2013
More on Nurses Hours
I wrote this for Nurses Week for the Progressive Media Project. It’s an oped service that goes out to a number of newspapers nationwide.
Celebrate Nurses Week by not overworking them
http://www.progressive.org/national-nurses-week
By Suzanne Gordon, May 6, 2013
National Nurses Week is from May 6 to May 12, and we should honor the work that nurses do, and insist that they get their long hours reduced.
The hours worked by registered nurses (RNs) – the largestt profession in health care – have actually increased over the past several decades.
The average hospital nurse now works a 12-hour shift. Studies on nursing hours have documented that most nurses do not leave after 12 hours but actually work 13 or 14 hours. (In some hospitals, nurses are required to work mandatory overtime, which could mean another eight to 12 hours at work.) When combined with commute times, nurses may be spending 16 or even 17 hours at work and getting to work. This significantly limits the time they have to rest between shifts.
To make matters worse, there are no regulations limiting the amount of back-to-back 12-plus-hour shifts a RN works. As a result, many RNs suffer from chronic sleep deprivation.
Nursing unions have been adamant that banning mandatory overtime is critical, since working extra hours is unsafe to both nurses and patients. The Massachusetts NursesAssociation, for instance, has successfully lobbied for legislation banning mandatory overtime in the Commonwealth.
But bans on mandatory overtime, while certainly necessary, do not address the safety issues inherent in 12-plus-hour shifts. Errors that lead to patient harm increase after eight hours and rise dramatically after 12 hours, particularly when a nurse suffers from chronic sleep deprivation.
Plus, the harm to nurses themselves is significant. Fatigue increases the chance of a needlestick injury, makes concentration on complex tasks more difficult, and creates the kind of irritability that makes it hard for RNs to be empathic or function effectively. What’s more, numerous nurses suffer from injuries sustained
while driving home when fatigued.
Ideally, nurses should go back to the eight-hour shift that so many working people fought for over the last 150 years. Until that happens, 12-hour shifts should be banned at least for those working in critical care area – intensive care units, emergency rooms, and laabor and delivery.
Similarly, working more than three back-to-back 12-hour shifts should not be permitted.
Airline pilots aren’t allowed to fly for more than eight hours, and truck drivers aren’t allowed to drive for more than 11. Both professions have minimum rest periods between their shifts.
So how can we countenance 12-plus hour shifts for the RNs upon whose skill, alertness and judgment so many patients’ lives depend?
(Journalist Suzanne Gordon’s latest book health care or nursing is Beyond the Checklist: What Else Health Care Can Learn from Aviation Teamwork and Safety published by Cornell University Press. She is co-editor of the Culture and Politics of Health Care Work Series at Cornell University Press and can be reached at Lsupport@comcast.net)
2013
Nurses Week Oped on Nurses’ Hours
Time to pull the plug on 12-hour nursing shifts
Bostonglobe.com
By Suzanne Gordon
All over the world during the month of May, time is set aside to celebrate nurses. But this month, the news for nurses is not what Florence Nightingale would have wished it to be. It’s not just that nurses have had to struggle to maintain safe staffing ratios at hospitals like Tufts New England Medical Center in Boston and Saint Vincent’s in Worcester. The bad news comes in yet another study — this time from Britain but funded by the US National Institute of Aging — documenting the impact of long work schedules on the human brain.
The study, entitled Change in Sleep Duration and Cognitive Function: Findings from the Whitehall II Study, which appeared in the May issue of the research Journal Sleep, should make all nurses reconsider their commitment to the 12-plus hour day.
In Europe, most nurses work a 37 hour week. In this country and in Canada, nurses increasingly work twelve hour shifts, usually back to back, sometimes for up to four or five days in a row. And very few nurses get out of the hospital after only 12 hours. Studies have documented that nurses routinely work 13 or more hours — and that’s without either voluntary or mandatory overtime. Add a commute to the RN work schedule, plus duties at home, and nurses simply don’t sleep enough.
Researchers Alison Trinkoff and Jeanne Geiger-Brown at the University of Maryland School of Nursing have confirmed that nurses who work 12-plus hour shifts aren’t getting enough sleep. Many nurses, these researchers report, work such long shifts that they simply don’t get the “opportunity to sleep” the seven or eight hours adults require for their health and well-being. In a study of nurses’ sleep habits, Geiger-Brown found that 58 percent averaged only 5.5 hours of sleep. When they work three or four 12-plus hour days, they are also unable to easily reestablish a “consistent sleep schedule.”
When the voluntary abandonment of the opportunity to sleep is compounded with overtime things become even more complicated for nurses and patients. Sleep studies document that errors go up. Nurse researcher Ann Rogers has reported that “risks of making an error were significantly increased when work shifts were longer than twelve hours, when nurses worked overtime, or when they worked more than forty hours per week.” But the impact of lack of sleep isn’t only on patients. It’s on nurses themselves.
Nurses who work such long hours have more back, neck and shoulder injuries, suffer from more depression and are also at risk for other health problems. A 2007 study has documented that lack of adequate sleep puts people at twice the risk for cardiovascular problems and early death.
And now we have this new study that tells us that people who don’t get enough sleep suffer from greater brain aging. If you don’t get your seven or eight hours, you can suffer as much as a four to seven year increase in age. Even before this study came out, Geiger Brown and her colleagues asked the question, “Is It Time to Pull the Plug on 12-Hour Shifts?”
