Many healthcare leaders don’t realize that, in addition to threatening patient safety, nurse fatigue is also a compliance risk, notes CEO Nick Merkin of Compliagent, a compliance consulting firm in Los Angeles.

In many states, certain healthcare facilities are required to maintain minimum staffing levels as a ratio of nursing hours per patient day, or other metrics, as a matter of state regulation, Merkin explains. The necessary calculations for making this determination are not so easy, however, as they might fluctuate depending on the acuity level of the patients under medical care that day, the skillset of the nurses on the floor at any given time, and many other variables. It takes real expertise to take all the relevant factors into consideration, give them appropriate weight, and have the right nursing resources in place and ready to deploy on short notice, Merkin says.

“The issue of fatigue is often brought up as a complaint from the nursing staff. Much of the concern seems to come from a perception from the nurses that their healthcare facilities are understaffed, shifts are too long, or that the rest periods during shifts are too brief,” he says. “And as a result of the current financial stresses within the healthcare industry, the problem will only become more acute as providers are under more and more pressure to cut staffing costs.”

Hitting the right balance with staffing and scheduling can be a challenge. The consequences of making the wrong call in this context can be severe, Merkin notes. On one hand, overstaffing is obviously expensive and is going to cut deeply into a healthcare provider’s bottom line. On the other hand, understaffing can result in government enforcement actions carrying fines, penalties, malpractice suits, and class actions against healthcare facilities and managers.

“There are plaintiffs lawyers out there who literally are making a career out of identifying areas of alleged nursing fatigue caused by understaffing and leading to poor patient outcomes,” Merkin says. “Healthcare providers who are not prepared from a compliance perspective are facing serious regulatory and financial risk.”


Nick Merkin, CEO, Compliagent, Los Angeles. Email: