Aims and objectives
To describe the levels of insomnia, fatigue and intershift recovery, and psychological well‐being (burnout, post‐traumatic stress and psychological distress), and to examine ...differences in these measures based on work‐related characteristics among nursing staff during COVID‐19 pandemic in the United States.
Background
The COVID‐19 pandemic has created a major physical and psychological burden on nursing staff in the United States and worldwide. A better understanding of these conditions will lead to tailored support and resources for nursing staff during and after the pandemic.
Design
Cross‐sectional study.
Methods
Hospital nurses and nursing assistants (N = 587) were recruited online between May–June 2020. The survey included measures on insomnia (Insomnia Severity Index) fatigue and intershift recovery (Occupational Fatigue and Exhaustion Recovery‐15), burnout (Maslach Burnout Inventory‐Human Services Survey), post‐traumatic stress (Short Post‐Traumatic Stress Disorder Rating Interview) and psychological distress (Patient Health Questionnaire‐4), and questions on work and demographics. The STROBE checklist was followed for reporting.
Results
The sample had subthreshold insomnia, moderate‐to‐high chronic fatigue, high acute fatigue and low‐to‐moderate intershift recovery. The sample experienced increased emotional exhaustion and depersonalisation, increased personal accomplishment, moderate psychological distress and high post‐traumatic stress. Nurses who cared for COVID‐19 patients had significantly scored worse on almost all measures than their co‐workers. Certain factors such as working hours per week and the frequency of 30‐min breaks were significant.
Conclusion
Nursing staff experienced poor sleep, fatigue and multiple psychological problems during the COVID‐19 pandemic. Moreover, staff who were involved in the care of COVID‐19 patients, worked more than 40 h per week and skipped 30‐min breaks showed generally worse self‐reported outcomes.
Relevance to clinical practice
Nursing administration is recommended to monitor for fatigue and distress on nursing units, re‐visit current scheduling practices, reinforce rest breaks and provide access to mental health and sleep wellness resources with additional support for their front‐line nursing groups.
Background
Type II (customer-on-worker) workplace violence (WPV) against nurses and its underreporting are ongoing safety and health challenges in health care. The COVID-19 pandemic has strained ...patients and nurses and, in turn, may have increased WPV. The purpose of this cross-sectional study was to describe and compare a sample of nurses’ reported prevalence of Type II WPV and their reporting of these events during the pandemic.
Methods
Data from an online survey of registered nurses (N = 373) working in hospitals were included. Prevalence was calculated for physical violence and verbal abuse, and their reporting of these events, including the experience of violence between nurses who did and did not care for patients with COVID-19.
Findings
Overall, 44.4% and 67.8% of the nurses reported experiencing physical violence and verbal abuse, respectively, between February and May/June 2020. Nurses who provided care for patients with COVID-19 experienced more physical violence (adjusted odds ratio aOR = 2.18, 95% confidence interval CI = 1.30, 3.67) and verbal abuse (aOR = 2.10, 95% CI = 1.22, 3.61) than nurses who did not care for these patients. One in 10 nurses felt reporting the incident was more difficult during the pandemic.
Conclusion/Application to Practice
A significant proportion of nurses who cared for patients with COVID-19 experienced more physical violence and verbal abuse, and more difficulty in reporting to management. As the pandemic continues, health care organizations need to recognize that workers may be at an elevated risk for experiencing WPV and may be less likely to report, resulting in an urgent need for prevention efforts on their part.
Aim
This study aimed to explore whether 30‐min rest breaks were as effective at lowering acute fatigue among 12‐h shift hospital nursing staff who cared for patients with COVID‐19 as among those who ...did not.
Design
The study was cross‐sectional in design.
Methods
Data from the SAFE‐CARE study collected online between May and June 2020 were used. A subsample (N = 338) comprised of nursing staff who reported working 12‐h shifts, and providing direct patient care in hospitals was used in this study. Data on socio‐demographics, work and rest breaks, and subjective measures of fatigue, psychological distress, sleep and health were used. Hierarchical multiple linear regression followed by stratified analyses was conducted to explore the relationships between rest breaks and acute fatigue among nursing staff groups with and without COVID‐19 patient care.
