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Ann E. Rogers PhD, RN, FAAN Associate Professor University of Pennsylvania School of Nursing

. Case Study. On July 4, 2006, a nurse worked a double shift that ended at midnight. The nurse had volunteered for the shifts some time prior to coming to work on July 4 and had arranged to sleep at the hospital following the shifts because she began another scheduled 8-hour shift on the Birthing Unit, at 7:00 a.m. on July 5th..

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Ann E. Rogers PhD, RN, FAAN Associate Professor University of Pennsylvania School of Nursing

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    1. Ann E. Rogers PhD, RN, FAAN Associate Professor University of Pennsylvania School of Nursing Indicate my pleasure in being back in WA, very sharp and sophiticated group of nurses. Plug for Ronda’s upcoming book on patient safety. Will be free and available on CD-ROM hopefully in JanIndicate my pleasure in being back in WA, very sharp and sophiticated group of nurses. Plug for Ronda’s upcoming book on patient safety. Will be free and available on CD-ROM hopefully in Jan

    3. READ BEFORE NEXT SLIDE If work a double shift, very likely to be awake for 19 or more hours. If awake 19 or 24 hours doesn’t mean that you will make a mistake, but suggests that very high risk of errors, just like someone with a high BAL is likely to have a crash. Next slide, shows what can happen when nurses are awake for sustained periods. From CAN website. READ BEFORE NEXT SLIDE If work a double shift, very likely to be awake for 19 or more hours. If awake 19 or 24 hours doesn’t mean that you will make a mistake, but suggests that very high risk of errors, just like someone with a high BAL is likely to have a crash. Next slide, shows what can happen when nurses are awake for sustained periods. From CAN website.

    4. READ BEFORE NEXT SLIDE If work a double shift, very likely to be awake for 19 or more hours. If awake 19 or 24 hours doesn’t mean that you will make a mistake, but suggests that very high risk of errors, just like someone with a high BAL is likely to have a crash. Next slide, shows what can happen when nurses are awake for sustained periods. From CAN website. READ BEFORE NEXT SLIDE If work a double shift, very likely to be awake for 19 or more hours. If awake 19 or 24 hours doesn’t mean that you will make a mistake, but suggests that very high risk of errors, just like someone with a high BAL is likely to have a crash. Next slide, shows what can happen when nurses are awake for sustained periods. From CAN website.

    5. READ BEFORE NEXT SLIDE If work a double shift, very likely to be awake for 19 or more hours. If awake 19 or 24 hours doesn’t mean that you will make a mistake, but suggests that very high risk of errors, just like someone with a high BAL is likely to have a crash. Next slide, shows what can happen when nurses are awake for sustained periods. From CAN website. READ BEFORE NEXT SLIDE If work a double shift, very likely to be awake for 19 or more hours. If awake 19 or 24 hours doesn’t mean that you will make a mistake, but suggests that very high risk of errors, just like someone with a high BAL is likely to have a crash. Next slide, shows what can happen when nurses are awake for sustained periods. From CAN website.

    6. READ BEFORE NEXT SLIDE If work a double shift, very likely to be awake for 19 or more hours. If awake 19 or 24 hours doesn’t mean that you will make a mistake, but suggests that very high risk of errors, just like someone with a high BAL is likely to have a crash. Next slide, shows what can happen when nurses are awake for sustained periods. From CAN website. READ BEFORE NEXT SLIDE If work a double shift, very likely to be awake for 19 or more hours. If awake 19 or 24 hours doesn’t mean that you will make a mistake, but suggests that very high risk of errors, just like someone with a high BAL is likely to have a crash. Next slide, shows what can happen when nurses are awake for sustained periods. From CAN website.

    7. READ BEFORE NEXT SLIDE If work a double shift, very likely to be awake for 19 or more hours. If awake 19 or 24 hours doesn’t mean that you will make a mistake, but suggests that very high risk of errors, just like someone with a high BAL is likely to have a crash. Next slide, shows what can happen when nurses are awake for sustained periods. From CAN website. READ BEFORE NEXT SLIDE If work a double shift, very likely to be awake for 19 or more hours. If awake 19 or 24 hours doesn’t mean that you will make a mistake, but suggests that very high risk of errors, just like someone with a high BAL is likely to have a crash. Next slide, shows what can happen when nurses are awake for sustained periods. From CAN website.

    9. To determine if the extended shifts and overtime worked by full-time hospital staff nurses had an adverse effect on patient safety

    10. 895 participants were predominately female (93%), middle-aged (mean age 44.5 ± 8.3,range 22-66), and Caucasian (82%) Worked at least 36 hours/week Were unit based and employed by a hospital Were members of the American Association of Critical Care Nurses or the American Nurses Association May also want to add a sentence to oral presentation that sample is representative of larger population of nurses in the US. I added the last phrase to provide a lead in to state that subjects were randomly selected from national sample of nurses. And to set the stage for a couple of later slides where you mention the two groups of subjects.May also want to add a sentence to oral presentation that sample is representative of larger population of nurses in the US. I added the last phrase to provide a lead in to state that subjects were randomly selected from national sample of nurses. And to set the stage for a couple of later slides where you mention the two groups of subjects.

