Are you fit to serve?

I am too tired to think, too tired to give meds, too tired to admit one more patient, and if I ever get to leave I am too tired to drive! 

Many occupations have strict rules regarding "fit to serve" meaning there is a body of evidence that concludes after -X- amount of hours the person becomes a hazard behind the wheel, flying, or making life and death decisions. Truck drivers, airline pilots have rules regarding the number of hours they can work and the number of hours they need to "recover".   It is well known nurses must remain alert while at work, the concept of vigilance is described in this article.   It is also known that being on high vigilance cannot be sustained for a prolonged period without a recovery period.  

There has been a steady rise in the number of phone calls to NDNA regarding staffing conditions.  Nurses are tired.  Nurses are frustrated.  Nurses are telling their employers they are at risk for making mistakes.  Nurses are telling us they are NOT being heard. 

ANA has a campaign called Safe Staffing Saves Lives.  

ANA has statements regarding nurse fatigue and the employers role and responsibilities.  Nurses are also responsible to monitor their level of fatigue to keep patients safe. 

The IOM has compiled a large body of evidence that supports a fatigued nurse is a dangerous nurse. 

Cole Edmonson, vice president and chief nursing officer at Texas Health Presbyterian Dallas Hospital writes "Professional, caring, competent, compassionate, and courageous nurses are what the public expects and the patients and families who entrust us with their care deserve. As nurses and nurse leaders, we have an obligation to be "fit for duty" when reporting to work, and a duty to construct and support healthy work environments for optimizing professional practice."  Complete story here. 

 There is a nation wide initiative to put into place legislation that compels employers to follow a set of rules regarding staffing.  Some legislation is very restrictive, leaving little room for those crisis events.  It could tie the hands of employers and nurses alike in keeping patients safe and cared for.  On the other hand, do employers become guilty of failure to act when staff documents and provides evidence that they are over tired and need time off?  And what kind of evidence do you need to determine staffing changes are in order?  If the criteria remains "well nothing has happened", you are left with a very unhappy staff...staff that will have a higher likelihood of leaving.

Nurses need to take responsibility as well for allowing the inadequate staffing to continue.  Sadly, most of the time the solution is to voice with your feet and leave. 

Nursing as the most trusted profession needs to find a solution to the unsatisfactory staffing problems.  Employers need to heed the call for help, tired nurses are NOT fit to serve.