Boston Globe: "Study links long hours, nurse errors"
July 7, 2004 -- Today the Boston Globe published a generally good story by Liz Kowalczyk about a new nursing fatigue study by University of Pennsylvania School of Nursing researchers. The study, which was published in Health Affairs, indicated that nurses working shifts of 12.5 hours or more were three times more likely to make mistakes than nurses on shifts of less than 8.5 hours. The study's lead author was sleep and fatigue expert Ann Rogers, R.N., Ph.D, FAAN.
The piece explains that the study was based on daily logbooks kept by 393 nurses nationwide during one month in 2002. It rightly notes that one possible weakness was the reliance on self-reporting, which could affect the results in different ways. One interesting finding was that working unplanned overtime actually increased the likelihood of a nurse making a mistake. Rogers theorizes that nurses who knew they would be working longer may have gotten more sleep, or felt they could accomplish tasks in a less hurried way. The story focuses on errors in giving medications.
The article sets the new research in national and local contexts. It notes that while there has been research into the effect of long hours on other professions, such as medicine, the application to nursing is relatively new. It explains that there has been increasing concern about nurses' workloads in view of the nursing shortage and "financial pressures on hospitals to to trim staff." The piece cites a 2002 study by Penn's Linda Aiken finding that higher nurse patient loads dramatically increased post-operative mortality, a study performed, like this one, by The Center for Health Outcomes and Policy Research. The article also cites the late 2003 Institute of Medicine report noting that nurses' long hours threaten patient safety and recommending limits.
The piece also explains that nurses' hours have become a contentious issue in Massachusetts, as nurses and hospitals have fought over proposed legislative and hospital-specific measures to end mandatory overtime. The article suggests that despite concerns over "flexibility," many hospitals are "bending to nurses['] demands on this front" because of the national "epidemic of medical errors." It offers the example of one Brighton hospital whose nurses recently negotiated an end to the practice of requiring shifts of more than 12 hours following a lengthy 2001 strike over the issue. One nurse on the bargaining team had mixed up the blood sugar levels and insulin requirements of two diabetic patients after 15 hours on the job.
In general, the story might have explained that medication errors are not the only kind of critical mistake a fatigued nurse can make, since the profession involves a wide range of assessments and interventions that have a great impact on patients' wellbeing. For instance, a serious complication might easily occur if a fatigued nurse failed to note a dramatic change in a patient's condition; many recent press articles have described the tragic consequences when patients are not adequately monitored. But on the whole, the piece is a strong account of important nursing research and of nurses fighting to protect their patients.
See Liz Kowalczyk's article "Study links long hours, nurse errors" in the July 7, 2004 issue of the Boston Globe.