Nurses' Short-Term Sickness Absences Before and After the Implementation of a Brief Napping Opportunity During Night Shifts.

BACKGROUND: Nurses who work at night have used naps to alleviate their sleepiness and fatigue. Research has shown night shifts, sleepiness, and fatigue predict nurses' missed workdays. Thus, nighttime napping may have a beneficial consequence of reducing nurses' sickness absences. The purpose of this brief report was to describe the difference in rates of short-term sickness absence before and after implementation of a 30-min nap opportunity in one U.S. hospital for 12-hr shift nurses. METHODS: The study was a retrospective pre-post evaluation design. Eight units provided nap opportunities for the nurses. Full-time nurses were classified into night and rotating shifts based on their 2 years of scheduling patterns. Absence data were extracted from the hospital's timekeeping system and annual absence rates were computed. A single linear mixed model with rank transformed data was conducted for each group. Median estimates, minimum and maximum, and p-values were reported. FINDINGS: The median absence rates for night shift nurses were 4.3% and 4.0% for the pre-napping and post-napping implementation periods, respectively; however, this difference was not statistically significant (p = .241). The median absence rates for rotating shift nurses were 2.0% and 3.9% for the pre-napping and post-napping implementation periods, respectively; and the difference increase was statistically significant (p < .001). CONCLUSION/APPLICATION TO PRACTICE: A nap policy which provides nurses with the opportunity to take nighttime naps did not benefit their sickness absence rates. Future research needs to examine the actual napping process on sickness absences, as well as explore other sickness management avenues.

Creating Interdisciplinary Engagement Through a Hospital-Based Endowed Chair in Nursing Research: The "Conway Chair Conversations".

Although clinical nurses' involvement in research is a role expectation, efforts to engage clinical nurses in nurse-led research have had notably mixed results. These efforts have most typically been single discipline-focused (nursing), although nursing care is a collaborative, interdisciplinary practice. Adding an interdisciplinary strategy to multiple other efforts to engage clinical nurses in research may contribute to more nurse involvement. Here, we describe the use of a hospital-based endowed chair in nursing research to simultaneously engage nursing and other disciplines in a monthly dialogue about clinically relevant, research-related challenges and solutions. Outcomes indicate that the research-related dialogue among nurses and interprofessional colleagues would likely not have taken place without this approach.

CE: Nurses Are More Exhausted Than Ever: What Should We Do About It?

ABSTRACT: For nurses, the challenges posed by demanding work environments and schedules often lead to fatigue, and this can be exacerbated during crises like the COVID-19 pandemic. In this article, the authors discuss causes and challenges of nurse fatigue and consider several evidence-based strategies and solutions for individual nurses and organizations. Barriers to implementation, including a negative workplace culture and inadequate staffing, are also described, and several resources are presented.

Going Beyond Position Statements: One Hospital's Successful Initiative to Implement Napping for Night Shift Nurses.

BACKGROUND: Sleepiness during the night shift is associated with errors, accidents, injuries, and drowsy driving. Despite scientific evidence that supports brief naps to reduce sleepiness, and guidance documents from policy organizations, napping has not been widely implemented. METHODS: An initiative to translate scientific evidence about napping was implemented in one hospital over one year. The initiative included garnering leadership support and resources, building a translation team, evaluating the evidence, responding to operational concerns, developing an implementation strategy, and then implementing and evaluating the results. Night shift nurses were surveyed pre and post nap implementation for drowsy driving, sleepiness, and work and coworker relationships. Qualitative data documented the nurses' perceptions about napping. FINDINGS: Three-fourths of the units that were eligible to nap successfully implemented and sustained napping. Most nurses felt refreshed by a brief nap and felt safer on the drive home, but one-fourth worried about or had sleep inertia symptoms. Drowsy driving remained unacceptably high. CONCLUSION: The initiative was successfully implemented on most nursing units. The mixed reaction to napping, and the unfavorable drowsy driving outcome point to the need for additional interventions to reduce sleepiness.