My recommendation? Before the month is over, nurses should take a visit to an exhibit at the American Textile History Museum in Lowell, Massachusetts. The museum is a monument to American fabrics and to the workers whose sometimes backbreaking labor produced them. One glass case exhibits a letter written to a mill official in 1867 and signed by dozens of mill workers. It reads as follows:
To the treasurer of the Appleton Corporation. We, the undersigned operatives in your employ, believing that 11 hours a day is inimical to our best moral & physical interests, would most earnestly request you to reduce the term of labor from 11 to 10 hours per day & your petitioners as in duty bound will ever pray.”
When you read this and combine it with all the documentary evidence, the answer to Geiger-Brown’s question — “Is It Time to Pull the Plug on 12-Hour Shifts?” — ought to be an enthusiastic “yes.”
Suzanne Gordon is editor of the Culture and Politics of Health Care Work series at Cornell University Press and co-editor of a forthcoming book on patient safety.
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2013
Patient Safety — Lose You Tie Boston Globe
We just published this article in the Boston Globe.
The Podium
Medical staff needs to lose the tie and the rings
By Suzanne Gordon and Michael Gardam
| May 01, 2013
Walk into a hospital in the United Kingdom, Ireland, the Netherlands and much of Scandanavia and take a good look around. What don’t you see? No male physicians wear ties. No one is wearing a lab coat. No one — male or female — is wearing rings, not even a lone wedding band. No watches adorn wrists – people pull them out of their pockets when they want to check vital signs. No stethoscopes dangle around the neck of either doctors or nurses. There is instead a stethoscope in each patient’s room.
Now consider the United States or Canada. White coats remain the symbol of status for physicians and some elite nurses, like nurse practitioners. Women and men wear rings galore, and it’s hard to find anyone without a wrist watch. Ties — mostly traditional long ones — are de rigeur for docs. And stethoscopes are draped casually around the neck as if the latest fashion accessory.
Why the difference in medical equipment and attire? Health systems in the UK and Europe have acted on studies that document the fact that pieces of standard medical equipment and attire pose the risk of harboring and transmitting a host of dangerous organisms to patients. Ties can dangle into wounds as a doctor is examining a patient; it isn’t therefore surprising that ties have been shown to be colonized with hospital superbugs. Rings can shelter untold dangerous organisms underneath the band, inside an intricate setting, or even in the tiny spaces etched out by a loving inscription. It is impossible to keep many germ free, even if medical staff members take off their rings and washed them everytime they cleaned their hands. Watches and bracelets carry the same infection control hazards. As for stethoscopes, it should come as no surprise that these can be laden with lethal organisms yet are rarely cleaned between patients.
As for lab coats, their long sleeves are constantly touching patients and transporting germs from one to another. They are never changed or washed between patients and rarely laundered everyday, as are hospital scrubs. With scrubs, which leave the arm below the elbow bare, it’s much easier to clean the entire arm that might have inadvertently brushed a patient, a bedsheet, or an open wound.
While numerous studies have documented these dangers, many in healthcare will argue that with the exception of artificial nails, there is no smoking gun that directly links pathogens on a ring, tie, watch etc. with a bad patient outcome. In a culture that worships randomized controlled trials, lack of such “grade A” evidence allows the system to maintain the status quo until further research comes along. One can only imagine how long it will take to run study where patients are rubbed with a contaminated tie or lab coat versus a placebo…
That’s why the Europeans have acted on available evidence rather than wait for the impossible to happen. For them, removing such obvious sources of possible contamination is just common sense much like wearing a helmet while snowboarding. In the United States and Canada, despite more than a decade of intense concern about patient safety and the increasing number of hospital borne infections and “superbugs” there has been little serious action taken on the tie/ring/lab coat etc front. In fact, many prominent patient safety advocates seem to dismiss these things with a kind of “what can we do about it?” shrug. Inactivity speaks volumes: are we really serious about these issues or are people more wedded to the trappings of status and power, or fashion, which not only provide infection risks to patients but also perpetuate the kind of silos and hierarchies that are rife in modern medicine and that are also risks to patient safety. On a recent trip to Sweden where doctors wore short sleeve scrubs and had forgone jewelry, they looked and acted like they were part of the team. Doing away with these medical accessories costs little or nothing. Plus it may help health professionals act their way into a new way of thinking about patient safety.
Suzanne Gordon’s latest book is “Beyond the Checklist: What Else Health Care Can Learn from Aviation Safety and Teamwork.” Dr. Michael Gardam is medical director of Infection Prevention and Control at University Health Network and Women’s College Hospital in Toronto.
2013
Yale School of Nursing Lecture
I had the honor of addressing the Yale School of Nursing on April 22, 2013. The YSN videoed the lecture entitled Team Intelligence in Action and it is available here.http://nursing.yale.edu/team-intelligence-highlighted-2013-sybil-palmer-bellos-lecture
The School has long been doing wonderful work and continues to pioneer in patient safety and in assuring that patients receive the highest quality care from the highest quality practitioners.
2013
More on The Difficult Patient
People have made some very interesting and important comments on my latest post. I want to add something here and also reiterate that I am not talking about patients who are truly abusive, or in other ways very difficult to care for. That said, I want to add something about the conditions that may lead Health Care Professionals (HCPs) to view patients with legitimate needs as difficult.
One barrier is, of course, workload and fatigue. Whether it is in the hospital or any other workplace, like primary care, people who are too tired, who have not eaten, and who have too much work tend to be irritable and have trouble attending to others. In healthcare settings, professionals and other staff are constantly expected to act in a professional manner when, as Lucian Leape and his colleagues argue, their institutions do not treat them respectfully and ask them to work too hard and too long. Read more >>
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