Knowing the ANA has given employers equal footing with nurses in the fatigue position statement and seeing the document gummed up in the board room does not make National Nurses United’s Ross optimistic. She fears the ANA is more in the business of representing health care managers and educators than it is in representing nurses. In fact, National Nurses United—like the New York State Nurses Association and others—used to be part of the ANA until it’s members voted to distance themselves from the ANA because they claim that the ANA manufactured reasoning and policy statements that were often too insensitive to the best interests of working nurses for National Nurses United to support.

Any recommendation from the ANA that would call for capping the number of hours nurses can work each week would come under fire by the entire nurse’s union, said Ross. Health care is a for-profit business in America, and nurse fatigue should not be used as a backdoor to cost-cutting efforts that possibly endanger patients while at the same time possibly reducing the earning potential of nurses, said Ross.

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“Allowing nurse to go on working when they are perfectly able to do so actually saves money for hospitals in the long run, but hospitals as businesses don’t have time to examine the long run,” Ross said, adding that California’s move to increase nurse staffing using nurse-to-patient ratios actually made money for California hospitals which in turn ran more smoothly, versus saving money by lowering nurse payrolls.


There may be better ways to schedule nursing units at safe fatigue levels than to cut hours or wonder about a nurse’s free time, said John Repique, RN, MS, CEO of Friends Hospital Philadelphia, Pennsylvania.

When first interviewed by Oncology Nurse Advisor, Repique was the senior vice president and chief administrative officer at Jackson Behavioral Health Hospital in Miami, Florida, a hospital that schedules its nurses in 12-hour shifts. Friends Hospital schedules its nursing staff in 8-hour shifts, and without cutting nurse hours, management gets better-rested nurses and fewer management headaches, said Repique.

Eight-hour shifts make it harder for nurses to schedule work with second jobs that may run 12-hour shifts, so there is an inherent reduction in nurse fatigue due to the restrictions that come with three nurse shifts per day versus two, said Repique. In addition, nurse staffing gets easier for management when 8-hour shifts are run, as 12-hours shifts are more difficult for management to keep staffed and cover for no shows and sick time off, he said.

Whatever comes of the ANA’s new policy statement on nurse fatigue, Repique does not predict a showdown between nurses and management as long as nurses retain the freedom to work when they please, earn what they need to earn, and do so “with management support towards more of a culture of safety,” Repique told Oncology Nurse Advisor.

Until the ANA publishes the final document, its current position for employers of nurses is to provide safe working hours and a pay scale that prevents the temptation for nurses to moonlight. The ANA’s current position for nurses when it comes to avoiding fatigue is essentially “know when you need to stop.”

Dan Neel is a medical writer based in San Francisco, California.


1. Official ANA Position Statements page. American Nurses Association web site. . Accessed September 15, 2014.

2. Neel D. Nurse fatigue gets a wake-up call. Oncology Nurse Advisor web site. Published December 18, 2013. Accessed September 15, 2014.

3. Board of Directors. American Nurses Association web site. Accessed September 15, 2014.

4. Wachter RM. The End Of The Beginning: Patient Safety Five Years After ‘To Err Is Human’. Published November 30, 2004. Accessed September 15, 2014.