Issue 38.3 - Fall 2008 - The Washington State Nurses Association

In Focus
in focus
Finding
Yourself
Dead
Tired
by Kim Armstrong, BSN, RNC
WSNA President
It wasn’t that
long ago, Washington
State
passed a law prohibiting
mandatory
overtime. I was
one of the nurses
who testified in favor of this law saying,
‘Let me decide when I’m well rested
enough to care for patients.’ I have
thought a lot about that testimony. Yes
it was absolutely right to pass this law,
and I will continue to work to close
the loopholes and expand it to nurses
in all settings. However, evidence
shows, the individual is not always
the best judge of his/her own fatigue
level. Yes, I do believe the individual is
better than the institution to judge, but
still maybe not the best judge. Studies
have shown the mental acuity of a
nurse working beyond twelve hours
approximates that of someone who is
intoxicated. Think about that. That’s
two alcoholic beverages. I don’t know
about you, but I feel ok with two drinks
on board and in my younger days,
would even drive. I don’t do that anymore!
So why would I chose to work
greater than 12 hours And I have to
ask, why anyone would really want to
work 12 hour shifts which in fact is a
minimum of 12.5 hour
In querying my colleagues - those who
work 8 hour, 12 hour, and a mixture of
both shifts - I have found varying opinions
of shift work. Their perspectives
are very interesting. The number one
reason cited as an advantage for 12 hour
shifts is the decreased number of trips
actually made to the work site. Anyone
can understand the desire for less time
on the road, less parking fees and more
days for personal life. Working 36 hours
a week and having 4 days off per week
is attractive. However, many of these
nurses wanted to ‘bunch’ scheduled
days together, some working 6 shifts in
6 days, thus having more days off without
interruption. Every 12 hour shifter,
especially those who work nights, says
they are often tired and are not getting
enough rest. One nurse who works a
mixture of both shifts stated she always
prepared for 12 hours, even if her
scheduled day was 8 hours and simply
counted leaving work at 8 hours as a
bonus. The most thought provoking
statement I heard in these discussions
was one nurse’s belief that 12 hour
shifts were a form of age discrimination.
Hmm.
The newspapers are quick to pick up
on stories of catastrophic errors made
when someone is simply too tired. One
story involved a nurse who inadvertently
injected an epidural line with a
medication which led to the patient’s
death. The nurse was in her 2nd double
shift of 16 hours with less than 7 hours
off in between shifts. Yes, systems problems
were identified, but why was this
nurse even allowed to work 32 out of 40
hours and why would she believe she
could be safe Many of us who work
under contracts, have clauses in those
contracts providing for an increased
rate of pay for double shifts, rest between
shifts and premiums for working
the so-called undesirable shifts. These
were originally placed in contracts as a
disincentive to the hospitals to prevent
nurses from working more hours. But
this is no longer the disincentive it was
meant to be: it has become a great incentive
to those nurses who see it as a
method for extra wages. In fact, some
nurses have based their life style and
personal budget on so-called ‘guaranteed
overtime.’ Contracts often call for
‘incentive pay’ which denotes a positive
image. Maybe we should have ‘incentive
pay rates’ for working extra time
on our days off when we are well rested
and ‘disincentive pay rates’ for working
after the end of our shifts or returning
to work without adequate rest. While
overtime will never be completely eliminated,
it should not be used for on-going
staffing issues. Even when units are
fully staffed, there are still unforeseen
problems such as personal and family
emergencies and illness which result
in overtime.
The work environment has also added
stress causing additional fatigue. Some
facilities are doing a great job, providing
quiet rooms and gardens and other
peaceful places were nurses and other
health care providers can rest their
minds and bodies. Some facilities
actually encourage the use of ‘power
naps’ of 15 to 30 minutes, while others
would characterize this practice as
“sleeping on the job” which can lead
to discipline. While most work places
are attempting to be more ergonomically
friendly, often it is still one size
fits all. The under flooring is still concrete,
the hallways long, patients are as
heavy if not heavier, the equipment is
heavy and difficult to move, the noise
levels from monitors, voices, telephones,
alarms — the list goes on and on. While
technology has greatly improved the
delivery of care to patients, it has also
The Washington Nurse | Fall 2008 | 5