Mitigating Drowsy Driving Risk for Night Shift Nurses.

Preventive measures range from napping to installing driver monitoring systems in cars.

Acute and chronic fatigue in nurses providing direct patient care and in non-direct care roles: A cross-sectional analysis.

Nurses are at risk for work-related fatigue, which can impact their health, well-being, and job readiness. The purpose of this study was to examine the levels, types, and factors associated with fatigue in registered nurses (RNs) in direct patient care (DCRNs) and in non-direct patient care (non-DCRNs) roles. A cross-sectional survey was administered to 313 RNs. Measures included: Multidimensional Fatigue Symptom Inventory, Occupational Fatigue Exhaustion Recovery, Brief COPE, PROMIS® Global Sleep Disturbance, and Job Content Questionnaire. Acute fatigue levels in RNs were similar to those in diseased populations, and nearly 50% reported moderate/high levels of chronic fatigue. DCRNs reported higher levels of acute and chronic fatigue than non-DCRNs, but the differences were small and disappeared when accounting for other factors associated with fatigue including sleep disturbance, job strain, workplace support, maladaptive coping, and especially intershift recovery, which accounted for 20%-41% of fatigue variability. This study suggests that it may not be only nurses providing direct patient care who are at risk for acute and chronic fatigue. Intershift recovery may be particularly important in alleviating acute and chronic fatigue in nurses.

Fatigue and risk of sickness absence in the working population: A systematic review and meta-analysis of longitudinal studies.

Objectives Fatigue, a common complaint in workers, has been related to sickness absence (SA). The purpose of this systematic review and meta-analysis was to determine the prospective association between fatigue and SA in the working population. Methods An electronic literature search was conducted in five databases: PubMed, Embase, CINAHL, Psyc-INFO and Cochrane CENTRAL. Longitudinal studies were selected that focused on fatigue and future SA in workers. Random-effects meta-analyses were conducted and pooled estimates [95% confidence intervals (CI)] were obtained for the association between fatigue and risk of long-term SA in total and by sex. Heterogeneity was assessed by I 2statistics. Results Of the 16 included studies in the review, 14 provided supportive evidence for an association between fatigue and SA. The meta-analysis of 9 studies (provided 15 estimates) that were mostly of high quality showed that baseline fatigue increased the risk of long-term SA by 35% (95%CI 1.23-1.47) in workers. Heterogeneity was low-moderate (I 2=40%). The pooled estimates for an increased risk for long-term SA were 35% (95% CI 1.18-1.54) in fatigued men and 22% (95% CI 0.93-1.60) in fatigued women however this relationship was not statistically significant. Conclusion There is conclusive evidence for the prospective association between worker fatigue and long-term SA. Whereas most studies in the review measured chronic fatigue and long-term SA, there was insufficient data for the meta-analysis to draw conclusions on fatigue type. Future research is needed in this area as well as greater exploration of fatigue and long-term SA in women.

Bio-mathematical fatigue models predict sickness absence in hospital nurses: An 18 months retrospective cohort study.

This study examined the associations between bio-mathematical fatigue-risk scores and sickness absence (SA) in hospital nurses over 18 months. Work schedules and SA data were extracted from the hospital's attendance system. Fatigue-risk scores were generated for work days using the Fatigue Audit InterDyne (FAID) and Fatigue Risk Index (FRI). Over the study period, 5.4% of the shifts were absence shifts. FAID-fatigue ranged from 7 to 154; scores for a standard 9-5 work schedule can range from 7 to 40. Nurses with high FAID-scores were more likely to be absent from work when compared to standard FAID-scores (41-79, OR = 1.38, 95%CI = 1.21-1.58; 80-99, OR = 1.63, 95%CI = 1.37-1.94 and ≥ 100, OR = 1.73, 95%CI = 1.40-2.13). FRI-fatigue ranged from 0.9 to 76.8. When FRI-scores were >60, nurses were at 1.58 times (95%CI = 1.05-2.37) at increased odds for SA compared to scores in the 0.9-20 category. Nurse leaders can use these decision-support models to adjust high-risk schedules or the number of staff needed to cover anticipated absences from work.