Results
The sample, on average, had high acute fatigue. Around 72% reported providing care to patients with COVID‐19, and 71% reported taking rest breaks ‘sometimes’, ‘often’ or ‘always’. In the group that cared for patients with COVID‐19, there was no significant relationship between rest breaks and acute fatigue (p = .507). In the group that cared for patients hospitalized for other reasons, rest breaks were associated with lower acute fatigue (p = .010).
Conclusion
Our findings showed both the importance and inadequacy of rest breaks in reducing acute fatigue. The process of within‐work recovery is complex, and routine rest breaks should be facilitated by nursing management on hospital units during and after the COVID‐19 pandemic.
Impact
Rest breaks may present an effective strategy in lowering fatigue. Although rest breaks were not associated with less fatigue among staff caring for patients with COVID‐19, other co‐workers experienced some fatigue recovery. For frontline nursing staff, routine rest breaks are encouraged, and a systematic evaluation pertaining the sufficiency of rest breaks during high work demands in future research is needed.
Aims
To evaluate the relationships between workload, nursing teamwork and nurse fatigue and the moderating effect of nursing teamwork on the relationship between workload and fatigue.
Design
This ...cross‐sectional online survey study used data from 810 United States hospital nurses collected between March and April 2021.
Methods
Workload, nursing teamwork and fatigue were measured using the Quantitative Workload Inventory, the Nursing Teamwork Survey, and the Occupational Fatigue Exhaustion Recovery scale. Hierarchical multiple linear regression models were used.
Results
All the nursing teamwork subscales (i.e. trust, team orientation, backup, shared mental model, team leadership) were significantly negatively related to acute and chronic fatigue. Nursing teamwork components of team orientation, shared mental model and team leadership moderated the relationship between workload and chronic fatigue. The relationships between workload and chronic fatigue were stronger when these components of nursing teamwork were high. No moderating effects were found with acute fatigue.
Conclusion
Efforts to increase nursing teamwork may be a promising strategy in managing nurse fatigue. It is equally important to monitor and modify high workload to protect nurses from elevated fatigue.
Impact
What problem did the study address?
Fatigue is negatively associated with the health and safety of hospital nurses and patients.
Nursing teamwork has been shown to improve the nursing care of hospitalized patients; yet, it is rarely explored in relation to nurse fatigue.
What were the main findings?
Greater nursing teamwork is significantly associated with lower acute and chronic fatigue.
The relationships between workload and chronic fatigue were stronger when nursing teamwork (i.e. team orientation, shared mental model and team leadership) was high than when nursing teamwork was low.
Where and on whom will the research have an impact?
Improving nursing teamwork, in addition to monitoring and modifying workloads, can be a promising approach for managing fatigue in healthcare organizations.
Background
Home healthcare workers (HHWs) provide medical and nonmedical services to home‐bound patients. They are at great risk of experiencing violence perpetrated by patients (type II violence). ...Establishing the reliable prevalence of such violence and identifying vulnerable subgroups are essential in enhancing HHWs’ safety. We, therefore, conducted meta‐analyses to synthesize the evidence for prevalence and identify vulnerable subgroups.
Methods
Five electronic databases were searched for journal articles published between 1 January 2005 and 20 March 2019. A total of 21 studies were identified for this study. Meta‐analyses of prevalence were conducted to obtain pooled estimates. Meta‐regression was performed to compare the prevalence between professionals and paraprofessionals.
Results
Prevalence estimates for HHWs were 0.223 for 12 months and 0.302 for over the career for combined violence types, 0.102 and 0.171, respectively, for physical violence, and 0.364 and 0.418, respectively, for nonphysical violence. The prevalence of nonphysical violence was higher than that of physical violence for professionals in 12 months (0.515 vs 0.135) and over the career (0.498 vs 0.224) and for paraprofessionals in 12 months (0.248 vs 0.086) and over the career (0.349 vs 0.113). Professionals reported significantly higher nonphysical violence for 12‐month prevalence than paraprofessionals did (0.515 vs 0.248, P = .015).
Conclusion
A considerable percentage of HHWs experience type II violence with higher prevalence among professionals. Further studies need to explore factors that can explain the differences in the prevalence between professionals and paraprofessionals. The findings provide support for the need for greater recognition of the violence hazard in the home healthcare workplace.
