In correctional settings the Christmas and New Year holidays bring special challenges. Prisons, jails and detention facilities operate 24/7 every day of the year and holidays can be stressful and busy. Inmates are particularly aware of their isolation from family, friendship and goodwill that characterize the holiday season. To prevent suicide, self-harm and victimization correctional staff must be extra vigilant and attentive to the population during this time. In addition to the challenges of the work environment staff also are preparing for and participating in their own holiday activities. Staff fatigue coupled with the heightened tensions and emotion that accompany the holiday season makes this a time of “high risk” for error. The last thing anyone wants right now is to be involved in an accident, injury or adverse patient care event. Here are some ways to thrive this holiday season.
Get sufficient sleep
Each hour of sleep less than eight increases an individual nurse’s risk of error by seven percent. So if you only got six hours of sleep your risk of error during the next work shift is 14 percent higher than if you slept eight hours. If there is one other nurse working the shift and you both had six hours of sleep the collective chance of patient care error is increased nearly 30 percent.
Getting enough sleep is independent of shift duration. For example if you get off at 2:30 pm but it takes 30 minutes to get home. Then you go to the gym, have dinner, help the kids with homework and watch television until 11:30 pm. The next day you arise at 5:00 am for work. This is less than eight hours of sleep. In this example you should alter your routine so that you can be asleep by 9:00 pm to get the recommended eight hours of sleep.
If you get less than six to six and a half hours of sleep you are probably not “fit for duty” from a patient safety standpoint. It is common to think that you can catch up on your days off but every shift you work until then you have greater chance of making an error. The chance of error increases for every hour less than eight hours of sleep in a 24 hour period.
The risk of error in patient care doubles when nurses work twelve or more consecutive hours. Errors also increase when nurses work more than 40 hours in a week or more than three twelve hour shifts without a day off.
Once I encountered a nurse who volunteered to work a third consecutive overtime shift at a maximum custody facility. This meant that the nurse was volunteering to work twenty four hours then come back 16 hours later and work another eight hour shift. I was shocked that there was no prohibition against working these hours in the collective bargaining agreement or in the regulations governing nursing practice in the state. It was basically up to the nurse to determine that he/she was “fit for duty” when volunteering to work extra shifts. The managers came to rely on these individuals, known as the “overtime dogs” to pick up whatever shifts needed coverage because they seldom turned down an opportunity for the extra pay.
The Veterans Administration is the only organization which has put limits on the hours that nurses can work in the interest of patient safety. Unions have generally limited mandatory overtime assignments but have been silent regarding voluntary overtime. Nurses are expected to make their own decision about their ability to work extended hours.
The data show that nurses’ motor skills are preserved when working extended hours but cognition and executive functions, such as assessment and clinical vigilance decline. Extended work hours result in decreasing situational awareness, an important component of personal safety and emergency response in the correctional setting. Finally nurses working extended hours are less accurate under time pressure such as in an emergency response or during medication administration. Your ability to perform essential nursing functions decreases the longer you work beyond your regular shift.
Take breaks and leave on time
The work demands of the shift usually determine when and if breaks will take place. Taking regular breaks helps to mitigate the adverse effects nurses’ fatigue has on patient care and shorter more frequent breaks are most effective. However 20 percent of hospital nurses report not taking breaks. Even more nurses said that they took breaks but were ready to be interrupted if patient care required; which is essentially not taking a break. Self-scheduling breaks has not been found to be effective. Nurses wait until they are too fatigued or chose to remain patient centered and subject to break interruption. Does this sound true for your setting?
Usual reasons for not leaving on time are to document or to make arrangements for continuity of patient care. Hospital nurses report that they leave on time only one out of five shifts. How true is this for you? Not leaving on time extends the work shift and impinges on the family and social obligations you have. These are especially important during the holiday season and can lead to loss of sleep that is associated with increased patient care error. Managing documentation and delegating responsibilities during the shift are critical to finishing your work on time and this is most important during the holidays when your family and social lives make additional demands.
Say “No” positively
During the holidays you may feel pressured to commit to working shifts and doing work you would otherwise decline. Remember you are not responsible for solving time pressures for others but instead for managing your own time and energy. Does this commitment leave you enough reserves for the other priorities that are important to you? If not, be firm but polite and say “No”. Suggested ways to say no in a positive way are:
- I would love to but I have other priories right now.
- I can’t do it this time but would like to be considered for another time.
- Thanks for giving me the opportunity but no, I can’t this time.
Your time and energy are limited and precious commodities; using them to honor your priorities is a sign of self-respect. Merry Christmas and Happy New Year.
For more about staffing, fatigue and patient safety read Chapters 4 in the Essentials of Correctional Nursing. Order your copy directly from the publisher. Use promotional code AF1209 for $15 off and free shipping.
Rogers, A. E. (2013) Navigating Shiftwork: 5 tips for managing fatigue. American Nurses Association Navigate Nursing Webinar 12/17/2013.
Sherman, R.O. (2013) Nurse Leader Insight: Reduce your stress by learning to say no. Emerging RN Leader. Accessed 12/19/2013 at http://www.emergingrnleader.com/nurse-leader-insight-reduce-stress-learning-say/?utm_source=rss&utm_medium=rss&utm_campaign=nurse-leader-insight-reduce-stress-learning-say.
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