The Nursing Performance Instrument: Exploratory and Confirmatory Factor Analyses in Registered Nurses.

BACKGROUND: The optimal performance of nurses in healthcare settings plays a critical role in care quality and patient safety. Despite this importance, few measures are provided in the literature that evaluate nursing performance as an independent construct from competencies. The nine-item Nursing Performance Instrument (NPI) was developed to fill this gap. PURPOSE: The aim of this study was to examine and confirm the underlying factor structure of the NPI in registered nurses. METHOD: The design was cross-sectional, using secondary data collected between February 2008 and April 2009 for the "Fatigue in Nursing Survey" (N = 797). The sample was predominantly dayshift female nurses working in acute care settings. Using Mplus software, exploratory and confirmatory factor analyses were applied to the NPI data, which were divided into two equal subsamples. Multiple fit indices were used to evaluate the fit of the alternative models. RESULTS: The three-factor model was determined to fit the data adequately. The factors that were labeled as "physical/mental decrements," "consistent practice," and "behavioral change" were moderately to strongly intercorrelated, indicating good convergent validity. The reliability coefficients for the subscales were acceptable. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The NPI consists of three latent constructs. This instrument has the potentialto be used as a self-monitoring instrument that addressesnurses' perceptions of performance while providing patient care.

Acute fatigue predicts sickness absence in the workplace: A 1-year retrospective cohort study in paediatric nurses.

AIMS: To examine the relationship between fatigue and sickness absence in nurses from a paediatric hospital over 12 months of follow-up. A secondary aim was to identify other work and personal factors that predict sickness absence. BACKGROUND: Sickness absence is often related to worker-fatigue, yet few studies have explored this relationship in nurses despite documented high fatigue levels. DESIGN: The study used retrospective cohort design. METHODS: Baseline data on 40 nurses from an intervention study were linked to absence data using the hospital's attendance records (2012-2013). A total of 6,057 work shifts were studied of which 5.2% were absence episodes. Fatigue was measured by the Occupational Fatigue Exhaustion Recovery scale. The questionnaire included instruments assessing sleep disturbances, workload and personal characteristics. Generalized linear mixed models were used to test the associations between fatigue, work, personal factors and sickness absence, while accounting for non-independency of repeated measures. RESULTS: With 1SD increase in acute fatigue scores, nurses were 1.29 times more likely to be absent from work. Factors such as intershift recovery, perceived workload, obstructive sleep apnoea and marital status also predicted sickness absence, that is, with 1SD increase in workload scores, nurses were 1.23 times more likely to be absent from work. Nurses with obstructive sleep apnoea had two times higher odds of sickness absence. CONCLUSION: Sickness absence is related to acute fatigue in paediatric nurses and to workload. Nursing leaders can monitor these factors to reduce sickness absence and screen for sleep apnoea and assist nurses in receiving the appropriate treatments.

Fatigue, Work Schedules, and Perceived Performance in Bedside Care Nurses.

Hospital nurses are expected to maintain optimal work performance; yet, fatigue can threaten safe practice and result in unfavorable patient outcomes. This descriptive cross-sectional study explored the association between fatigue, work schedules, and perceived work performance among nurses. The study sample included 77 bedside nurses who were mostly female, single, and between 20 and 29 years of age. The majority worked 8-hour shifts and overtime. Nurses who worked during off days reported significantly higher chronic fatigue compared with those nurses who took time off. Nurses who reported feeling refreshed after sleep had significantly less chronic and acute fatigue and more intershift recovery. Nurses with acute and chronic fatigue perceived poorer physical performance. Also, nurses who reported chronic fatigue perceived they were less alert and less able to concentrate when providing patient care. Less effective communication was also associated with acute and chronic fatigue. In conclusion, fatigue has safety implications for nurses' practice that should be monitored by nursing management.

