Tired, Sleep-Deprived Nurses May Regret Clinical Decisions

Larry Hand

December 30, 2013

Nurses who reported that they were tired, did not get enough sleep, or could not recover adequately between shifts were more likely than unimpaired nurses to regret some clinical decisions they made during their shifts, according to an article published in the January 2014 issue of American Journal of Critical Care.

Although such regret applies to past decisions and adverse outcomes, it also could lead to future work-related stress that could compromise future patients' safety, the authors write.

Linda D. Scott, RN, PhD, associate dean for academic affairs at the University of Illinois at Chicago College of Nursing, and colleagues sent questionnaires to 3500 nurses working at least 36 hours a week, randomly selected from about 14,000 nurses on the membership list of the American Association of Critical Care Nurses.

No incentives were offered for completing and returning the questionnaires.

In addition to collecting personal and work-related information on fatigue, sleep quality, daytime sleepiness, and amount of sleep, the researchers also inquired about how the nurses viewed their self-efficacy and regret regarding the clinical decisions they made.

Almost a Third Regret Decisions

Of the 605 nurses whose responses were included in the analysis, 546 (90%) answered the question about decision regret, and 157 (29%) of those responded that they had regretted some clinical decisions. Although personal and work-related characteristics were similar among nurses with and without decision regret, those with regret were more likely to work at night and on 12-hour shifts.

The researchers used 3 different models to analyze the effects of sleep, nurse characteristics, and satisfaction. They found that in model 1, decision regret was associated with less intershift recovery, greater sleep debt, and daytime sleepiness. In model 2, they found that being male replaced sleep debt, whereas less intershift recovery and sleep debt remained associated, and in model 3 they found that being male, working longer shifts (≥12 hours; P = .01), and having less satisfaction in clinical decision making was associated with more decision regret.

Critical care nurses and healthcare employers should work together to "acknowledge the impact" of these factors on clinical performance and patient outcomes and then develop mitigating strategies, the researchers write. They offer suggestions for both nurses and employers, such as nurses taking naps and avoiding excessive consecutive work shifts and employers implementing new scheduling models and education.

"Registered nurses play a pivotal role as members of the health care team, but fatigued and sleep-deprived critical care nurses put their patients and themselves at serious risk," the authors write.

"[P]roactive intervention is required to ensure that critical care nurses are fit for duty and can make decisions that are critical for patients' safety."

This research was supported by Kirkhof College of Nursing, Grand Valley State University, and the American Association of Critical Care Nurses. The authors have disclosed no relevant financial relationships.

Am J Crit Care. 2014;23:13-23.


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