    11. Demographic Questionnaire Logbooks (2) 28-day record of sleep/wake patterns, work hours, difficulties remaining alert on duty and errors Can note that logbooks also used to collect data about errors, the findings of which have been published. Can note that logbooks also used to collect data about errors, the findings of which have been published.

    12. The majority of nurses no longer work traditional 8 hour day, evening, or night shifts

    14. Over one third of the shifts were scheduled for 12.5 hours or longer, and 43% of the shifts exceeded 12.5 consecutive hours. There were 44 shifts scheduled for = 20 consecutive hours, and 123 shifts where nurses worked = 20 consecutive hours.

    20. Working longer than scheduled was normal Nurses rarely left work at the end of their scheduled shift (19%, 13%) They averaged almost an hour (55 minutes, 49 minutes) extra work/day Overtime was less frequent when nurses worked 12-hour shifts (79% versus 85%). ANA Sample

    21. Working longer than scheduled was normal Nurses rarely left work at the end of their scheduled shift (19%, 13%) They averaged almost an hour (55 minutes, 49 minutes) extra work/day Overtime was less frequent when nurses worked 12-hour shifts (79% versus 85%). ANA Sample The frequency of mandatory overtime varied ANA Sample 360 shifts (7%) were mandated and 143 voluntary overtime shifts (3%) were coerced AACN Sample 263 shifts (16.5%) were mandated and 152 voluntary overtime shifts (12.3%) were coerced

    23. Just under one-third of the participants reported making an error during the data-gathering period. Near errors were reported by one third of the participants.

    27. Emphases that it made not difference in whether overtime was mandated or voluntary, overtime of any sort was associated with an increased risk of making an errorEmphases that it made not difference in whether overtime was mandated or voluntary, overtime of any sort was associated with an increased risk of making an error

    36. Sleepy nurses can endanger the general public

    37. Note that these numbers are very similar to those reported for struggling to stay awake at work. Approximately 2/3 of sample have trouble staying awake at work. Slightly higher number of shifts affected. Drowsiness 1 in 5, drowsy driving approximately 1 in 4 shifts.Note that these numbers are very similar to those reported for struggling to stay awake at work. Approximately 2/3 of sample have trouble staying awake at work. Slightly higher number of shifts affected. Drowsiness 1 in 5, drowsy driving approximately 1 in 4 shifts.

    38. number of times that drowsy driving was reported ranged from 1-20 times only 21% of those who reported struggling to stay awake driving home, reported it only once just under 1/4 of participants reported struggling to stay awake driving home from work at least 75% of the time 30 nurses (5%) reported difficulties staying awake driving home after every shift they worked At present can’t explain the differences between the two samples. Not sure why age and high caffiene intake shortens sleep among members of ANA sample and not members of the AACN sample. Or why elder care responsiblities shortened sleep by 20 minutes for members of the AACN sample and not the ANA sample. At present can’t explain the differences between the two samples. Not sure why age and high caffiene intake shortens sleep among members of ANA sample and not members of the AACN sample. Or why elder care responsiblities shortened sleep by 20 minutes for members of the AACN sample and not the ANA sample.

    39. Working 12-hour shifts doubled the risk of drowsy driving Longer commutes Working at night (at least 6 hours between 2200 and 0600) nearly quadrupled the risk of struggling to stay awake driving home At present can’t explain the differences between the two samples. Not sure why age and high caffiene intake shortens sleep among members of ANA sample and not members of the AACN sample. Or why elder care responsiblities shortened sleep by 20 minutes for members of the AACN sample and not the ANA sample. At present can’t explain the differences between the two samples. Not sure why age and high caffiene intake shortens sleep among members of ANA sample and not members of the AACN sample. Or why elder care responsiblities shortened sleep by 20 minutes for members of the AACN sample and not the ANA sample.

    40. Note that these numbers are very similar to those reported for struggling to stay awake at work. Approximately 2/3 of sample have trouble staying awake at work. Slightly higher number of shifts affected. Drowsiness 1 in 5, drowsy driving approximately 1 in 4 shifts.Note that these numbers are very similar to those reported for struggling to stay awake at work. Approximately 2/3 of sample have trouble staying awake at work. Slightly higher number of shifts affected. Drowsiness 1 in 5, drowsy driving approximately 1 in 4 shifts.

    41. David Dinges PhD Wei-Ting Hwang PhD Linda Scott PhD, RN

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