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Nurse fatigue: The silent epidemic

By: Holly Carpenter, BSN, RN; Kendra McMillan, MPH, RN; and Ruth Francis, MPH, MCHES

Mitigating this serious threat to health and safety

Are you getting the recommended 7 to 9 hours of sleep in a 24-hour period? According to ANA Enterprise’s new Healthy Nurse Healthy Nation® survey results, 40% of nurses and nursing students surveyed aren’t getting this much-needed rest, and 14% report nodding off or falling asleep while driving in the past 30 days. The American Nurses Foundation “Pulse on the nation’s nurses COVID-19 survey series: Mental health and wellness” revealed that 60% of nurses reported difficulty sleeping in the past 14 days.

Nurse fatigue threatens nurses’ health, their patients’ safety, and public health. Nurses and their employers must work together to mitigate fatigue.

The American Nurses Association position statement on addressing nurse fatigue to promote safety and health recommends that RNs work no more than 40 hours of professional nursing during a 7-day period and that “organizations establish an evidence-based staffing plan to address registered nurse responsibilities in extreme or unusual situations, when nurses and employers are at risk of being pushed beyond their physical capacity.”

Promoting nurse mental health

Nurses are experiencing an unprecedented amount of burnout, depression, and anxiety. Stressful work environments, workplace bullying, and workplace cultures unsupportive of personal…

Nurses and their employers can implement the following strategies to alleviate nurse fatigue.

Nurses at home

  • Avoid screen time at least 1 hour before bedtime.
  • Consider taking a nap before your shift.
  • When preparing to sleep, ensure the room is quiet, dark, and cool.
  • Meditation, prayer, a warm bath, light reading, focused breathing, Emotional Freedom Techniques, and mindfulness can help you relax before falling asleep.
  • Avoid heavy or spicy meals, caffeine, and alcohol before bedtime.

Nurses at work

  • Take meal, hydration, rest, and bathroom breaks as needed.
  • Avoid drowsy driving. Use a reputable ride share service, taxi, or public transportation, or have a trusted acquaintance drive you home.
  • Know the side effects of all the medications you take.
  • When considering a job, analyze commute time, staffing, employee satisfaction, and safety culture.
  • Establish a buddy system where you and a colleague can check in with each other about fatigue and a quick “time out.”


  • Ensure safe levels of staffing.
  • Enforce meal, rest, and bathroom breaks.
  • Allow nurses to decline overtime and extra shifts without penalties.
  • Eliminate mandatory overtime.
  • Keep work to 40 hours or less per week.
  • Cap shift length to 12 hours or less.
  • Follow the Centers for Disease Control and Prevention recommendation of at least 11 consecutive hours of protected off-duty time for employees between shifts.
  • Provide transportation home for nurses too tired to drive safely.
  • Offer onsite fatigue-management resources.

Nurses and employers must work together to ensure manageable shifts, optimal staffing, and a safety culture that allows nurses to report fatigue in themselves and others, as well as errors, incidents, and near misses without fear of reprisal. These reports must then be carefully analyzed by an interprofessional group to enact safer practices and policies. AN

Holly Carpenter, Kendra McMillan, and Ruth Francis work in the Nursing Practice and Work Environment Department at the American Nurses Association.


ANA Enterprise. Pulse on the nation’s nurses COVID-19 survey series: Mental health and wellness. nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/what-you-need-to-know/mental-health-and-wellbeing-survey

Hittle BM, Wong IS, Caruso CC. Managing fatigue during times of crisis: Guidance for nurses, managers, and other healthcare workers. Centers for Disease Control and Prevention. April 2, 2020. blogs.cdc.gov/niosh-science-blog/2020/04/02/fatigue-crisis-hcw

Centers for Disease Control and Prevention. What workers and employers can do to manage workplace fatigue during COVID-19. May 19, 2020. cdc.gov/coronavirus/2019-ncov/hcp/managing-workplace-fatigue.html?deliveryName=USCDC_10_4-DM27902

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