Understanding Nurse Fatigue: Facility FAQ

Nurse fatigue is a feeling of chronic, persistent exhaustion that can be experienced by nursing staff, impacting job performance and decreasing the quality of patient care. Staff nurses are at risk of developing fatigue due to the exposure to suffering that is so often inherent in the nurse-patient relationship, along with other factors such as sleep debt, rigid scheduling, and the underlying comorbidities associated with nursing.

It’s important for managers to understand this phenomenon and how it may affect staff nurses’ performance. Through increased awareness and recognition of early warning signs, nurse managers can take a proactive approach to helping staff prevent exhaustion. Here are answers to your questions on the topic, including tips for speaking to staff about fatigue and some proactive solutions to implement at your facility.

What Is Nursing Fatigue?

Nursing fatigue isn’t a recognized illness, but rather an experience that nurses report that connects the demands of work to a feeling of generalized exhaustion. There are, however, several diagnoses related to nursing fatigue.

• Nursing diagnosis listed in NANDA International (NANDA-I): Fatigue, characterized as an energy imbalance within the functional health category of activity/rest.
• Medical diagnosis listed in the International Classification of Diseases (ICD-10): Other fatigue, characterized by tiredness and lack of energy that can not be attributed to other causes such as heat, excessive exertion, or a depressive episode.

In addition, the World Health Organization (WHO) included the related experience of burnout in the 11th edition of the International Classification of Diseases (ICD-11) as an occupational phenomenon with a primary symptom of a feeling of energy depletion.

What Are Some of the Causes of Fatigue for Nurses?

Persistent exhaustion at the workplace can be caused by a number of factors, including:

• Long shifts or back-to-back shifts.
• Insufficient sleep before or between shifts.
• Constant changes at work (i.e., policy updates, new technology).
• High demands at the workplace.
• Compassion fatigue.
• Moral distress and moral injury.
• Underlying health conditions related to nursing (such as depression, PTSD, hypertension, and sleep disorders).

How Does Nursing Staff Fatigue Impact Patient Care?

When nurses are experiencing fatigue, the quality of patient care decreases. Physically, nurses may not have the energy to contribute adequately to the care team, forcing other team members to put in more effort. For example, a nurse struggling with physical exhaustion may ignore a call light related to a patient’s request to get out of bed to use the bathroom. If other team members are engaged in care they can’t walk away from, the patient’s request remains unanswered — and the patient may stand without assistance, risking a fall.

In addition, emotionally exhausted nurses may display signs of detachment toward patients rather than responding with compassion and empathy.

Nurse Fatigue and Patient Safety: Are They Related?

A growing number of studies confirm that healthcare worker fatigue has a negative impact on patient safety. For example, researchers found that nurses who got less than 6 hours of sleep within 24 hours were more likely than their coworkers to make errors while performing nursing tasks, with a 3.4% chance of making an error. This equated to the likelihood of 34 events (or near miss events) per day in an average teaching hospital.

What Are Some Warning Signs of Tiredness and Exhaustion for Nurses?

Nurses who are on the brink of fatigue, or currently battling it, may display the following behaviors and symptoms:

• Frequent call-outs or no-call no-shows
• Changes in prior patterns of behavior (e.g., a nurse who was talkative becomes withdrawn)
• Increased numbers of medical errors
• Reduced effort in patient care duties
• Poor documentation
• Mood swings
• Detachment
• Impaired ability to focus on tasks

How Can Managers Support Nurses Experiencing Fatigue?

Tiredness can be insidious, meaning it has a gradual and subtle onset for the individual experiencing it. A nurse may identify that they’re often in a bad mood with coworkers, for example, or that they’ve been having trouble focusing — without attributing it to fatigue. As a manager providing oversight for your staff, you may be the first to make the connection. Here are some ways you can support your staff.

1. Provide Training to Increase Awareness

Teach staff what nursing-related fatigue is, what it looks like in practice, and why it happens. Emphasize that it’s not a personal flaw, but rather a systemic issue that many nurses struggle with.

2. Encourage Wellness Initiatives

Provide leadership-level support for nurse-led wellness initiatives such as committees and preventative health in-services from visiting instructors.

3. Facilitate One-on-One Conversations

Invite staff nurses to speak to you about the contributing factors to their exhaustion. Is it related to scheduling, difficult relationships with coworkers, or a related health condition? Exploring the deeper causes of the issue may reveal potential fixes.

Discover More Ways to Support Your Nursing Staff

Preventing nurse fatigue at your facility may require a mix of leadership strategies. Whether you’re considering a change to your current staffing model or looking for ways to improve team dynamics, we’re here to support you. Get streamlined healthcare leadership insights designed to help you successfully manage your team.