Working when Fatigued & Assuring Patient Safety: RN's and Employers Responsibility

gonzo1, ASN, RN · Apr 7, 2007

It's about time something like this is brought forward. I have only been a nurse for 4 years, with the last 2 being in ER. I have worked about 5 16 hour shifts, being asked to stay for 4 more near the end of a 12. I soon recognized that after 14 hours I become an idiot. If I stay over now I do it in triage as that is my strongest skill and less chance for a mistake to be made. I don't want to work doubles though. And when I do, I do not drive home, I get a ride or my spouse comes and gets me.

I know of several of my coworkers who work way too many hours and brag about coming to work consistently on 2-3 hours of sleep per day. This scares the hell out of me.

I hate to think that if I end up in the hospital I might be cared for by someone who has so little sleep.

Most of us supplement our income with some agency work because we are not getting paid what we should as staff nurses. After 4 years I am only at 23 an hour. ANd I donate countless hours back to the hospital in the form of missed breaks and lunches.

We all need to start taking these issues seriously and start to make some changes.

pickledpepperRN · Apr 7, 2007

If I am tired and they beg me to stay over I say, "I would if I could, but I can't because to do so would endanger my patients. Fatigue could cause mistakes and accidents."

sanctuary, BSN, MSN, RN · Apr 7, 2007

If I am tired and they beg me to stay over I say, "I would if I could, but I can't because to do so would endanger my patients. Fatigue could cause mistakes and accidents."

:bow: :bow: Hooray for you. If all did that, the true nursing shortage would be known. I will work my days off, but won't work a double (unless it would be an emergency, of course)

HM2VikingRN, RN · Apr 7, 2007

beyond 12 is unsafe......My patho teacher shared that any time she worked beyond 12 dt weather or whatever that she would no longer pass or setup meds for patients.

TrudyRN · Apr 7, 2007

Interesting that we have an obligation to speak up when we see a fatigued colleague trying to work. Looks like everything is either our fault or our responsibility. When will lawmakers get some b***s and force employers to act right? Let's put the responsibility where it belongs.

In my job, we are told when hired that we have mandatory OT and we can be written up for refusing to work it, unless we are acutely ill or we are off the next day.

So what if we are too fatigued in a case like that? Then what?

purplemania, BSN, RN · Apr 7, 2007

the legislation needs to be carefully worded so that people who can and want to work "extra" are allowed to do so. But fatique plays a major part in errors, IMHO. However, our med errors are more often associated with agency nurses. Don't have control of how many hours they work and don't know if fatique is a factor there.

oramar · Apr 7, 2007

Some of the wording in the article says that the nurse is in charge of deciding when she/he is to tired to continue. I have to tell you I have seen people who were so tired they were silly and did not know it. I have had to point this out to them and found them impared to the state of beligerence. Yes, I am saying a extremely tired person is like a person on drugs/alcohol that does not know when to stop. I have also told managment a coworker was to tired to work and managment has gotten beligerent.(I don't think they like to be told this stuff because if they have been warned and accident happens then they can't just push the blame on the person who accepted too many hours. As we all know managment is all about ducking responsiblity and shifting blame, it is main requirement) I think the goverment is ducking out on it's responsibility to set limits for nurses like it does for pilots and truck drivers.

pickledpepperRN · Apr 7, 2007

Interesting that we have an obligation to speak up when we see a fatigued colleague trying to work. Looks like everything is either our fault or our responsibility. When will lawmakers get some b***s and force employers to act right? Let's put the responsibility where it belongs.
In my job, we are told when hired that we have mandatory OT and we can be written up for refusing to work it, unless we are acutely ill or we are off the next day.
So what if we are too fatigued in a case like that? Then what?

I would write on paper, "This is to document that i informed ***** that I am fatigued and unable to safely care for assigned patients, Therefore the hospital is responsible for any adverse effects on patient care. I will under protest do the best I can."

I would in front of witnesses ask whoever is mandating me to work over to sign it. If he or she refused to sign I would list all the witnesses

In reality the one time I did this they "magically" found a registry RN.

Really though try saying "I would if I could but I can't because..."

I learned that in a clas and it really works!

Midwest4me · Apr 7, 2007

Interesting that we have an obligation to speak up when we see a fatigued colleague trying to work. Looks like everything is either our fault or our responsibility. When will lawmakers get some b***s and force employers to act right? Let's put the responsibility where it belongs.
In my job, we are told when hired that we have mandatory OT and we can be written up for refusing to work it, unless we are acutely ill or we are off the next day.
So what if we are too fatigued in a case like that? Then what?

I, too, work where we can be mandated to do OT(due to all the call-ins constantly) and if we refuse we can be written up...and get into some very serious trouble. Some units are worse than others: some nurses get mandated 2+times a week--it's actually possible to probably get mandated 3 times or more a week. The mandates then cause a vicious cycle--people are mandated too many times then become ill and they call in, causing others to get mandated. It's asinine. If you were to raise your concerns with managment, you'd be referred to as "not a team player". If you voiced your concerns to those who called in and ultimately CAUSED your mandate, then you'd probably be considered "creating a hostile work envirnment"---I've seen it happen. We agreed to the possible mandates when we hired on; we have no legs to stand on. VERY sad.....

MrsWampthang, BSN, RN · Apr 8, 2007

Funny, I was just discussing this with my DON the other night. We have kind of the opposite problem where I work. I have a coworker who consistently signs up for extra shifts, working everyday for two to three weeks sometimes. These are 12 hour day shifts so she ends up working 84 hours a week, week after week. Anyway, I talked about the DON about this, and she told me that if she didn't work so many hours at our hospital, she would just work extra hours somewhere else. True, if she doesn't get hours at her full time job, she will pick up shifts through her agency. The DON agreed with me that it can be dangerous for her to be putting in so many hours at our hospital or anywhere else, but what can anyone do? You can't force someone to take days off, especially when she openly admits that things are so bad at home that she'd rather be at work, not to mention the fact that she needs the money due to debt. The last time I worked with her, I could tell she had been working too many hours, she was loud, pushy and short with her coworkers. I guess I can only hope that she doesn't make any fatal errors in her overworking. But again, what can you do? She is the first one that anyone calls when someone extra is needed cause she will drop what she is doing to come in. Again, I hope that she doesn't get so fatigued that she does something really stupid or has breakdown at the wrong time. I don't know what else I can do.

Pam

txspadequeenRN, BSN, RN · Apr 8, 2007

this is a really good idea!! i get beyond stupid when tired...

beyond 12 is unsafe......my patho teacher shared that any time she worked beyond 12 dt weather or whatever that she would no longer pass or setup meds for patients.