Patient safety and human factors: human factors - stress and fatigue
Definition: Stress is the "adverse reaction people have to excessive pressure or other types of demand placed upon them". (Health and Safety Executive 2007, p.7)
Definition: Fatigue is " the state of tiredness that is associated with long hours of work, prolonged periods without sleep, or requirements to work at times that are “out of synch” with the body’s biological or circadian rhythm’"(Caldwell and Caldwell 2003, p.15).
Work-related stress is widely reported as major problem for the European workforce (European Agency for Safety and Health at Work 2009). The interim report of the Boorman review (NHS Health and Well-being Review 2009a) showed that stress was widespread in the NHS. Respondents to their survey generally did not believe that managers beyond their immediate line manager were interested in their health and well-being (NHS Health and Well-being Review 2009a).
Nurses have one of the highest rates of work-related stress among self reporting groups of workers in the UK (European Agency for Safety and Health at Work 2009). Significant levels of stress/fatigue have been reported among nursing students (Rella et al. 2009). Accumulated hours and non-standard shift patterns produce physical and mental fatigue that can contribute to errors and impact on performance (Garrett 2008). Despite this the emotional labour associated with nursing care often goes unrecognised (Sawbridge and Hewison 2011).
While other industries have developed programmes to reduce fatigue-related errors, similar interventions are few for nursing (Scott et al. 2010). Targeted strategies to improve fatigue management and reduce error rates such as fatigue countermeasures programmes (Scott et al 2010), and changing staffing patterns (Warren et al. 2008) have had positive results.
The relationship between nursing staffing levels and skill mix and patient outcomes and quality has been the subject of research and official reviews and reports (Ball 2010). In the UK a succession of high profile cases has highlighted the issues surrounding nursing staffing levels and compromised care (Ball 2010). Feedback from key human resources and outcome indicators are powerful signals and need to be used proactively by health organisations (Ball 2010).
The Boorman review recognised the extent of the changes required: "Changing perceptions and approaches will require fresh thinking and a willingness to innovate, targeting prevention as a first priority and then ensuring trusted, high-quality care when needed" (NHS Health and Well-being Review 2009b, p.4).
For ideas about how to reduce risks to do with stress and fatigue go to our Action on stress and fatigue page.
References
These resources were last accessed on 21 November 2012. Some of them are in PDF format - see how to access PDF files.
Ball J (2010) Guidance on safe nurse staffing levels in the UK (PDF 1.7MB), London: RCN.
Caldwell JA and Caldwell JL (2003) Fatigue in aviation: a guide to staying awake at the stick, Burlington, Vermont: Ashgate.
European Agency for Safety and Health at Work (2009) European Risk Observatory Report. OSH in figures: stress at work - facts and figures (PDF 4,112KB) , Bilbao, Spain: European Agency for Safety and Health at Work.
Garrett C (2008) The effect of nurse staffing patterns on medical errors and nurse burnout, AORN Journal, 87(6) June, pp.1191-2,1194,1196-1200.
Health and Safety Executive (2007) Managing the causes of work-related stress: a step-by-step approach to using the Management Standards, London: HSE.
King’s Fund (2011) The future of our leadership and management in the NHS. No more heroes, London: King’s Fund.
King’s Fund (2012) Leadership and engagement for improvement in the NHS. Together we can, London: King’s Fund.
NHS Employers: NHS well-being at work website.
NHS Health and Well-being Review (2009a) NHS health and well-being. Interim report (the Boorman Review), The Review website.
NHS Health and Well-being Review (2009b) NHS health and well-being. Final report (the Boorman Review), The Review website.
Rella S et al. (2009) When does nursing burnout begin? An investigation of the fatigue experience of Australian nursing students, Journal of Nursing Management, 17(7) November pp.886-897.
Royal College of Physicians (2011) Implementing NICE public health guidance for the workplace: a national organisational audit of NHS Trusts in England, London: RCP.
Sawbridge Y and Hewison A (2011) Time to care? Responding to concerns about poor nursing (PDF 146.8KB) , Birmingham: Health Services Management Centre. University of Birmingham.
Scott LD et al. (2010) An interventional approach for patient and nurse safety: a fatigue countermeasures feasibility study, Nursing Research, 59(4) Jul-Aug, pp.250-258.
Warren A and Tart RC (2008) Fatigue and charting errors: the benefit of a reduced call schedule, AORN Journal, 88(1) July, pp.88-95.