Implications for Nurses

Implications for nurses of this research are profound when the nurse must choose to work overtime, work a second job or be pressured into working overtime. The implications are mainly ethical with possible legal ramifications, i.e., loosing one's license from an error committed while fatigued.

Foundational to the decision that faces the nurse is the Code of Ethics for Nurses with Interpretive Statements (ANA, 2001). This Code of Ethics for Nurses serves as a succinct statement of the ethical obligations and duties of every individual who enters the nursing profession. A code of ethics makes explicit the primary goals, values, and obligations of the profession.

Four provisions within the Code of Ethics for Nurses with Interpretive Statements (ANA, 2001) speak to the obligation of registered nurses to act in a manner that is consistent with maintaining patient and personal safety.

  • First, the second provision of the Code states that "The nurse's primary commitment is to the patient, whether an individual, family, group, or community."

  • The third provision, "The nurse promotes, advocates for, and strives to protect the health, safety and rights of the patient" (ANA, 2001) is also relevant to consider.

  • Provision # 4, "The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse's obligation to provide optimum patient care" (ANA, 2001) recognizes that individual nurses bear the primary responsibility for the nursing care that their patients receive and are individually and collectively accountable for their own practice.

  • Finally, provision # 6 states; "The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action" (ANA, 2001).

These ethical provisions must be taken into consideration by any nurse when deciding whether to work prolonged hours. Interpretive Statement 6.3 further delineates the ethical responsibilities of nurse managers and administrators to take action to curtail extended work hours and insufficient rest time between shifts:

"Acquiescing and accepting unsafe or inappropriate practices, even if the individual does not participate in the specific practice, is equivalent to condoning unsafe practice." (ANA, 2001)

Although the Registered Nurse is held accountable for her/his practice, the institution also has a responsibility to the nurse, the patient, the facility and the public to recognize the need for a work environment conducive for safe patient care.

Summary

Fatigue and its impact on the individual Registered Nurse is a complex and individual occurrence. It is, however, a safety and ethical issue. Nursing must work together so nurses do not feel the need to work additional hours or jobs to meet reasonable financial needs. Nursing must also not punish nurses that refuse to work overtime but accept their decision as one made with the best interests of the patient at heart. The question needs to be asked, "Is having a nurse working fatigued a greater threat to patient and nurse safety than not having anyone present at all? Let's make sure we put the patient's well-being first, which in this instance means putting our own well-beings first also.