Effects Of Sundowners During The Night Shift

Significance: Because nursing is the largest health care profession and nurses provide most of the patient care, and as an acute nurse, I can relate to how unsafe nurse staffing/low nurse-to-patient ratios can have negative impact on patient satisfaction and outcome, can lead to medical and/or medication errors and nurse burnout. It can also bring about anxiety and frustration, which can also clouds the nurses’ critical thinking. Most patients might not know the work load on a particular nurse and can assume that her nurse is just not efficient. Doctors also can become very impatient with their nurses because orders are not being followed through that can delay treatments to their patients. There is also delays in attending to call lights resulting in very unhappy patients who needed help.

As a result, overtime can compromise patients ' health or safety. Medical residents cited fatigue as a cause for their serious mistakes in four out of 10 cases (Boodman 2001), and two studies linked infection outbreaks at hospitals to overtime work (Arnow et al. 1982; and Russell et al. 1983). Indeed, the California Nurses Association reports that more nurses are refusing to work in hospitals with unsafe conditions, in which they include being forced to work unplanned overtime. The American Nurses Association (ANA), in a national survey of 7,300 of its members, found, disturbingly, that 56% of nurses believe that the time they have available for care for each patient has decreased, and 75% feel that the quality of patient care at their own facility has decreased in the last two years. The cited inadequate staffing as the chief reason.

Miscommunication and missed information, resulting in potential errors, have been on the rise at Pelham Medical Center. In the past, the primary nursing staff was giving verbal report to oncoming nurses at the nursing stations. There are many disadvantages to this practice. Verbal report at the nursing station is distracting with so many nurses talking at the same time and is frequently interrupted by other staff, call bells, and family members. There are also potential HIPPA violations when reporting on patients within earshot of other people who are not involved in that patient’s care. The patients and their family members or care

With growing concern about patient safety and satisfaction, a change in where shift report is given has been a cause of concern. Traditionally, change-of-shift report is done at the nurses’ station or away from patients. Numerous studies have been conducted on moving the change-of-shift report from the nurses’ station or hallway to the patient’s bedside. An analysis of bedside shift reporting has revealed the benefits of increased patient satisfaction and safety as well as several challenges of implementation of bedside shift reporting.

Nurse staffing have an effect on a variety of areas within nursing. Quality of care is usually affected. Hospitals with low staffing tend to have higher incidence of poor patient outcomes. Martin, (2015) wrote an article on how insufficient nursing staff increases workload and job dissatisfaction, which in effect decreases total patient care over all. When nurse staffing is inadequate, the ability to practice ethically becomes questionable. Time worked, overtime, and total hours per week have significant effect on errors. When nurses works long hours, the more likely errors will be made. He also argued that inadequate staffing not only affects their patients but also their loved ones, future and current nursing staff, and the hospitals in which they are employed. An unrealistic workload may result in chronic fatigue, poor sleep patterns, and absenteeism thus affecting the patients they take care of.

A nurse’s typical day isn’t without stress; it is usually a lot of complex planning, critical thinking, time management, an abundance of communications with all departments of the hospital, and documenting events that have happened throughout the day on their entire patient assignment. “Nurses who are mandated following the completion of their regular shift are often ill-equipped to continue working. They have not planned for that situation with: proper advanced rest, arrangements for

Patients in a hospital and/or healthcare facilities have to be cared for all day and all night, everyday of the week by nurses. The usual way to fulfill this need is to divide up the day into three 8-hour shifts. Different shifts have been put into place to help improve nurse satisfaction, decrease the nursing shortage and save the hospital money. The 24-hour day is made up of two 12-hour shifts; 12 hours in the day and 12 hours at night. There has been quite an ongoing debate over the years regarding this issue of nurses working over 8 hours in a single day. Many people, such as hospital nursing administrators, have reason to believe that working long hour shifts causes more errors in

Limited attention has been paid to the hours worked by nurses, or the effects of these hours on patient safety (Rogers, 2008). Even though most nurses favor 12- hour shifts and overtime, it is associated with difficulties staying awake during times of duty, reduced sleep times, and triple the risk of making an error (Rogers, 2008). The most significant risk of making an error occurred when nurses were scheduled to work 12.5 hours or more.