Shift Work and Shift Work Sleep Disorder: Clinical and Organizational Perspectives.

Throughout the industrialized world, nearly one in five employees works some form of nontraditional shift. Such shift work is associated with numerous negative health consequences, ranging from cognitive complaints to cancer, as well as diminished quality of life. Furthermore, a substantial percentage of shift workers develop shift work disorder, a circadian rhythm sleep disorder characterized by excessive sleepiness, insomnia, or both as a result of shift work. In addition to adverse health consequences and diminished quality of life at the individual level, shift work disorder incurs significant costs to employers through diminished workplace performance and increased accidents and errors. Nonetheless, shift work will remain a vital component of the modern economy. This article reviews seminal and recent literature regarding shift work, with an eye toward real-world application in clinical and organizational settings.

Intentions and willingness to drive while drowsy among university students: An application of an extended theory of planned behavior model.

A web-based questionnaire was used to assess the utility of constructs from the Theory of Planned Behavior (TPB) and the Prototype Willingness Model (PWM) to predict intentions and willingness to engage in drowsy driving in a sample of 450 university students. Those students who reported more favorable attitudes and subjective norm and greater perceived control and willingness in relation to drowsy driving behavior were more likely to report stronger intentions to engage in drowsy driving behavior. Augmenting the TPB constructs with the PWM construct of willingness significantly explained up to an additional 8 percent of the variance in drowsy driving intention. Perceived behavioral control and willingness were consistently the strongest predictors of drowsy driving intention in the augmented model, which together with the control (personal) variables explained up to 70 percent of the variance in intention. Thus, the Theory of Planned Behavior and the Prototype Willingness Model may be useful for understanding motivational influences on drowsy driving behavior in young people and present promising theoretical frameworks for designing more effective interventions against drowsy driving in this population.

CE: Original Research: Napping on the Night Shift: A Two-Hospital Implementation Project.

UNLABELLED: : BACKGROUND: Nurses who work the night shift often experience high levels of sleepiness. Napping has been adopted as an effective countermeasure to sleepiness and fatigue in other safety-sensitive industries, but has not had widespread acceptance in nursing. PURPOSE: To assess the barriers to successful implementation of night-shift naps and to describe the nap experiences of night-shift nurses who took naps. METHODS: In this two-hospital pilot implementation project, napping on the night shift was offered to six nursing units for which the executive nursing leadership had given approval. Unit nurse managers' approval was sought, and where granted, further explanation was given to the unit's staff nurses. A nap experience form, which included the Karolinska Sleepiness Scale, was used to assess pre-nap sleepiness level, nap duration and perceived sleep experience, post-nap sleep inertia, and the perceived helpfulness of the nap. Nurse managers and staff nurses were also interviewed at the end of the three-month study period. RESULTS: Successful implementation occurred on only one of the six units, with partial success seen on a second unit. Barriers primarily occurred at the point of seeking the unit nurse managers' approval. On the successful unit, 153 30-minutes naps were taken during the study period. A high level of sleepiness was present at the beginning of 44% of the naps. For more than half the naps, nurses reported achieving either light (43%) or deep (14%) sleep. Sleep inertia was rare. The average score of helpfulness of napping was high (7.3 on a 1-to-10 scale). Nurses who napped reported being less drowsy while driving home after their shift. CONCLUSION: These data suggest that when barriers to napping are overcome, napping on the night shift is feasible and can reduce nurses' workplace sleepiness and drowsy driving on the way home. Addressing nurse managers' perceptions of and concerns about napping may be essential to successful implementation.

The Prevalence of Coworker Conflict Including Bullying in a Unionized U.S. Public Sector Workforce.

Workplace violence is an enormous problem worldwide; incidents where the perpetrator is a current or former employee are an important dimension. This large cross-sectional survey examined the prevalence of this problem among a U.S. state government unionized public sector workforce. Using participatory action research methods, we conducted a web-based survey of members of that workforce from a single northeast U.S. state, receiving 11,874 completed surveys (response rate: 71.8%). Overall, 10.0% of the respondents indicated that they had been bullied at work during the prior 6 months, with 71.9% of those who reported regular bullying identifying the perpetrator as a supervisor and/or top management. The prevalence of bullying was similar to the rates reported in Europe and Scandinavia (5%-30%). Those reports also identified the person(s) responsible for the behavior as being predominantly of higher status within the organization.

Self-reported sleep quality and acute exacerbations of chronic obstructive pulmonary disease.

BACKGROUND: Many patients with chronic obstructive pulmonary disease (COPD) suffer from poor sleep quality. We hypothesized that poor sleep quality in otherwise stable patients predicted exacerbations in these patients. METHODS: This is a secondary analysis of the results of a previously published randomized trial of azithromycin in 1,117 patients with moderate to severe COPD who were clinically stable on enrollment. Sleep quality was measured using the Pittsburgh Sleep Quality Index. Other quality of life indices included the Medical Outcome Study 36-item Short Form Health Survey and the St Georges Respiratory Questionnaire. Outcomes included time to first exacerbation and exacerbation rate. RESULTS: Sleep quality was "poor" (Pittsburgh Sleep Quality Index >5) in 53% of participants but was not related to age or severity of airflow obstruction. Quality of life scores were worse in "poor" sleepers than in "good" sleepers. Major classes of comorbid conditions, including psychiatric, neurologic, and musculoskeletal disease, were more prevalent in the "poor" sleepers. Unadjusted time to first exacerbation was shorter (190 versus 239 days) and exacerbation rate (1.7 versus 1.37 per year) was greater in the poor sleepers, but no differences were observed after adjusting for medications and comorbid conditions associated with poor sleep. CONCLUSION: Poor sleepers had greater exacerbation rates than did good sleepers. This appeared to be due largely to them having more, or more severe, concomitant medical conditions and taking more medications.

Cognitive behavioral therapy in persons with comorbid insomnia: A meta-analysis.

Cognitive behavioral therapy for insomnia (CBT-I) is effective for treatment of primary insomnia. There has been no synthesis of studies quantifying this effect on insomnia comorbid with medical and psychiatric disorders using rigorous selection criteria. The objective of this study was to quantify the effect of CBT-I in studies including patients with medical or psychiatric disorders. Studies were identified from 1985 through February 2014 using multiple databases and bibliography searches. Inclusion was limited to randomized controlled trials of CBT-I in adult patients with insomnia diagnosed using standardized criteria, who additionally had a comorbid medical or psychiatric condition. Twenty-three studies including 1379 patients met inclusion criteria. Based on weighted mean differences, CBT-I improved subjective sleep quality post-treatment, with large treatment effects for the insomnia severity index and Pittsburgh sleep quality index. Sleep diaries showed a 20 min reduction in sleep onset latency and wake after sleep onset, 17 min improvement in total sleep time, and 9% improvement in sleep efficiency post-treatment, similar to findings of meta-analyses of CBT-I in older adults. Treatment effects were durable up to 18 mo. Results of actigraphy were similar to but of smaller magnitude than subjective measures. CBT-I is an effective, durable treatment for comorbid insomnia.

Certified Nurse Aide scope of practice: state-by-state differences in allowable delegated activities.

