According to research presented in the American Journal of Critical Care (AJCC)’s January edition, exhausted nurses have a higher probability of voicing out apprehensions about the regretful decisions they make regarding the care of a patient.

Nurses who commonly experienced tiredness, lack of enough rest and sleep, daytime drowsiness, and inability to adjust during shifting schedules are more probable to admit making bad health care assessments than well-rested nurses, as revealed in the “Association of Sleep and Fatigue with Decision Regret among Critical Care Nurses”.

Decision regrets are pessimistic cognitive feelings that root when the real result is not similar to the expected or wanted outcome. In relation to nursing practice, it is comparable to the bad decisions they formulate in relation to the patient’s welfare.

Even though decision regret is a product of past decisions and unfavorable results, it may also aid in building up work-associated fatigue and affect the safety of the patient in the future.

The connection between fatigue and bad decision supports the need for proper staffing to make sure that fatigue management approaches are being utilized in order to ensure the patient’s safety and good working condition.

The Chicago College of Nursing’s Associate Dean for Academic Affairs and an associate professor at the University of Illinois, Linda D. Scott, RN, PhD, NEA-BC, FAAN, is the lead author. The co-authors are Cynthia Arslanian-Engoren, RN, PhD, ACNS-BC, FAHA, FAAN, and Milo C. Engoren, MD, FCCM, from the University of Michigan, Ann Arbor.

“Registered nurses play a pivotal role as members of the healthcare team, but fatigued and sleep-deprived critical care nurses put their patients and themselves at serious risk,” Scott mentioned. “Proactive intervention is required to ensure that critical care nurses are fit for duty and can make decisions that are critical for patients’ safety.”

The critical care nurses, together with their employers, should collaborate and realize the adverse outcome of stress, lack of sleep and too much daytime tardiness on the work performance of nurses and care of the patient and must participate in ways on how to address these problems.

Appropriate scheduling should be implemented by health care management systems to prevent employee burn out. Additionally, ample resources and materials must be available for reference in relation to making clinical decisions. Lastly, staff relievers should always be present to offer work breaks, like short naps, for fatigued staff.

“By working together to manage fatigue, critical care nurses and employers can ensure patients receive care from alert, vigilant and safe employees,” Scott added.

In the research, questionnaires were handed out to more than 600 critical care nurses who work full-time in their units. These questionnaires contain matters related to work, sleeping quality and quantity, daytime sleepiness, efficiency on decision-making and decision regret.

The majority of the respondents showed moderately high fatigue, a considerable amount of sleeplessness, and daytime sleepiness. All of these factors have a significant effect on the nurse’s ability to be attentive, alert and safe. To add, the respondents reported that they don’t get enough rest during non-working times.

According to the results, decision regrets are most frequent among male nurses who are on duty for 12-hour shifts and have a low appraisal for their clinical decisions.

The study was conducted in cooperation with the Kirkh of College of Nursing at Grand Valley State University, Grand Rapids, Michigan, and the American Association of Critical-Care Nurses (AACN).

Photo credit: (1)
“Fatigued Nurses More Likely to Regret their Clinical Decisions”. American Association of Critical-Care Nurses (AACN). January 2014.


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