Shift working nurses will be surveyed about fatigue-related errors during a major research project to develop a cutting-edge approach to managing nurse fatigue.
The Health Research Council last week announced funding of $890,000 towards the three-year project, which will see sleep and nurse researchers working together to better manage fatigue, with the goal of improving both patient safety and the health and wellbeing of hospital nurses on shift work.
The project is led by Professor Philippa Gander, the director of Massey University's Sleep/Wake Research Centre, who will be working with centre researcher Dr Karyn O'Keeffe, NZNO researcher Dr Leonie Walker, Massey nursing professor Annette Huntington and a nurse-dominated advisory group.
Gander says there are no 'magic bullets' for reducing shift work-related fatigue but the research aims to develop a cutting-edge Code of Practice providing science-based and innovative solutions to managing fatigue for hospital nurses.
"The only 'perfect' shift is unrestricted sleep at night and permanent day work – that's what the human body is designed for – but seeing we can't have the easy answer in (hospital) nursing we've got to look at something else," said Gander. The Health and Safety at Work Act (2015), which came into effect in April, also places responsibilities on district health boards and nurses to manage workplace hazards, including shift work related fatigue.
One of the first steps of the project will be a major online survey of nurses working in six hospital practice areas identified as having a high risk of fatigue-related errors: surgical, medical, inpatient mental health, child health (including neonatal), intensive care/critical care and emergency departments.
The confidential and anonymous survey will ask nurses about their work and sleep patterns and about their levels of sleepiness at work and experiences of fatigue-related outcomes including errors.
Gander says the centre asked similar questions about errors when it surveyed junior doctors and anaesthetists and had a high response rate of clinicians reporting errors that they perceived to be fatigue-related.
O'Keeffe says it was aiming to have the survey up online in about three months on the project's dedicated website, which will also focus on another aspect of the project – education on the science around sleep loss and fatigue, including the effect of sleeping in 'suboptimal' times in the circadian body clock cycle.
Survey participants will be invited through the New Zealand Nurses Organisation (NZNO) and other promotions to complete the online survey, with findings being used to develop an evidence-based matrix for evaluating the fatigue risk of different roster patterns.
Gander and O'Keeffe says DHBs currently rely heavily on duty or rest guidelines set in industrial agreements to manage fatigue. But this did not adequately address the combination of factors leading to fatigue, which was dependent not only on the length and gaps between shifts but also on when and what people were being asked to do during those shifts and with whom they were working.
The tools developed for the fatigue management code of practice for nurses will also build on work that the centre has done with junior doctors, which included developing a fatigue risk assessment matrix that is now being used to evaluate DHB rosters for junior doctors. "In the end we are aiming for better patient safety, better patient care and better health, safety and wellbeing for the nurses themselves."
Leonie Walker says the research project also follows on from Gander's previous work with the airline industry, which "revolutionised the way that airlines and pilots work together to reduce the risks of fatigue".
NZNO lead organiser Lynley Mulrine, who is part of the research advisory group, says the sector has known for a long time that shift work increases the risk of fatigue-related errors and the project means that now it can do something about it.
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