prevention seems like such a central issue in our intricate medical
environment. However, as we provide more multifaceted care, we have not kept up
with caring for those giving the care. The consequences of fatigue at this long-term
care facility show that patients are not receiving adequate care, more errors
are made, and patient safety is being jeopardized due to inadequate staffing
caused by fatigue and lack of effective recognition of the problem by leaders/management. 

of Problem and Proposed Change

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Fatigue is recognized globally as an
occupational hazard in the nursing profession for nurses and their patients.
Fatigue has implications on the health and safety of nurses and patients.  As recognized in this facility, as well as
many others, nurses are subjected to extended work hours, high nurse patient
ratios, and high physical and mental burdens creating fatigue which in turn
causes patients to receive inadequate/unsafe care. With that said, in this long
term care facility,  increased
nurse-patient ratios, longer shift hours, mandating, and frequent nurse
turnovers cause the remaining nurses and patients to suffer the consequences of

Management and leaders of this facility
need to recognize what causes their nurses to become fatigued. They should ensure
that appropriate leadership is in place and emphasize ways to reduce fatigue by
identifying and utilizing stress relieving measures, such as education and
resources. These measures should be incorporated into the work environment to
prevent fatigue and when fatigue is identified to help ensure that adequate staffing
is provided, quality care is given, and patients are kept safe. Remove
distractions like cellphones, social media, televisions, and computers (except
for work purposes). Encourage nurses to improve their health with stress
management, diet, and exercise. Ensure that rest breaks and meals are being
used. Adopt and implement an evidence based policy that would allow nurses to
refuse an assignment based on fatigue risk. Provide sleep rooms and monitor
their use. Allow nurses to have protected time off of work. All of these
measures will reduce fatigue allowing nurses to provide the quality/safe care
which is what patients deserve.


A thorough literature review was conducted
from peer reviewed articles between the years of 2010 and 2017 using various
search engines using the search words fatigue, long term care facilities,
leadership, and nurses. This research has shown that measures to reduce fatigue
should be incorporated into the everyday work environment to ensure that
staffing needs are met and patients receive quality/safe care. The research is
interrelated and will be discussed in one main category because leadership and
staffing are important factors for providing quality/safe care.

Leadership, Quality/Safe
Care, and Staffing

According to Havig, Skogstad, Kjekshus,
& Romeoren, 2011, leaders in long term care facilities should be focusing
on creating task-oriented behavior like structures. They believe this can be achieved
by coordination, clarifying roles staff play, and monitoring operations to
increase the quality of care. Long term care facilities should use
many measures to reduce fatigue because research results indicated that
increasing staffing levels alone is not likely sufficient to increase quality/safe
care, according to Havi, Skogstad, Kjekshus, & Romøren, 2011). By
adopting measures to ensure that fatigued is reduced, long term care facilities
can ensure that adequate staffing is provided to deliver quality/safe care for
patients. Such measures include: ensuring task-oriented leadership, providing a
strong, supportive, work environment that includes a culture of safety for
nurses and their patients, developing and monitoring use of anonymous reporting
systems for employees to report accidents, errors, and near misses to identify
possible fatigue, and establishing lower nurse patient ratios considering patient
acuity (Havi, Skogstad, Kjekshus, & Romøren, 2011, MacKusick
& Minick, 2010, Barker, & Nussbaum, 2011).


to MacKusick & Minick, 2010, further studies show the importance of
management and leaders recognizing the consequences of fatigue. They suggest
that awareness and management of the causes of fatigue will help retain nurses
alleviating the shortage and improving the quality of care provided to the
patients. Another study performed by Gellasch, 2015, shows that extended work
hours have put nurses at risk for intensifying fatigue which in turn may cause
nurses to quit their jobs making the shortage worse. Yet another study showed
that quality/safe care would not be provided with errors occurring if nurses
work longer hours (Aiken et al…, 2010).

Littlejohns (2015) executed a study which
showed that sufficient staffing saved lives, reduced all types of errors and
complications, and improved dissatisfaction among patients and nurses, while
reducing fatigued nurses. Littlejohns (2015) concluded that all inaccuracies,
problems, incorrect/unfinished documentation, and unsafe/lower quality care
occur more often when nurses have a higher nurse to patient ratio. States regulate
many aspects of the nursing profession. Therefore, the state should regulate patient
to nurse ratios based on updated information that is reevaluated annually. This
information should include: patient acuity, new diagnosis, age, etc. All of
this combined causes nurses to spend increased amounts of time with their
patients. In 2010, a study performed on three different states was completed. Two
states did not have state regulated ratios and one did. The results of this
study showed that lower ratios are associated with lower mortality rates, less
job dissatisfaction, less fatigue, and better quality/safe care provided to
patients (Aiken et al…, 2010).


need to be proactive with recognizing, alleviating, and preventing fatigue in
long term care facilities. Research has shown that measures to reduce fatigue
have been successful by providing improved resources and support to nurses in
need which helps alleviate nursing fatigue (MacKusick & Minick
study, 2010). By providing adequate staffing, improved work environments, education
and resources, fatigue would be reduced in this long term care facility. Most
importantly, by implanting these practices, your patients would be assured that
they are receiving quality/safe care.

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