OBJECTIVES: To gain a better understanding of the state-by-state differences in allowable delegated activities for Certified Nurse Aides (CNAs) working in long-term care settings, this exploratory descriptive study assessed what are the allowable tasks for CNAs based on findings from each state board of nursing. Specifically, findings from each state determined whether the care tasks allowed were consistent with those delineated by the 42 CFR § 483. DESIGN: This descriptive study included data drawn from all 50 states' regulatory offices or health care services agencies. Data were obtained from the regulations listed on each state's board of nursing, department of health, department of aging, department of health professions, department of commerce, and office of long-term care, among like agencies. MEASURES: The Code of Federal regulations (42 CFR § 483) listed 9 tasks that are allowable by each state. These tasks are identified as items 1 to 9: (1) personal care skills, (2) safety/emergency procedures, (3) basic nursing skills, (4) infection control, (5) communication and interpersonal skills, (6) care of cognitively impaired residents, (7) basic restorative care, (8) mental health and social service needs, and (9) residents' rights. RESULTS: Nine tasks delineated in the 42 CFR § 483 were identified as allowable in each state. On data analysis, it was found that 11 states noted that CNAs were able to perform workplace tasks that could be considered "expanded" care tasks, tasks beyond the basic care tasks listed in the 42 CFR § 483. CONCLUSIONS: Findings from this exploratory study aid in limiting the confusion around the application of workplace duties across states, providing a useful description of the care tasks CNAs are allowed to perform in an attempt to find uniformity state-by-state. Overall, states reported considering expanding the scope of practice or authorized duties for CNAs to strengthen patient care and safety. States may choose to expand CNA authorized duties so as to equip CNAs with specific training so that the CNA is able to provide a certain level of care when or if he or she is needed to do so. Without uniformity of CNA authorized duties, it is difficult to interpret whether expanding the scope of the CNA can result in outcomes such as improved patient care. State regulations vary and there were state boards of nursing that were not sure about the true extent of CNA workplace responsibilities.

Experience of insomnia, symptom attribution and treatment preferences in individuals with moderate to severe COPD: a qualitative study.

Persons with chronic obstructive pulmonary disease (COPD) are known to have poor sleep quality. Acceptance of and adherence to therapies for sleep problems may depend on how the person with COPD regards the source of his sleep problem, yet little is known about their attribution as to the cause of these sleep symptoms. The objective of this study was to describe the subjective sleep complaints of individuals with COPD along with their attributions as to the cause of these symptoms, and their treatment preferences for insomnia. Three focus groups were conducted (N=18) with participants who have moderate to severe COPD. Focus group data were transcribed, compared and contrasted to identify themes of attribution. Participants reported difficulty falling asleep, staying asleep, and daytime sleepiness. They attributed their sleep problems primarily to their pulmonary symptoms, but also poor air quality (thick humid air) and death anxiety when awake during the night. There was no clear preference for type of treatment to remedy this problem (medication, cognitive therapy), although they indicated that traveling to the clinic was difficult and should be avoided as much as possible. These data suggest that environmental manipulation to improve air quality (eg, air conditioning) and modifications to reduce death anxiety could be beneficial to persons with COPD. In-person multi-session therapy may not be acceptable to persons with moderate to severe COPD, however internet-based therapy might make treatment more accessible.

Factors associated with work-related fatigue and recovery in hospital nurses working 12-hour shifts.

Nurse fatigue threatens both nurse and patient safety; fatigue affects nurses' neurocognitive functioning and hinders their work performance. The authors assessed the association of work and non-work factors with acute and chronic fatigue and intershift recovery among hospital nurses working 12-hour shifts. This study used survey data from 80 nurses who provided full-time direct patient care on medical-surgical and critical care units in a large teaching hospital. Psychological job demands (e.g., work load and social support from supervisor or coworker) were significantly associated with acute and chronic fatigue and intershift recovery. Rotating shifts were significantly related to acute fatigue. Findings suggest the need for a comprehensive approach to fatigue management, including organizational support to provide healthful work schedules and favorable nursing work environments, fewer psychological and physical demands, and assistance to improve nurses' sleep quality and quantity. [Workplace Health Saf 2014;62(10):409-414.].