A primary responsibility for the post-acute care provider is to ensure the safety of all residents and patients. This requires a focus on the environment in which care takes place, as well as who is delivering that care.
Part of the challenge in health care delivery is that it is not a nine-to-five endeavor. Caregivers are needed 24/7/365 in some settings and at varied times and days in other settings. To accomplish this and provide for the accommodation of a work/life balance that includes personal time off, holidays, and vacation time, as well as equitable distribution of undesirable shift work, a caregiver’s work hours are most often scheduled in a varied pattern of weekdays and sometimes varied shifts.

Varied Patterns, Shifts Weary Workers

The different combinations of weekdays and shifts have the potential to create diverse levels of fatigue in the worker. In addition, the length of a shift can increase the likelihood of fatigue. Shifts of 12 or more hours are more frequently the norm because the workforce finds them desirable or because overtime is required to address vacancies or absenteeism.

Work-hour patterns can cause worker fatigue, and a fatigued worker is not a safe worker.

The aviation, petroleum, and transportation industries, whose workforces are also deployed using varied patterns of shifts and weekday schedules, have long since recognized the risk to safety that a fatigued worker represents. They have addressed the issue of worker fatigue through regulations or standards of practice in scheduling to limit fatigue-generating scheduling practices.

It is time for the health care industry to do the same.

Survey Reveals Alarming Rate Of Fatigue

As an industry, health care has acknowledged that errors in care occur at an alarming rate. The types of errors are also significant, with either temporary or permanent harm being inflicted on the care recipient.
Additionally, the impact of the error results in residents and/or patients being returned to acute-care hospitals for treatment. The emotional and financial costs are not acceptable.

In March 2014, the Department of Health and Human Services Office of Inspector General released a report on adverse events for Medicare beneficiaries in skilled nursing facilities (SNFs).

The results were startling, with 33 percent of those studied experiencing an adverse event or temporary harm. This was a higher rate than the 27 percent rate found in a study of the same population in an acute-care hospital. Over half of the residents that experienced harm in the SNFs required a return to the hospital for treatment.

Clearly, safety is an issue in the post-acute care environment. Though there are many causes that trigger errors, worker fatigue is known to be among those that can and should be addressed.

Caregivers Self-Report Safety Concerns

To understand the potential magnitude and impact of worker fatigue in the health care industry, Kronos Incorporated, a leader in workforce management issues in health care, in partnership with HealthLeaders Media, conducted a survey of caregivers. The results were alarming; they confirmed that worker fatigue is pervasive and resident/patient safety is currently at risk in the health care industry.

Of the 150 respondents surveyed, 69 percent reported that feeling fatigued had caused them concern about their ability to provide care safely. Surprisingly, 27 percent actually admitted to having made an error because of being fatigued.

Besides the potential negative impact to the care recipients that a fatigued worker represents, the survey revealed a concern over the safety of the worker, with 92 percent reporting feeling tired while driving after their shift.

The risks in drowsy driving should not be underestimated. Workers who drive as part of their work are themselves at risk when fatigued. As an industry, the safety of the worker is also a responsibility.

Scheduling Key To Relief

With the confirmation that worker fatigue in the health care industry is a significant issue, the question becomes: how to address it? There is significant research available on the impact of shift lengths, shift patterns, shift rotation, overtime, and overall worked hours as these relate to worker fatigue.

Ann Rogers, PhD, RN, professor at Emory University, led a research study that provided evidence that shifts exceeding 12 hours in length, as well as overtime, lead to overall work hours exceeding 40 hours per week, which increases the risk of errors in care.

So much is known and validated about the issue that the Joint Commission, a well-respected health care organization providing accreditation services across the continuum of care, released a sentinel alert to the industry warning of the risks of worker fatigue pertaining to safety.

Included in the sentinel alert are recommendations for health care organizations to assess their policies related to scheduling practices, including shift lengths and consecutive shifts, as well as involving the workforce in the actual schedule creation.

When the survey respondents were asked about work scheduling practices, more often than not the schedules were reportedly being created manually.

Manual schedule creation is time-consuming, fraught with potential for errors, and not guided by alerts or warnings to ensure compliance with policies or regulatory requirements related to labor management. The lack of automation in scheduling workers is both inefficient and inherently risky.

Involve Workers In Scheduling

Fewer than 28 percent of workers reported that they were involved in the schedule creation. With little involvement in the process, it is unclear how work/life balance can be achieved. Work schedules out of sync with the realities of life—such as family, child care, school, and, increasingly, elder care demands—can have a negative impact on a worker’s ability to get restorative sleep and thereby increase the likelihood of fatigue.

There is perhaps no better place in workforce management technology to prove its value in supporting the creation of a safe environment for both the caregiver and the care recipient. With the rules-based automation of work schedules, health care organizations can be assured that safe scheduling practices are adhered and alerted to worker schedules that pose potential risk.

The implementation of employee self-scheduling adds yet another layer of protection in ensuring that employees have control over their own schedules and have the opportunity to directly manage their work/life balance.

The negative impact of worker fatigue on the quality of care provided to residents and patients in the post-acute care environment is real. It is the responsibility of the health care industry to minimize the adverse impact of worker fatigue and provide for a safer care environment.

The implementation of research-based worker scheduling practices that are supported by scheduling technology is available to address the problem today.
Susan Reese, MBA, RN, CPHIMS, is chief nurse executive and director of health care practice group, Kronos Incorporated. She can be reached at (727) 741-0712.