Nursing issues
With no State or Federal regulations restricting the number of
hours a nurse may work in 24 hours or in a 7-day period,
hospitals have extended nurses' work shifts and overtime to cope
with the shortage of registered nurses (RNs). In many cases,
nurses work a shift lasting longer than 12 hours, which triples
the likelihood of medical error, according to a study supported by
the Agency for Healthcare Research and Quality (HS11963). Logbooks
completed in 2002 by a random nationwide sample of 393 hospital
staff nurses over a 4-week period revealed that 80 percent of the
time nurses worked longer shifts than scheduled, nearly 40 percent
of the 5,317 work shifts they logged exceeded 12 hours, and half
of them exceeded 10.5 hours.
The nurses used the logbooks to collect information about hours
worked (both scheduled and actual hours), time of day worked,
overtime, days off, and sleep/wake patterns, as well as
information about medical errors and near errors. The logbooks
also showed that 14 percent of nurses worked 16 or more
consecutive hours (double shifts) at least once during the 4-week
period. The longest shift worked was nearly 24 hours. Nurses left
work at the end of their scheduled shift less than 20 percent of
the time. They worked, on average, 55 minutes longer than
scheduled each day, and one-quarter of the nurses worked more than
50 hours per week for 2 or more weeks of the 4-week period.
These long hours increase the likelihood of medical errors,
notes Anne E. Rogers, Ph.D., R.N., F.A.A.N., of the University of
Pennsylvania School of Nursing. The likelihood of making an
error was more than three times as high when nurses worked shifts
lasting 12.5 hours or more. Working overtime doubled the odds
of making at least one error, regardless of how long the shift was
originally scheduled. Finally, working more than 40 hours per week
significantly increased the risk of making an error or near error.
See "The working hours of hospital staff nurses and patient
safety," by Dr. Rogers, Wei-Ting Hwang, Ph.D., Linda D. Scott,
Ph.D., R.N., and others, in the July/August 2004 Health Affairs
23(4), pp. 203-212.
Reprints (AHRQ Publication No. 04-R070) are available from the
AHRQ Publications Clearinghouse.
these are excerpts from the AHRQ Research Activities,
you can read the full report at
http://www.ahrq.gov/research/oct04/1004RA20.htm
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