What is known as complexity compression—the ever-increasing demands on direct care nurses today—is amplified by physical and mental fatigue. Talking about fatigue, stress, and overload must become acceptable and nurses should receive education about ways to mitigate them.
"It starts with the chief nurse at the organization setting expectations about healthy life/work balance, raising awareness of fatigue-related errors, talking about fitness for duty, and really helping nurses to understand how they may put themselves and patients at risk if they come to work not fit for duty," says Edmonson.
He points out that hospitals and healthcare systems have virtually no way of knowing whether a nurse has slept in the last 12 hours before a shift. Which is why the Texas Board of Nursing, Texas Nurses Association, and Texas Organization of Nurse Executives have come together to promote a "fitness for duty" concept that puts the onus on individual nurses to be the gatekeepers for themselves and their fitness for work that day. Fit for duty means they have had enough sleep and that they are mentally and physically prepared for their shift.
"As nurse leaders, we need to give direct care nurses permission to say no," says Edmonson. "Often in order for hospitals to provide staffing, they must continually call nurses asking, 'Can you pick up an extra shift, or can you come in early?' We're trying to make sure we are staffing safely for patients, but we may sometimes unintentionally put nurses in difficult situations. The CNO needs to make sure nurses who work in the facility know they will be supported if they actually do say no to the supervisor or manager or charge nurse or peer calling them to pick up an extra shift if they are not fit for duty."
Edmonson says it's his belief that staff are better at the healthcare facility if they are better at home, so his organization focuses on "life-work balance" (not work-life balance) and emphasizes the importance of nurses concentrating on mental, physical, and spiritual refreshment on time away from work. In fact, Edmonson's organization sponsors retreats for staff and leadership that focus on maintaining a healthy balance as a professional nurse.