Health Care Organizations: Sources Of Nurse Fatigue (Essay Sample)

Nurse Fatigue
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Nurse Fatigue
Available nursing scholarship shows that nurse fatigue has major implications on the health and safety of nurses and patients, in large part due to the capacity of the physical, emotional and spiritual symptoms associated with the problem to render the nurse unable to demonstrate care or empathize with the patient’s suffering (Domen, Connelly, & Spence, 2015). Although nurse fatigue can be relieved by regular rest, many nurses continue to suffer in silence due to the demanding nature of the nursing profession (Chen, Davis, Daraiseh, & Davis, 2014; Hunsaker, Chen, & Maughan, & Heaston, 2015), which in turn leads to physical, emotional and mental exhaustion (Liu et al., 2016). The problem is entrenched in acute care and emergency settings due to heavy workloads, long shifts lengths, and overtime provisions associated with these practice settings (Martin, 2015). This paper discusses the issue of nurse fatigue with the view to underscoring the need for health care organizations to implement evidence-based strategies aimed at proactively addressing the problem.
Types of Nurse Fatigue
For the purpose of clarity, this paper categorizes nurse fatigue into two types, namely work-related fatigue and compassion fatigue. Work-related fatigue encompasses stressful events associated with factors such as poor working environment, heavy and demanding workload, long shift length and overtime, as well as lack of inter-shift recovery period (Domen et al., 2015). It is important to note that, in the absence of efforts aimed at ensuring that nurses cope with the high psychological and physical demands of their work, an acute fatigue incidence (state of energy depletion resulting from work-related activities) may lead to chronic fatigue that is reinforced by the long-term maladaptation to work-stress or activities (Liu et al., 2016).
Compassion fatigue, on the other hand, is a type of fatigue that results “from the nurse’s involvement in relationships with patients and families in which the nurse witnesses the trauma or suffering of patients” (Lachman, 2016, p. 275). When nurses are continually exposed to the aftermath of life-threatening illnesses that often characterize critical care settings, they are likely to experience physical, mental and spiritual symptoms associated with the compassion fatigue phenomenon (Sacco, Ciurzynski, Harvey, & Ingersoll, 2015). According to Lachman (2016), compassion fatigue consists of several components namely burnout (prolonged response to chronic emotional and interpersonal stressful activities on the job, resulting in a multiplicity of physical and emotional exhaustion), secondary traumatic stress (result of knowledge about a traumatizing event experienced by a patient and consequent stress arising from the urge to assist the traumatized patient), and vicarious traumatization (type of psychological distress resulting from extended exposure to trauma, which essentially shifts the cognitive orientation of the nurse on life issues such as intimacy, trust, safety and self-esteem).
Sources of Nurse Fatigue
Research is consistent that work-related and compassion types of fatigue are triggered by numerous sources. For example, work-related fatigue is often caused by physical sources and factors related to the physical environment, such as time constraints, multi-tasking in care delivery, heavy workloads, room layout, noise, temperature, and lighting (Steege, Drake, Olivas, & Mazza, 2015). Nurse fatigue is also caused by psychosocial factors (e.g., lack of teamwork and management support, social pressure, and lack of independence) and organizational inhibitions (e.g., poor nurse staffing, poor working environment, high workload, and increasing complexity of health care reform and structure of the workforce) that characterize the practice environment. Although compassion fatigue is associated with repeated exposure to traumatizing experiences, the actual sources of the problem include pressure, anxiety, negative feelings, and lack of adequate coping skills (Sacco et al., 2015). Most of these sources can be addressed if health care organizations take the effort to implement evidence-based fatigue avoidance strategies.
Symptoms and Outcomes of Nurse Fatigue
It is evident that nurse fatigue is associated with potentially dangerous symptoms and outcomes that serve to reinforce the need for hospitals to implement best practices and strategies aimed at addressing the problem. Lachman (2016) categorizes the symptoms of compassion fatigue using five components namely physical symptoms (stomach pains, headaches, weight gain or loss, accident proneness, exhaustion, and insomnia), emotional or mental symptoms (loss of empathy, sadness, emotional breakdown, cynicism, oversensitivity, avoidance of suffering patients, poor concentration, and memory impairment), spiritual symptoms (loss of hope, loss of spiritual awareness, and lethargy), and workplace symptoms (absenteeism, reduced performance, poor judgment, job dissatisfaction, and decreased quality of care). Most of these symptoms are replicated in work-related fatigue, meaning that the symptomatic dynamics are almost similar.
Several negative outcomes have been associated with nurse fatigue, most of which lower patient care outcomes and cause nurses to experience a multiplicity of health problems. For example, Domen et al. (2015) document the negative outcomes of nurse fatigue as “increased risk of obesity and associated complications such as diabetes, hypertension and cardiovascular disease, and higher rates of motor vehicle accidents” (p. 123). On their part, Liu et al. (2016) argue that “insufficient recovery from work fatigue is an indicator of performance breakdown, health problems, sick leaves, psychological distress, and decision to leave” (p. 67). Similarly, Lachman (2016) asserts that compassion fatigue may lead to a situation in which the nurse may lose the ability to care for the patient due to secondary traumatic stress and vicarious traumatization, resulting in poor nurse and patient outcomes in terms of inadequate performance, increased medication errors, and overall decline in the nurse’s holistic health and wellbeing.
It is important to note that, apart from nurse- and patient-oriented outcomes, nurse fatigue exposes health care organizations to additional costs in terms of high nurse turnover ratio, nurse performance issues, lack of patient satisfaction with care, and high rates of nurse absenteeism due to health concerns (Hunsaker et al., 2015; Martin, 2015). Owing to the fact the turnover cost per nurse is estimated to range from US$20,561 to US$48,790 across countries (Liu et al., 2016), it is extremely important for hospitals to adopt evidence-based practices aimed at reducing voluntary turnover associated with nurse fatigue.
Fatigue Avoidance Strategies
Research is consistent that there is need to develop and implement fatigue intervention programs, particularly in hospitals where nurses work 12-hour shifts (Chen et al., 2014) and in acute care contexts where professionals are repeatedly exposed to traumatizing experiences (Sacco et al., 2015). These programs need to consider the delicate balance between nurse resources and demands if they are to succeed in ensuring that nurses working for longer periods of time or exposed to traumatizing experiences are able to provide care in a safe environment. Some of the fatigue avoidance strategies documented in the literature include using support systems and mentors to guide new nurses through practice changes, developing a culture of caring within the organization, empowering nurses with self-awareness and stress-coping skills, increasing the number of breaks in between duty shifts, reducing the number of hours in duty shifts, demonstrating meaningful recognition to increase nurse satisfaction, and providing management support (Chen et al., 2014; Lachman, 2016; Kelly, Runge, & Spencer, 2015; Liu et al., 2016). Available literature demonstrates that these str...