Hyeonmi Cho, RN, MSN, PhD Student, University of Wisconsin-Madison School of Nursing, Wisconsin, USA; Linsey M. Steege, PhD, Associate Professor, University of Wisconsin-Madison School of Nursing, Wisconsin, USA
The objective was to evaluate differences in hospital nurses’ acute and chronic fatigue levels based on personal and work-related characteristics.
Occupational fatigue levels are high among hospital nurses, which has been associated with negative outcomes for both safe, quality patient care and nurses’ personal safety and health (Barker & Nussbaum, 2011; Cho & Steege, 2021). Working on the front line during the coronavirus disease 2019 (COVID-19) pandemic, hospital nurses have experienced increased fatigue levels (Sagherian et al., 2020). Organizations should actively monitor and manage nurse fatigue so nurses can provide safe, quality patient care during and after the pandemic. Examining whether certain subgroups of nurses were more vulnerable to fatigue during the COVID-19 pandemic can provide the basis for creating effective strategies to address fatigue.
This cross-sectional online survey study was conducted between March and April 2021. Convenience and snowball sampling were used. Survey links were distributed through social media and listservs from professional nursing organizations and state government agencies across the United States. Data from 1,196 hospital registered nurses (RNs) providing direct patient care on inpatient units were used. Fatigue levels were assessed using the Occupational Fatigue Exhaustion Recovery scale (Winwood et al., 2005; Winwood et al., 2006). Nurses were asked to answer questions on personal (i.e., age, gender, marital status, dependents, sleep quality/quantity) and work-related (i.e., RN experience, shift type/length, work hours, unit type, unit staffing, number of patients cared for, number of patients with COVID-19 cared for, frequency of caring for patients with COVID-19 over the past few months, hospital size, Magnet status) characteristics. Descriptive statistics, t-tests, and one-way ANOVAs were used.
The sample overall had high acute fatigue (mean=77.23, standard deviation=17.06) and moderate-to-high chronic fatigue (mean=64.11, standard deviation=23.53). Nurses with very bad/fairly bad sleep quality had significantly higher acute and chronic fatigue levels than those with fairly good/very good sleep quality (acute fatigue: t=152.71, p<0.01; chronic fatigue: t=185.04, p<0.01). Nurses reporting less than 7 hours sleep before workdays had significantly higher acute and chronic fatigue levels than those reporting 7 hours or more (acute fatigue: t=34.79, p<0.01; chronic fatigue: t=30.19, p<0.01).
Nurses working extended shifts (>=10hours) had significantly higher acute and chronic fatigue levels than those working traditional shifts (=<8hours) (acute fatigue: t=22.15, p<0.01; chronic fatigue: t=7.80, p=0.01). Nurses perceiving their unit staffing as less adequate (acute fatigue: F=78.18, p<0.01; chronic fatigue: F=144.15, p<0.01), and caring for higher numbers of total patients (acute fatigue: F=6.27, p<0.01; chronic fatigue: F=26.13, p<0.01) and patients with COVID-19 (acute fatigue: F=4.77, p<0.01; chronic fatigue: F=8.50, p<0.01) had significantly higher acute and chronic fatigue levels.
Nurses who never/very rarely/rarely cared for patients with COVID-19 over the past few months had significantly lower acute and chronic fatigue levels than those who cared for COVID-19 patients occasionally/very frequently/always (acute fatigue: F=15.47, p<0.01; chronic fatigue: F=16.76, p<0.01). Nurses working in medium (101-250 beds) and large (>= 251 beds) hospitals had significantly higher acute and chronic fatigue levels than nurses working in small (=<100 beds) hospitals (acute fatigue: F=3.32, p=0.04; chronic fatigue: F=4.75, p=0.01).
Consistent with previous studies, poor sleep quality, shorter sleep hours, and extended work shifts were significantly related to higher fatigue levels (Barker & Nussbaum, 2011; Sagherian et al., 2020). Inadequate unit staffing and higher numbers of patients cared for, factors closely related to higher workload, were significantly related to nurses’ elevated fatigue levels. Work demands related to the pandemic, including number of patients with COVID-19 cared for on last shift and frequency of caring for patients with COVID-19 over the past few months, showed significant relationships with nurse fatigue levels. To maintain patient and nurse safety and assure quality care, organizations should identify and monitor these risk factors and conduct appropriate interventions to mitigate their impacts.
This study has some limitations. Convenience and snowball sampling methods limit the generalizability of the findings. Additionally, because variables were measured using self-reports, there might have been recall bias.
Hospital nurses had higher acute and chronic fatigue levels than reported in studies conducted before the COVID-19 pandemic and two to three months after the pandemic onset (Cochran, 2021; Sagherian et al., 2020). The pandemic may have long-term impacts on the health and safety of the nursing workforce, particularly the levels of chronic fatigue. Organizations should implement strategies to ensure adequate unit staffing and manage nursing workloads. Additionally, hospitals should actively monitor sustained high levels of fatigue nurses may be experiencing and allocate sufficient resources to implement interventions and initiatives to support nurses. Future research using a larger randomized sample and objective measures is necessary to better understand risk factors for nurse fatigue.