This cross-sectional study aimed to explore the characteristics, content, and context of rest breaks taken by hospital nurses.
Nurses often miss, skip, or take interrupted breaks. To improve the ...quality of breaks and promote within-shift recovery, it is important to understand current rest break practices including break activities and contextual challenges around them.
Survey data from 806 nurses were collected between October and November 2021.
Most nurses did not take regular breaks. Rest breaks were often interrupted, spent being worried about work, and rarely resulted in a relaxed state. Common break activities were having a meal or a snack, and browsing the Internet. Regardless of workload, nurses considered patient acuity, staffing, and unfinished nursing tasks when deciding to take breaks.
Rest break practices are of poor quality. Nurses mainly consider workload-related factors when taking breaks, which warrants the attention of nursing administration.
Hospital nurses are expected to maintain optimal work performance; yet, fatigue can threaten safe practice and result in unfavorable patient outcomes. This descriptive cross-sectional study explored ...the association between fatigue, work schedules, and perceived work performance among nurses. The study sample included 77 bedside nurses who were mostly female, single, and between 20 and 29 years of age. The majority worked 8-hour shifts and overtime. Nurses who worked during off days reported significantly higher chronic fatigue compared with those nurses who took time off. Nurses who reported feeling refreshed after sleep had significantly less chronic and acute fatigue and more intershift recovery. Nurses with acute and chronic fatigue perceived poorer physical performance. Also, nurses who reported chronic fatigue perceived they were less alert and less able to concentrate when providing patient care. Less effective communication was also associated with acute and chronic fatigue. In conclusion, fatigue has safety implications for nurses’ practice that should be monitored by nursing management.
Background:
The coronavirus disease 2019 (COVID-19) pandemic has profoundly impacted the health and psychological well-being of hospital nursing staff. While additional support is needed to better ...cope with increased job stressors, little is known about what types of hospital resources have been provided and how nursing staff perceive them. This study addressed this gap by describing nursing staff perceptions of resources provided by hospitals during the COVID-19 pandemic in the United States.
Methods:
Registered nurses and nursing assistants who were working in hospitals during the pandemic were recruited to an online survey via social media posts and emails between May and June 2020. A total of 360 free-text responses to an open-ended survey question were analyzed using content analysis.
Results:
Over half of participants reported being provided with hospital resources. “Basic needs” resources that included food on-site, groceries, and childcare support were the most frequently reported compared with four other types of resources (personal health and safe practice, financial support, managerial support, communication). Four themes emerged related to staff perceptions of support: community support, unequal benefits, decreasing resources, and insufficient personal protective equipment.
Conclusion:
Our findings can assist organizational leaders in the planning and allocation of different types of resources that are meaningful to nursing staff and thus ensure sustainability, optimal performance, and worker well-being during crises.
Background
As older adults prolong working life and face age‐related health changes, insomnia symptoms and fatigue may jeopardize their ability to stay in the labor force. Our study explored the ...relationships between insomnia symptoms, fatigue, and job exit in workers aged 65 years and older.
Methods
Data from the National Health and Aging Trends Study were used (2011–2017). The sample included 953 Medicare beneficiaries with paid work at the time of the interview. Workers were followed annually for 6 years to the time of job exit. Insomnia measures included the number and type of symptoms, and fatigue (measured as low energy). Crude and adjusted odds ratios and 95% confidence intervals were estimated within discrete‐time survival analysis. Models were adjusted for health, lifestyle, and sociodemographic characteristics.
Results
At baseline, approximately 49% of workers had either one or two insomnia symptoms. Difficulty falling asleep and difficulty maintaining asleep were prevalent in 35% and 37% of the sample. Fatigue was common in <30% of the sample. Workers with difficulty falling asleep were 1.29 times at higher odds to have job exit when compared with workers with no insomnia (p = 0.033). Conversely, fatigued workers were 0.73–0.77 times at lower odds to have job exit when compared with nonfatigued workers (p < 0.05).
Conclusion
Difficulty falling asleep negatively affects future work status, unlike feeling fatigued. Healthcare providers are encouraged to assess for insomnia and discuss treatments with workers, and workplaces should be flexible with the start of workdays to support worker longevity.
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