Study shows link between nurse fatigue and clinical decision regret

Fatigued nurses are more likely to express concern that they made a wrong decision about a patient's care, according to a study in the January issue of American Journal of Critical Care (AJCC).

"Association of Sleep and Fatigue With Decision Regret Among Critical Care Nurses" found that nurses impaired by fatigue, loss of sleep, daytime sleepiness and an inability to recover between shifts are more likely than well-rested nurses to report decision regret.

Decision regret is a negative cognitive emotion that occurs when an actual outcome differs from the desired or expected outcome. For nurses, it reflects concerns that the wrong decision may have been made regarding patient care.

Although decision regret reflects previous decisions and adverse outcomes, it may also contribute to work-related stress and compromise patient safety in the future.

This link between nurse fatigue and decision regret adds to the body of evidence that supports the need for appropriate staffing to ensure the use of fatigue management strategies to promote both patient safety and a healthy work environment.

Lead author Linda D. Scott, RN, PhD, NEA-BC, FAAN, is associate dean for academic affairs and an associate professor at the University of Illinois at Chicago College of Nursing. Cynthia Arslanian-Engoren, RN, PhD, ACNS-BC, FAHA, FAAN, and Milo C. Engoren, MD, FCCM, from the University of Michigan, Ann Arbor, served as co-authors.

"Registered nurses play a pivotal role as members of the healthcare team, but fatigued and sleep-deprived critical care nurses put their patients and themselves at serious risk," Scott said. "Proactive intervention is required to ensure that critical care nurses are fit for duty and can make decisions that are critical for patients' safety."

Critical care nurses and their employers must acknowledge the effect of fatigue, sleep deprivation and excessive daytime sleepiness on clinical performance and patient outcomes and must engage in strategies to mitigate these impairments.

Healthcare employers should implement scheduling models that maximize management of fatigue, ensure that support resources for clinical decisions are available and encourage the use of relief staff to provide completely relieved work breaks and strategically planned nap times.

"By working together to manage fatigue, critical care nurses and employers can ensure patients receive care from alert, vigilant and safe employees," Scott said.
For the study, more than 600 nurses working full-time in critical care units completed a questionnaire on personal and work-related data, sleep quality, daytime sleepiness, sleep quantity, clinical-decision self-efficacy and decision regret.

Most respondents reported moderately high fatigue, significant sleep deprivation and daytime sleepiness, all of which affect their ability to be alert, vigilant and safe. Furthermore, the nurses were not likely to sufficiently recover from their fatigue-related states during non-work periods.

Decision regret was most common among nurses who are male, work 12-hour shifts and have lower levels of satisfaction with their clinical decisions.