Measuring and modeling the effects of fatigue on performance: Specific application to the nursing profession

Background: High rates of medical errors have been documented within the healthcare industry. Fatigue is a factor that has been linked to performance decrements in numerous industries, including healthcare. Due to the nature of their work, nurses may be particularly susceptible to multiple dimensions of fatigue, and their performance is closely linked to patient safety. Objectives: Perceived levels of mental, physical, and total fatigue, as well as acute and chronic fatigue states, were quantified in registered nurses from a range of work environments. Relationships between dimensions of fatigue and performance were also investigated, as were differences in fatigue levels across demographic and work environment variables. Methods: 745 registered nurses completed an online survey comprised of eight survey instruments designed to measure mental, physical, and total fatigue dimensions; acute and chronic fatigue states; and performance. Results: Registered nurses reported higher levels of total fatigue than mental fatigue or physical fatigue. Further, mental fatigue levels were higher than physical fatigue levels, and acute fatigue levels were 31% higher than chronic fatigue levels, although nurses did report a moderate level (~50%) of chronic fatigue. Fatigue dimensions and states were negatively correlated with perceived performance, further supporting the role of fatigue in nursing performance. Shift length and hours worked per week were associated with changes in physical and total fatigue levels; longer shifts or increased hours worked per week led to higher levels of fatigue. Mental, physical, and total fatigue levels were also related to shift schedule. Conclusions: Registered nurses reported relatively high levels of mental, physical, and total fatigue, and all fatigue dimensions and states were significantly negatively correlated with performance. Work environment variables also were significantly associated with differences in perceived levels of fatigue. Thus, by altering the work environment it may be possible to reduce fatigue levels and ultimately also reduce the rates of medical errors.