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Fit for Duty

Healthcare provider fatigue may lead to patient neglect, injuries or even death.

A nurse in New York pleaded guilty to endangering the welfare of a disabled person and was sentenced to serve 90 days in jail followed by five years probation. The nurse was asleep on her job while her patient suffered hypoxemia. The nurse was supposed to check the patient every two hours, but the patient was not checked for more than eight hours. The patient died two weeks later due to brain damage caused by the hypoxemia. The investigation revealed that the nurse and other employees at the same facility were known to regularly sleep during their shifts.

New York and several other states are increasing their investigations and oversight of healthcare providers and facilities with regards to fatigued employees. Fatigued employees are more likely to make medication errors and other errors due to their fatigue and sleep deprivation. Fatigued employees are also more likely to make poor clinical decisions due to their fatigue. The problem of fatigued employees is more pronounced in clinical setting where developmentally disabled and mentally ill patients reside. Vulnerable patients require additional supervision, but the facilities where those patients reside are often smaller and less able to cover staff shortages.

Fir for DutyMost states have not been tracking adverse incidents related to fatigued or sleeping staff members. The egregious facts of the New York case will probably persuade more states to at least examine the issue of fatigued staff, and healthcare providers sleeping on the job, particularly when they are voluntarily sleeping while caring for vulnerable patients.

SEE ALSO: Egregious Actions

Healthcare providers that willfully sleep on the job are more likely to be prosecuted or disciplined for endangering or neglecting their patients. The New York nurse admitted in court that she was willfully sleeping on the job as part of her plea agreement. Several years ago, a healthcare provider in Ohio pleaded guilty to neglecting patients based upon her leaving the medication cart unlocked and accessible to patients while willfully sleeping on the job. However, any healthcare provider that is fatigued can be subjected to discipline or even prosecution under the right circumstances.

Healthcare providers that routinely volunteer for overtime shifts should make sure they are fit for duty and have not volunteered for too many extra shifts. Facilities should also be aware of how many extra shifts their employees are working and make sure the patients are not placed in danger by a fatigued staff member.

Any healthcare provider pleading guilty to endangering or neglecting a patient should anticipate severe disciplinary action by their licensing board. Most healthcare practice acts require healthcare providers to report any criminal conviction related to the practice of their profession to their licensing boards. Endangering or neglecting a patient is always related to the practice of a healthcare profession. Most boards revoke licenses in matters involving endangerment or abuse even when it is a first offense.

Beyond Control
Addressing the problem of fatigued healthcare providers is difficult because healthcare providers may be fatigued for numerous reasons. Every healthcare provider has experienced fatigue due to circumstances beyond their control at some point in their career. For example, a sick child or family member can cause a healthcare provider to be fatigued. Staff shortages can result in healthcare providers working extended shifts and extra shifts thereby becoming fatigued. Healthcare providers that are poorly compensated may volunteer for too many overtime shifts, or take part-time jobs that make them more likely to be fatigued. No single solution can address all the reasons healthcare providers are fatigued. However, every healthcare provider is ultimately responsible for ensuring that they are fit for duty when they are caring for patients.

Healthcare facilities need to have clear policies that address fatigued staff, and that deter willful sleeping by healthcare providers. Those facilities need to also have policies and procedures that address incidents when staff members are too fatigued to fulfil their work responsibilities. The administrators and managers responsible for facilities need to take steps to ensure that the policies and procedures are being followed usually by unannounced visits to the facility. An administrator of one facility in New York made an unannounced visit and found the staff members asleep, the doors to the patient rooms barricaded, and an alarm clock set to wake the staff members before the day shift arrived.

"Healthcare providers that routinely volunteer for overtime shifts should make sure they are fit for duty."

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Healthcare providers need to arrive for work fit for duty. Those same providers need to have their own plan to address intermittent fatigue during their shifts. Healthcare providers should not willfully sleep on the job, and should not be complicit in coworkers that willfully sleep on the job.

Michael L. Smith is board certified in health law by The Florida Bar and practices at The Health Law Firm in Altamonte Springs, Fla. This article is for general information only and is not a substitute for formal legal advice.

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Curious about fatigue and mandating employees with very short notice. Particularly relating to mandating for the overnight shift....making the shift 1500 to 0730. Sixteen hours isn't unheard of, but if someone wasn't expecting to work an overnight and therefore has not slept it seems unsafe and excessive. Any recommendations on how to address this issue? Thanks.

Jennifer ,  RRTJune 26, 2015
Springfield, MA


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