Why Are Nurses So Exhausted?
While driving home after work at 8 one evening, Kim saw police headlights in her rear view mirror. She glanced down at her speedometer. She wasn’t going over the speed limit. Puzzled, she pulled over. The police officer bent his head down to her window. “Did you know you just ran a red light?” he asked. “Ran a red light?!” Suddenly in her mind’s eye Kim did see the red light. Her eyes had seen it but her brain had not processed it.
Driving while drowsy is a phenomena well-known to exhausted nurses driving home after a long shift. They can go from hyper-alert while on duty to a kind of half-awake sleep state in the car. Ryan, an ED nurse, walked in the front door of his house after his shift…but can’t remember driving home.
Why Are Nurses So Exhausted?
There’s many reasons why nurses are so exhausted.
One reason is sustaining a state of hyper-alertness. Much like firemen who wait for the next alarm to go off or a new mother anticipating her baby’s cry, nurses are on high alert all during their shift. Fatigue is at bay until the vigilance/adrenalin surge is no longer needed. “On my days off I just want to lay around and do nothing” and “On my first day off I feel like I was hit by a Mac truck” are descriptions of nurses recuperating from working two to three twelve-hour shifts in a row.
Being busy is one thing. Being overwhelmed is another. Hospitals are chaotic and complex. There are so many demands coming at a nurse that the situation can change from manageable to unmanageable in a heartbeat. Being overwhelmed is not only emotionally, intellectually and physically depleting, it’s unsafe.
Caring for the same 5 patients is entirely different from caring for 5 beds with revolving patients. Additional energy is required to admit and discharge, and even more energy is required to “learn” each new patient. With high turnover, there’s no downtime. The pace is often relentless. Some hospitals even have a requirement that a nurse must accept a new patient within 5 minutes of a room being cleaned following a discharge.
[Tweet “It’s exhausting to respond compassionately at all times when there’s nothing left to give”]
“I was off for 5 days and everything changed” joked a nurse. Last week’s MRSA screening guidelines are different from this week. Pressure injuries are now charted in a different place in the computer and the translation service provider has changed. There is pressure to stay informed but often no time to read and process all the practice change.
Nurses are working more with less and exhorted to “Work smarter, not harder”. Being told to work “smarter, not harder” can be a way of re-directing valid concerns about nurse-patient ratios. In many hospitals, tasks from other disciplines are passed onto nursing to reduce costs- such as respiratory therapy, phlebotomy, and even housekeeping.
Consequences of Exhaustion
Nurse fatigue is a huge threat to patient safety. While it is possible to push through on adrenaline, part of being fatigued is losing the ability to judge your own level of alertness.
Nurses suffer impaired problem solving, and reduced comprehension, and memory. Exhausted nurses are at risk of increased risk-taking and slower reaction times. Responses are slower and the nurse is duller.
Errors such as failure to rescue are linked to fatigue. Medication errors increase and the capacity for compassion decreases, leading to guilt.
Resilience must be cultivated and depletion must be recognized. Night nurses should take a short nap or rest during their break. All nurses should be provided regular breaks during their shift during which they are relieved of all duties, including answering their phone. New graduate RNs need to be taught to recognize signs of fatigue in themselves and develop emotional boundaries. Debriefing should be provided after codes and deaths.
Mandatory overtime should not be used as a staffing option. Instead of being targeted for overtime, new grads should be educated regarding the risks of working overtime. Nurses need to be their own advocates because hospitals typically will call the nurse who is known to say “Yes” without regard for their work-life balance. It’s Ok to say No to overtime and even excessive committee work on days off.
Burnout happens whether or not the nurse knows it’s happening.
According to the ANA’s position statement, nurses should work no more than 40 hours in a seven-day period and no more than 12 hours per 24-hour period.
Until such time as nurses’ workloads and nurse-patient ratios are viewed as a matter of public safety in much the same way as truck drivers and airline pilots, it is up to us to support one another, promote a healthy workplace, and practice self-care.