American Nurses Association (ANA) breakthrough statement struggles over hours worked

Long, stressful hours can take their toll.
Long, stressful hours can take their toll.

 As the American Nurses Association (ANA) prepares to go public with its first position statement on nurse fatigue in almost 10 years, the landmark document appears to be leaning towards recommendations to limit the total number of hours nurses can work during a week, no matter where that might be.

The ANA will not disclose the exact details of its groundbreaking fatigue policy statement, which is the first from the organization to include recommendations for nurses and employers in the same document. Until now the ANA traditionally produced separate position statements for employers (hospitals and clinics) if deemed necessary.1

Marie-Elena Barry, RN, senior nursing policy and practice analyst for the ANA in Silver Springs, Maryland, told Oncology Nurse Advisor that merely asking nurses to stay alert when they worked was no longer enough to prevent fatigue-related accidents. She said the ANA wants to give employers a greater role in combating nurse fatigue and thus “believe that the statement should recognize that nurses and employers work together.” 

Recommendations to cap the number of hours worked by nurses within any given week are expected as part of the new policy statement, which Barry reports has stronger language for both nurses and employers regarding hours worked in a 7-day period. This stronger language will point out and disapprove of excessive hours logged at second and third jobs, which many nurses have, as well as some aspects of how nurses use their own free time, said Barry.

Handing nurses a pay cut by empowering management to limit the number of hours nurses can work and possibly prying into their social life will not sit well with the nurse union, said Jean Ross, RN, co-president, National Nurses United, Minneapolis, Minnesota. Nurses have a unique opportunity to exceed average wage earnings by plying their trade at more than one care center, and that's a right that will not be taken away, said Ross.

Tragic reports of often-fatal incidents related to extreme nurse fatigue have made steady headlines since the ANA's last nurse fatigue position statement was issued in 2006. With every headline, attention to the issue has grown, and the ANA knew this new nurse fatigue policy statement would be closely scrutinized given the number and types of care facilities nurses can work in, Barry said. The ANA has from the get go intended that its recommendations for nurse fatigue find their way into law, she said.

In November 2013, the ANA made it clear that it was going after a change in employer oversight of nurse time off.2 Barry listed things the ANA wanted considered when deciding if a nurse is too fatigued to work a shift safely. The list included things outside the workplace and beyond the traditional control of health care employers, things such as overtime, personal anxiety, learning new technology, travel to nursing assignments, night shift and day shift ratios, multiple jobs, physical fatigue, and other daily stresses.  

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