Five Reasons to Prioritize Nurse Fatigue Management

Five Reasons to Prioritize Nurse Fatigue Management

Both registered nurses and employers have a joint responsibility to “reduce risks from nurse fatigue and to create and sustain a culture of safety, a healthy work environment, and a work-life balance.”

The American Nurses Association also stated that "registered nurses and employers have an ethical responsibility to carefully consider the need for adequate rest and sleep when deciding whether to offer or accept work assignments, including on-call, voluntary, or mandatory overtime.”

Here are five reasons why you should prioritize nurse fatigue management:

1. The Prevalence of Fatigue Among Nurses

An abundance of research data on nursing fatigue exists to support the conclusion that fatigue is a serious concern for the healthcare industry.

Compared to the 7-8 hours of sleep required for optimal alertness and performance, it’s sobering that 80% of nurses get less than 6 hours of sleep prior to working a shift and 55% of nurses report that they “almost always” or “all of the time” felt fatigued during work (Scott et al., 2007; Geiger-Brown et al., 2012; Canadian Nurses Association & Registered Nurses Association, 2010).

2. High Injury Rates Among Healthcare Workers

According to the Occupational Safety & Health Association (OSHA), the healthcare and social assistance industry reported more injury and illness cases than any other private industry sector in 2011.

Fatigued workers exhibit up to 4x the workers compensation costs of non-fatigued workers, as shown in Figure 1 (CIRCADIAN, 2005).

Between 2006 and 2011, the average workers’ compensation claim for a hospital injury was found to be $15,860 among the roughly 1,000 hospitals surveyed (Aon Risk Solutions, 2012).

Figure 1. Workers Compensation Claims & Fatigue Levels
workers compensation and worker fatigue

3. High Turnover Rates & United States Nursing Shortage

There is a nursing shortages as a significant segment of the nursing workforce is nearing retirement. Experts project that more than 1 million nurses will reach retirement age in the next 10 to 15 years. This poses a major concern for members of the healthcare industry, as nursing school enrollment rates have been on a steady decline. Because of these factors, it’s become increasingly important for healthcare systems to retain nurses.

It’s no secret that high turnover rates are having serious implications on the healthcare industry, as a national survey of home healthcare agencies reported a 21% turnover rate for registered nurses (Hospital and Healthcare Compensation Services, 2000).

Interestingly, turnover rates are found to be significantly higher in workforces experiencing employee fatigue and stress problems, as seen in Figure 2 (CIRCADIAN, 2005).

Figure 2. Association between Turnover Rates and Fatigue and Stress Levels

employee turnover fatigue and stress

Replacing a nurse’s position has been estimated to cost an employer between $27,000 and $103,000 (Li & Jones, 2012). Given the high cost, fatigue risk management can be a cost-effective approach for reducing the high turnover rate among nurses.

4. Overtime & Workplace Injuries

Research looking at 110,326 U.S. job records revealed that working in jobs with overtime schedules was associated with a 61% higher injury hazard rate as compared to jobs without overtime. Working at least 12 hours per day was associated with a 37% higher injury hazard rate and working at least 60 hours per week was associated with a 23% increased hazard rate (Dembe, Erickson, & Banks, 2005).

These findings may not even account for all workplace injuries. One study found that 24% of nurses and nursing assistants changed shifts or took sick leave to recover from an unreported injury (Siddharthan, Hodgson, Rosenberg, Haiduven, & Nelson, 2006).

5. Joint Commission Statement on Fatigue

In December 2011, the Joint Commission, which accredits more than 20,000 U.S. healthcare organizations, recommended that healthcare organizations “create and implement a fatigue management plan.”

According to the Joint Commission’s Sentinel Event Alert, Health Care Worker Fatigue and Patient Safety, “There are now some evidence-based actions that healthcare organizations can take to help mitigate the risk of fatigue that results from the extended work hours – and, therefore, protect patients from preventable adverse outcomes.”

Commitment to Care

The mission statement of most healthcare organizations highlights the organization’s commitment to excellence in providing health care, patient safety, and improving the well-being of their local community.

A commitment to excellence is only truly upheld when an organization employs all possible measures to ensure unsurpassed patient care and safety. This means addressing workforce problems that impact the individual care providers, as these issues can have a domino effect that negatively impacts the quality of patient care.

If your organization isn’t addressing and managing the fatigue of the care providers, then scientific research suggests that your organization will suffer lapses in its commitment to superior patient care.

Solutions for Nurse Fatigue

To learn more about solutions for addressing, mitigating and managing nurse fatigue, download our white paper titled “Fatigued Nurses: Assessing the Risk, Implementing the Defenses

Nurse Fatigue White Paper



CIRCADIAN® is the global leader in providing 24/7 workforce performance and safety solutions for businesses that operate around the clock. Through a unique combination of consulting expertise, research, software tools and informative publications, CIRCADIAN helps organizations in 24/7 workforces optimize employee performance and reduce the inherent risks and costs of their extended hours operations.


Aon Risk Solutions (2012). Health Care Workers Compensation Barometer.

Canadian Nurses Association & Registered Nurses’ Association of Ontario (2010): Nurse fatigue and patient safety research report. Fatigue_Safety_2010_EX%20Summary_e.pdf (retrieved February 22, 2013).

CIRCADIAN (2004). Shiftwork Practices 2004.

CIRCADIAN (2005). Shiftwork Practices 2005.

CIRCADIAN (2007). Shiftwork Practices 2007.

CIRCADIAN (2014). Shiftwork Practices 2014.

Geiger-Brown J et al. (2012): Sleep, sleepiness, fatigue, and performance of 12-hour-shift nurses. Chronobiology International 29(2): 211-219.

Hospital and Healthcare Compensation Services, Homecare Salary & Benefits Report, 2000-2001. Oakland, NJ: Hospital & Healthcare Compensation Service, 2000.

The Joint Commission (2011). Health care worker fatigue and patient safety. Sentinel Event Alert. 48.

Li , Y., & Jones, C.B. (2012). A literature review of nursing turnover costs. Journal of Nursing Management. 21(3): 405-418. (Dollar amounts presented here are adjusted to 2013 prices.

Siddharthan, K., Hodgson M., Rosenberg D., Haiduven D., and Nelson, A. (2006). Under-reporting of work-related musculoskeletal disorders in the Veterans Administration. International Journal of Health Care Quality Assurance. 19(6): 463-476

From the blog