impacts health and wellness among intensive care nurses. Workplace Health Saf 2019;67(5):241–9. - PubMed
  35. Colten HR, et al. Sleep disorders and sleep deprivation: an unmet public health problem. Washington, DC: National Academies Press; 2006. Consensus study report; https://www.nap.edu/catalog/11617/sleep-disorders-and-sleep-deprivation-an-unmet-public-health-problem. - PubMed
  36. Scott LD, et al. The relationship between nurse work schedules, sleep duration, and drowsy driving. Sleep 2007;30(12):1801–7. - PubMed
  37. Boyle LN, et al. Driver performance in the moments surrounding a microsleep. Transp Res Part F Traffic Psychol Behav 2008;11(2):126–36. - PubMed
  38. Lee ML, et al. High risk of near-crash driving events following night-shift work. Proc Natl Acad Sci U S A 2016;113(1):176–81. - PubMed
  39. National Highway Traffic Safety Administration. Asleep at the wheel: a national compendium of efforts to eliminate drowsy driving. Washington, DC: U.S. Department of Transportation; 2017 Mar. DOT HS 812 352. https://www.nhtsa.gov/sites/nhtsa.gov/files/documents/12723-drowsy_driving_asleep_at_the_wheel_031917_v4b_tag.pdf. - PubMed
  40. Barnes-Farrell JL, et al. What aspects of shiftwork influence off-shift well-being of healthcare workers. Appl Ergon 2008;39(5):589–96. - PubMed
  41. Jansen NW, et al. Antecedents and consequences of work-family conflict: a prospective cohort study. J Occup Environ Med 2003;45(5):479–91. - PubMed
  42. Liu YE, et al. Experiences of front-line nurses combating coronavirus disease-2019 in China: a qualitative analysis. Public Health Nurs 2020;37(5):757–63. - PubMed
  43. Weinstein SM. B is for balance: 12 steps toward a more balanced life at home and at work. 2nd ed. Indianapolis, IN: Sigma Theta Tau International; 2015. - PubMed
  44. Manzano García G, Ayala Calvo JC. The threat of COVID-19 and its influence on nursing staff burnout. J Adv Nurs 2021;77(2):832–44. - PubMed
  45. Geiger-Brown J, et al. CE: original research: napping on the night shift: a two-hospital implementation project. Am J Nurs 2016;116(5):26–33. - PubMed
  46. Scott LD, et al. An interventional approach for patient and nurse safety: a fatigue countermeasures feasibility study. Nurs Res 2010;59(4):250–8. - PubMed
  47. Scott LD, et al. Implementing a fatigue countermeasures program for nurses: a focus group analysis. J Nurs Adm 2010;40(5):233–40. - PubMed
  48. Takahashi M, et al. Nurses' workload associated with 16-h night shifts. II: effects of a nap taken during the shifts. Psychiatry Clin Neurosci 1999;53(2):223–5. - PubMed
  49. da Silva Borges FN, et al. Effects of naps at work on the sleepiness of 12-hour night shift nursing personnel. Sleep Sci 2009;2(1):24–9. - PubMed
  50. Ruggiero JS, Redeker NS. Effects of napping on sleepiness and sleep-related performance deficits in night-shift workers: a systematic review. Biol Res Nurs 2014;16(2):134–42. - PubMed
  51. Vanlaar W, et al. Fatigued and drowsy driving: a survey of attitudes, opinions and behaviors. J Safety Res 2008;39(3):303–9. - PubMed
  52. Dossey BM. Forward. In: Weinstein SM, editor. B Is for balance: 12 steps toward a more balanced life at home and at work. 2nd ed. Indianapolis, IN: Sigma Theta Tau International; 2015. - PubMed
  53. Cox S. The power of gratitude. Nurs Manage 2018;49(4):56. - PubMed
  54. Fishman MDC. The silver linings journal: gratitude during a pandemic. J Radiol Nurs 2020;39(3):149–50. - PubMed
  55. Sexton JB, Adair KC. Forty-five good things: a prospective pilot study of the Three Good Things well-being intervention in the USA for healthcare worker emotional exhaustion, depression, work-life balance and happiness. BMJ Open 2019;9(3):e022695. - PubMed
  56. Miyoshi Y. Restorative yoga for occupational stress among Japanese female nurses working night shift: randomized crossover trial. J Occup Health 2019;61(6):508–16. - PubMed
  57. Resnicoff M, Julliard K. Brief mindfulness meditation with night nursing unit staff: a qualitative study. Holist Nurs Pract 2018;32(6):307–15. - PubMed