In the acute care setting, nurses are responsible for the care of multiple patients with varying levels of acuity and individual needs. Because of this, the nurse’s time and attention is prioritized to complete the necessary requirements with little time left for care that does not directly affect the nurse’s responsibilities to avoid legal negligence. Research shows that 45% of people who have had a direct hospital experience believe that their safety or the safety of their family member was impaired because of the decreased availability of the nurses (National Consumers League, 2004). In the same study, 35% of patients or family members felt that care was not provided in a timely manner and 45% even believed that there was no prompt response to their calls for assistance (National Consumers League, 2004). In light of these statistics, the question is raised: Do nursing staffing hours influence missed nursing care in patients who are admitted to an acute care setting in hospital stays longer than three days?

Patient safety is among one of the top priorities associated with nursing as a profession. One of the common factors that contribute to fatigue is sleep (Rogers, 2008). According to Rogers (2008), it is shown that nurses have the inability to be efficiently productive with inadequate sleeping habits. This ultimately results in an inability to provide safe, competent care, as nurses are over worked, thus triples the chance of making an error (Rogers, 2008). Greater chances of making errors are most likely to occur when a nurse works past 8.5 hours (Rogers, Hwang, Scott, Aiken, & Dinges, 2004).

Many hospitals around the world consist of nurses working standard twelve-hour shift patterns, while eight-hour nursing shifts are gradually diminishing from the healthcare setting (Ball, Day, Murrells, Dall'Ora, Rafferty, Griffiths & Maben, 2017). As extended work shifts are becoming more popular, little is known about how this affects patient care or the well being of the nurse (Stimpfel, Sloane, & Aiken, 2012). The issue at hand is if eight-hour nursing shifts are safer and more beneficial for patients and staff opposed to twelve-hour nursing shifts. This issue is important because twelve-hour shifts are increasingly being introduced into healthcare settings, despite little evidence of them improving patient outcomes (Harris, Sims, Parr,

The risks of making an error were significantly increased when work shifts were longer than twelve hours, when nurses worked overtime, or when they worked more than forty hours per week. (Trossman, 2009). Working longer hours in a high stress area will always increase the error rate. Designating an adequate number of RN positions to ensure nurses work an appropriate schedule without overtime and that their workload allows for breaks. Managerial staff must work to develop specific policies about the length of work times based on the setting, patient and provider needs. Those policies should limit nurses from working more than 12.5 consecutive hours. Provide education for all care providers on the hazards and causes of fatigue. Continue to document unsafe staffing conditions and work with others to change the current work culture so that it recognizes the effects of fatigue on patient safety, as well as the nurse. (Berger, et al. 2006)

Controversy has never been limited to whether there is or there is not an increment in weekend mortality rate, but extended to causes behind this suggested higher mortality rate. The list of possible reasons are many; for example some authors speculated that although lower staffing levels at the weekend could have an effect, patients with more urgent conditions, those who cannot wait to see a doctor on Monday, are admitted more frequently at the weekend (1). Emergency surgical interventions, with probably more dangerous events, is therefore more frequently done at the weekend than on other weekdays (7). Moreover Mortality rate was also higher in hospitals with fewer nurses and physicians on duty at weekends and these findings led

The fatigue associated with working the night shift was brought into the spotlight after an aircraft incident that occurred on June 10, 1990. British Airways flight 5390 had just departed from Birmingham International Airport when the aircraft experienced a rapid pressure loss due to the pilot’s windshield blowing out of the aircraft. This resulted in the pilot being sucked halfway out of the aircraft and another flight crew member grabbing the pilots belt and holding him from being sucked completely out while the copilot to take control of the aircraft and land it safely at a nearby airport. The official findings of the accident investigation linked the windshield blowout to the wrong size bolts being installed. The bolts were installed early in the morning hours and the fatigued shift maintenance manager who installed them didn’t recognize that they were the wrong bolts. He thought that the countersinking on the window was unusually large (Baron, 2009). This is just one example of mistakes made on night shift due to fatigue. Fatigue is a dangerous human factor that is present in the aircraft maintenance community.

One of the many goals of the nursing profession is to provide high-quality, safe patient care. There are many responsibilities that come with a nursing career and when the nurse to patient ratio increases, there is a possibility that it may hinder the safe care that patients deserve, and this may result in negative patient outcomes and level of satisfaction. Staffing is one of the many issues that healthcare facilities face. In many facilities, there never seems to be enough nurses per shift to provide high quality, thorough patient care which often leads to burnt out staff, and frustrated patients and families. This review discusses the findings of quantitative studies and one systematic review that involves patient outcomes in relation to nurse staffing.