The Health and Safety at Work Act (2015) places responsibilities on DHBs and on nurses for managing fatigue as a cause of workplace hazards, with WorkSafe guidance material identifying shift work as a major cause of fatigue. Scientific research has highlighted that performance impairment due to fatigue is caused primarily by sleep loss, extended wakefulness, working and sleeping at suboptimal times in the circadian body clock cycle, and workload. Duty/rest limits do not adequately address this combination of. The approach the project is taking follows the basic safety management cycle.
The overall goal is to improve health service delivery by improving both patient safety (reducing fatigue-related clinical error and improving the quality of nursing care) and the safety, health, quality of life, and retention of nurses. Our approach draws from international best practice in nursing and other sectors.
Building fatigue awareness and knowledge across the sector through: a) project promotional activities (website, traditional media, and stakeholder meetings); and b) a comprehensive package of accessible fatigue management training materials.
Fatigue assessment tools
Developing fatigue assessment tools to evaluate different rosters, based on a nationwide survey of Registered and Enrolled Nurses' work patterns in 6 practice areas with high a priori risk of fatigue-related error.
Code of Practice
Developing and disseminating a Code of Practice for shift work and fatigue management in hospital-based nursing, in collaboration with key stakeholders and with broad sector consultation.
Defining an Agency
Defining an agency with representation from all stakeholders, to take ongoing responsibility for establishing a cycle of continuous improvement in fatigue risk management.
The project has an Advisory Group of senior representatives of the nursing community and an expert in epidemiology and biostatistics. The website is your portal to a range of project information and activities. For the national survey, a questionnaire has been piloted to gather data on work-related and demographic factors that contribute to fatigue. Survey participants are being recruited through NZNO and through project promotional activities, to complete an on-line version of the questionnaire. Survey data will be used to develop a fatigue risk assessment tools to evaluate rosters for each target practice area. Survey participants also have the opportunity to provide written comments that will give insights into nurses' experience of fatigue, their views on its causes, and potential mitigation strategies.
A Code of Practice for shift work and fatigue management in hospital-based nursing will be developed based on the survey data, international initiatives and with broad sector consultation, culminating in a public launch event. It will include guidance on scientific principles for fatigue management and roster design, how to use the fatigue risk assessment matrices, educational materials, and guidance on organisational and personal fatigue risk mitigation strategies.
This project is made possible by a 3-year project grant from the Health Research Council of New Zealand, with additional support from the New Zealand Lottery Grants Board, McCutchan Trust and Massey University.