  58. Nooner AK, et al. Using relaxation and guided imagery to address pain, fatigue, and sleep disturbances: a pilot study. Clin J Oncol Nurs 2016;20(5):547–52. - PubMed
  59. Loft MH, Cameron LD. Using mental imagery to deliver self-regulation techniques to improve sleep behaviors. Ann Behav Med 2013;46(3):260–72. - PubMed
  60. Occupational Safety and Health Administration (OSHA). Healthcare wide hazards: needlestick/sharps injuries. Washington, DC; 2002. Hospital eTool; https://www.osha.gov/SLTC/etools/hospital/hazards/sharps/sharps.html. - PubMed
  61. Jang SW, Ahn B. Implementation of detection system for drowsy driving prevention using image recognition and IoT. Sustainability 2020;12(7): https://doi.org/10.3390/su12073037. - PubMed
  62. Taub EA. Sleepy behind the wheel? Some cars can tell. New York Times 2017 Mar 16. - PubMed
  63. Chueh KH, et al. Psychological distress and sleep disturbance among female nurses: anxiety or depression. J Transcult Nurs 2021;32(1):14–20. - PubMed
  64. Melnyk BM, et al. Critical care nurses' physical and mental health, worksite wellness support, and medical errors. Am J Crit Care 2021;30(3):176–84. - PubMed
  65. Stokowski LA. Should night-shift nurses nap at work. Medscape 2016 Aug 5. https://www.medscape.com/viewarticle/866836. - PubMed
  66. Hughes KE, et al. Sleep and lifestyle habits of osteopathic emergency medicine residents during training. J Am Osteopath Assoc 2018;118(8):e45–e50. - PubMed
  67. Kotwal A, Taneja D. Health care workers and universal precautions: perceptions and determinants of non-compliance. Indian J Community Med 2010;35(4):526–8. - PubMed
  68. Taneja J, Mishra B. Promotion of successful hand hygiene practices in the intensive care units of a tertiary care hospital. Journal of Patient Safety and Infection Control 2015;3(3):130–33. - PubMed
  69. Hessels AJ, Larson EL. Relationship between patient safety climate and standard precaution adherence: a systematic review of the literature. J Hosp Infect 2016;92(4):349–62. - PubMed
  70. Nichol K, et al. Behind the mask: determinants of nurse's adherence to facial protective equipment. Am J Infect Control 2013;41(1):8–13. - PubMed
  71. Dempsey C. The question of 12-hour shifts. Industry Edge: a Press Ganey publication 2016 May. - PubMed
  72. Mousazadeh Y, et al. Advantages and disadvantages of different methods of hospitals' downsizing: a narrative systematic review. Health Promot Perspect 2013;3(2):276–87. - PubMed
  73. Houghton K. COVID-19 infections causing health care worker shortages. AP 2020 Oct 26. https://apnews.com/article/pandemics-virus-outbreak-health-helena-montana-71b4a1f83cf6e2d6c97cba6613085d23. - PubMed
  74. Shaffer FA, Curtin L. Nurse turnover: understand it, reduce it. Am Nurse 2020;15(8):57–9. - PubMed
  75. National Academies of Sciences, Engineering, and Medicine. Taking action against clinician burnout: a systems approach to professional well-being. Washington, DC: National Academies Press; 2019. Consensus study report; https://www.nap.edu/catalog/25521/taking-action-against-clinician-burnout-a-systems-approach-to-professional. - PubMed
  76. American Nurses Association. Addressing nurse fatigue to promote safety and health: joint responsibilities of registered nurses and employers to reduce risks. Silver Spring, MD; 2014 Sep 10. ANA position statement; https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/addressing-nurse-fatigue-to-promote-safety-and-health. - PubMed
  77. Wakefield M, et al. The future of nursing 2020-2030: charting a path to achieve health equity. Washington, DC: National Academies Press; 2021. Consensus study report; https://www.nap.edu/catalog/25982/the-future-of-nursing-2020-2030-charting-a-path-to. - PubMed
  78. Moran D, et al. Cost-benefit analysis of a support program for nursing staff. J Patient Saf 2020;16(4):e250–e254. - PubMed

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