Nurses Caring for Elders at Home Report More Errors at Work
Nurses Caring for Elders at Home Report More Errors at Work
Abstract & Commentary
By Leslie A Hoffman, RN, PHD, Department of Acute/Tertiary Care, School of Nursing, University of Pittsburgh, is Associate Editor for Critical Care Alert.
Dr. Hoffman reports no financial relationship to this field of study.
Synopsis: Compared with their peers, staff nurses with care-giving responsibilities for elders at home logged the least amount of sleep and also reported making significantly more errors at work.
Source: Scott, LD, et al. The impact of multiple care giving roles on fatigue, stress, and work performance among hospital staff nurses. J Nurs Adm. 2006;36:86-95.
This study reports findings from a sample of 393 nurses who completed a daily log book for 28 days by recording information about work hours, sleep/wake patterns, perceptions of fatigue and stress, and errors or near errors during work shifts. The sample was randomly selected from the American Nurses Association national membership and consisted of nurses who provided direct patient care and were employed full time (≥ 36 h/wk). Nurses who worked for an agency or float pool were not eligible. The respondents were predominately female (79%), 45 ± 9 years of age (range, 22-66 yrs); 51% worked on medical-surgical floors or critical care units.
Of the respondents, 50% reported no dependents, 34% cared for children, 8% for elders, and 7% for elders and children. The proportion who reported drowsiness (struggling to remain awake) was similar among respondents who had no dependents (19%), cared for children (22%), cared for elders (23%), or cared for both children and elders (22%) (P = NS). A total of 199 errors and 213 near-errors were reported, including medication-related (56%), procedural (18%), charting (12%), and transcription mistakes (6%). Nurses who were providing elder care reported the least amount of sleep. When analyzed by logistic regression, the likelihood of making an error was doubled among nurses who were providing elder care at home (odds ratio [OR] = 2.38; P =.005). However, elder care was not associated with the risk of making near errors (OR = 1.33; P = .33). As anticipated, nurses caring for both elders and children reported higher levels of mental and physical fatigue (P < .05), compared to those without dependent care responsibilities.
Commentary
Long work hours, once a hallmark of physician training, have been restricted for housestaff due to concerns about potential adverse effects. These restrictions were put in place to improve patient safety based on the belief that fatigue contributes to medical errors. Subsequently, several studies have reported that shorter work hours decreased errors and resulted in less stress and detrimental effects on morale and personal life.
This study reports a different and largely unrecognized source of stress that has the potential to impact patient safety. Informal (unpaid) care giving is an essential component of the health care system in the United States. More than 54 million Americans are estimated to be involved in family care giving, which often involves providing care for a chronically ill, disabled, or elderly family member. There is evidence that the profile of family caregivers is changing. Their mean age has decreased, making it more likely that care givers are full-time employees who are also responsible for dependent children. Combining these roles is difficult and the consequence is often sacrificing personal time or restricting hours of sleep. Concurrently, the practice of working 12-hours shifts impacts the amount of sleep that is possible during the work week. A nurse who works a 12-hour shift and leaves work on time (which happens less than 20% of the time) has 12 hours to accomplish personal and family responsibilities, the daily commute, and sleep before the next shift.
Findings of this study provide interesting data regarding potential adverse effects of care giving responsibilities on medical errors. The strength of these findings is limited by the small sample and limited number of respondents who provided care for elders, and children and elders. Given the nursing shortage, escalating need for family care givers, and long work hours typical in nursing today, the topic is certainly worthy of further study.
This study reports findings from a sample of 393 nurses who completed a daily log book for 28 days by recording information about work hours, sleep/wake patterns, perceptions of fatigue and stress, and errors or near errors during work shifts.Subscribe Now for Access
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