Put a Ceiling on Nurses' Hours

Q: What's the difference between a tired doctor and a drunk? A: If you're the doctor's patient, not much. A fatigued physician and someone who's legally drunk both think, focus, and perform skilled work at about the same level, according to the American Medical Student Association. Nurses might not be different, as one of them recently reminded me in her post on an Internet site devoted to discussions about patient safety (listserv: patientsafety-l@LISTSERV.NPSF.ORG).

That's why in 2003 teaching hospitals had to stop requiring residents to put in 120-hour weeks and 36-hour shifts; the usual limits now are mere 80-hour weeks and shifts of no more than 24 hours straight (although it is conventional wisdom in the medical community that some hospitals try to get away with more). Residents were the main source of concern because historically they were the physician underclass; the grueling schedule miraculously eased once a resident was no longer an acolyte at the beck and call of the masters.

But what about nurses? If you wandered through a hospital and asked a few nurses at random how many hours straight they have worked, you might well hear 15 or 20 or more. The nurse who posted to the Internet site above stated that she has had to work more than 34 hours without a break. She was sure that after the 12th hour she was not as alert as she should have been. She is undoubtedly right—a 2006 study in the American Journal of Critical Care found that compared with nurses working shifts of eight hours or less, those who worked up to 12 1/2 hours made 50 percent more errors, and those who worked more than that made twice as many.

All healthcare workers, argued this nurse, should have their hours limited. It's hard to argue with that. Every year the Joint Commission, which accredits hospitals, publishes its proposed safety goals for the coming year. Apparently, putting a ceiling on the number of shift hours for nurses is not one of them for 2008. It should be.