Now the nurse fatigue position statement is stuck as a draft in the steering committee where it has been for the last 6 months. Half a year after the ANA’s Professional Issues Panel (PIP) completed its deliberations and the 20-day public comment period for the PIP’s draft (which ended on February 10, 2014), any new detail of the fatigue position statement—exactly how the ANA will recommend reducing nurse fatigue using scheduling and observation of free time—is a closely guarded secret.

“ANA cannot speak to the content of the document until it is approved and available for public release,” said Jamie Dawson, the senior policy analyst on occupational safety and health at the American Nurses Association.

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“The nurse is licensed to protect the public. The nurse must be responsible to know their personal limitations,” said Trica Hunter, RN, executive director of the California branch of the ANA in Sacramento, California. “Many nurses work for multiple employers that one employer cannot monitor. The employer must also recognize that as a nurse there is a limitation to the hours I can work.  I remember working all night and the employer expecting me to work the next day. This is unreasonable.”

This type of backlash from nurses told that management soon may feel obligated by the ANA’s policy statement to reduce the working hours of nurses it believes are fatigued might explain why the new ANA policy statement has been stuck in the lap of the steering committee for 6 months. Whatever ideas or suggestions the ANA’s PIP conjured up in the months they held conference calls to develop the draft of the position statement were intense. Some too intense to put before the ANA Board of Directors for final approval as a position statement without some tempering, Barry explained.

“There are intense stories that create passion from every person that has participated on the PIP.  Having said that, we need to more closely examine the evidence that provides support to these tragic stories,” said Barry, who added “We want to make sure that we are documenting best practices from peer reviewed literature and current events that spark public interest on nurse fatigue. Not solely on human emotion or the latest sleep deprived accident that is highlighted in the media.”

The fatigue PIP included 15 ANA members who applied to participate in monthly conference call deliberations that began in August 2013. The ANA routinely gathers PIPs for insight, but the nurse fatigue document marks the first time a PIP was organized specifically as a means to draft an ANA position statement, an ANA spokesperson told Oncology Nurse Advisor. A select group of applicants not chosen for the PIP—the Advisory Panel—were given the chance to take part in some of the PIP’s deliberations, according to the ANA.

The PIP finished its work right on time in February 2014, and in December a draft of the fatigue document was briefly posted on the ANA’s web site for public comment from ANA members and a broader audience who were notified of the public comment period and the document’s whereabouts.

From there the steering committee was to tidy the document up and move it to the ANA Board for final approval, but a new round of deliberations has sprung up between the steering committee and the Board, according to Barry.

Behind closed doors the ANA board and the steering committee are debating limits to the number of hours a nurse can work in a 7-day period. In front of the two groups is an Institute of Medicine (IOM) report that discusses placing ceilings on how many hours an RN can work. The IOM report cites several pieces of evidence similar to a recent study that “found that intensive care residents working shorter shifts committed fewer errors.”4 Barry explained that the question right now with the board is “Does current EBP [experienced best practices] support the 2004 IOM report? Do we need to revisit maximum hours in a 7-day period of time?”

The weighting of nursing and administrative backgrounds of the 10 nurses making up the ANA Board and who’ll get final say is not detailed on the ANA web site.3 Two current ANA board members were specifically appointed for their nursing backgrounds as a way for the Board to maintain a bearing on issues most crucial to nurses in the daily challenges of the job, an ANA spokesperson said.