Fatigue countermeasures programs, which require employees to take responsibility for acquiring sufficient sleep and remaining alert on the job, are often used in place of and along with hours-of-service regulations.

Although no particular approach, whether work hour regulation, guidelines, fatigue countermeasures programs, or some combination of these, can be applied to all industries or all settings within a particular industry, there appears to be some agreement that working longer than 12 consecutive hours without at least 8 hours off duty can be hazardous. Accident rates rise exponentially after 12 hours of work, particularly when employees work at night. Some work environments limit nighttime workers to shorter shifts (e.g., 8 hours) or consider 1 hour of nighttime flying to be equal to 1.4 hours of flight time during the day (U.S. Army). Many industries in which fatigued employees could compromise public safety do not allow employees to work more than 8–12 consecutive hours.

More research is needed to understand the effects of fatigue on patient safety. Controlled trials are needed to determine optimal work schedules in hospital settings and to test fatigue countermeasures. According to Olson and Ambrogetti (1998): “We do know enough to end the worse abuses of the human sleep-wake cycle, and we need to see a shift by both hospital employers and the medical [nursing] profession towards addressing this issue.” The authors of the early hours-of-service regulations understood that people cannot work for long periods of time each day without adequate time to sleep. It is perhaps time to acknowledge that nurses cannot provide safe care when they are fatigued, have worked for more than 12 hours, and/ or have not had at least 12–16 hours off between shifts.

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