Introduction
Perhaps the most important factor in case of providing healthcare services to clients is that of efficiency . This efficiency is dependent on a number of factors and, it needs to be mentioned, it depends on the infrastructure of healthcare facilities as well. This presentation will focus on this aspect as it highlights the importance of identification and reduction of fatigue in the nursing workplace environment which are psychological in nature. Fatigue can be of two types – physical and psychological; psychological fatigue, which is invisible , is in fact a serious threat which can harm the overall service quality to clients. The following sections will highlight the different aspects associated with implementation of an educational framework and identification mechanism within the organization.
1. Obtaining approval and securing support from leadership and staff
The first and foremost requirement in the planned development implementation is to be able to secure support from staff and leadership and obtain approval from the leadership for the implementation of the program. In other words, securing an audience among the stakeholders of the organization is the major challenge in this process . In this case, the first and foremost task to perform is to convince the leadership of the organization about the need to ensure prevention of fatigue in the workplace and why it is essential to raise awareness about the problem. The steps which will be associated in the same are mentioned under:
Step 1 - informal discussion with the floor-in-charges of the three shifts and superintendent on the importance of fatigue identification and prevention
Step 2 – preparation of a tentative workshop-cum-training schedule mentioning the number of staff members to attend each session and the duration of such sessions
Step 3 – review by the floor-in-charges and senior practitioners on the content and duration of each session with the staff members for any necessary changes
Step 4 – presentation of the workshop proposal to the superintendent for approval on the content, schedule and duration of awareness session and participants
Step 5 – informing the entire organization and the intended staff members about the date and duration of the sessions through email and other official correspondence which confirms their presence.
2. Addressing the current problem
In order to gain more attention to the intended session, focus needs to be given on the importance and relevance of the issue in the first place . In this aspect an important fact which needs to be mentioned about the organization is that there is a prevalent practice of carrying over shifts (double shifts) by staff members when the relieving staff member has either taken leave or is unable to make it to work for the particular shift. The organizational practice does not encourage or force, but it allows a staff member to work two consecutive shifts (8 hours per shift) in such an event. The gravity of this aspect lies in the implications itself.
The most common after-effect of long hours is fatigue. There have been instances earlier whereby the organization received complaints that the assigned staff member could not follow instructions or indications, caused a potentially hazardous situation and also it had happened once that one nurse had collapsed in the middle of a service to a client. Investigations into these incidents revealed that in two cases, the nurse on duty was working on a second shift (of a double shift) while in another case, domestic disturbance had led to fatigue and the nursing staff almost ended falling on a tray of sharp surgical tools like scalpel and scissors. While fatigue may have serious health implications on the nursing staff, the health and safety of clients and patients are also jeopardized . As a result, it is the duty and responsibility of the leadership to address the issue to prevent untoward incidents, especially when it had already affected well-being and proper performance of duties by the staff.
3. Detailed proposed solution
The proposed solution to the problem of prevalence of fatigue in the workplace is generating awareness about the causes, implications and remedy to fatigue in the workplace and also to be able to introduce the staff members to two specific changes regarding duty and working hours. The following two solutions are strongly recommended in terms of addressing the challenge of workplace fatigue, which is cause due to lack of sleep:
(1) The supervisors and floor managers need to assess fatigue levels of the nursing staff round the clock. For the supervisors and floor managers to achieve this, the training and development session will highlight the ways in which fatigue and stress could be identified among their staff such as headache, dizziness, slow response and reflexes, mood swings and impaired decision making .
(2) Nursing staff to be allowed to take a small short nap between their shift breaks and meal periods.
(3) The nursing staffs who work for the night shifts should be allowed to take a nap before the commencement of their shifts.
4. Rationale behind selection of the proposed solution
The main objective of introduction of this proposed solution is to reduce the instances of fatigue and tiredness among the nursing staff which ultimately affects their performance of duties and the quality of healthcare provided to the clients of the organization . Fatigue and sleepiness in the workplace is a serious threat to health and safety of both patients and nursing staff yet they are more often than not overlooked and dismissed as a trivial issue. Also, in the healthcare industry and others fatigue is looked upon as not so dangerous a threat as (for example) a contagious disease or unawareness of HACCP protocols. Yet the outcomes and implications of prevalence of this health condition are grave, and more so, it is not really possible to be able to identify presence of fatigue in a person without closely monitoring him or her. In other words, fatigue is a discreet danger whose presence cannot be easily identified.
5. Summarizing literary evidence on the issue
The next question which is most likely to arise in this case is then why do adhere to the three proposed solutions; and why is there a need to conduct a training and awareness session on the issue? The answers to both these questions lie in the literary evidence presented hereby. In the first case, sleep depravity causes the brain to function poorly which also interferes with the other body functions. Due to improper rest of the body (which is the case of sleep depravity and stress) the nervous system becomes stress and normal functioning of the reflexes are interfered. It leads to poor decision making, improper reflexes and even physical discomfort such as muscle pains and improper metabolism .
The reason why short naps of 45 minutes or less are recommended is because it will prevent a medical condition known as sleep inertia. Deep sleep and sudden waking up might lead to inability in performing physical or mental tasks and impaired alertness (due to the motor dexterity) . While for nursing staff working the night shift which usually starts at 11 pm, their body temperatures is the lowest and they are more likely to fall asleep. It is because of the fact that they are awake for a longer period of time before commencing duties as compared to their colleagues working in a day shift or morning shift. The nap will help in creating a balance in mental and physical activeness.
6. Implementation logistics
As far as the organization is concerned, the leadership is lucky as the employee locker room comes equipped with a 9-seater bunker bed facility, which was indeed intended to provide resting places for staff working on emergency duties. It needs to be highlighted that the organization has reserved the right to admission to the bunkers on a strictly permission and priority basis. The logistical challenge involved in this case is merely to bring a change in organizational policies and make the area accessible to all staff members. While the training and development session will highlight the importance of prevention of fatigue, it will be the duty of the floor managers to grant access of the area to the staff, especially when staffs arrive for night shift. However, vigilance is needed at the same time to ensure that the facility is not misused. While on duty, it will be the responsibility of supervisors to rotate staff duties daily so that each staff member does get at least 45 minutes spare time to replenish their energy levels.
7. Required resources for the change implementation
For the training and development exercises, the entire staff of the organization needs to be formed into groups or batches of 7-8 members who will participate in an interactive session aided by the use of videos and power point presentations. However, just as it is important to provide inputs, the leadership needs to ensure that the staff members provide feedback for which questionnaires and quiz sessions will be organized to gauge at the level of intake of each employee. Other than these, the training and developmental exercise will utilize stationery resources in the form of printed handouts on fatigue and its prevention, for which there would be the need of funds (mainly for the paper and printer cartridge).
Conclusion
It has been clear as to why fatigue needs to be considered a serious threat to normal functioning and performing duties. However, the more important reason behind this presentation is to provide a possible approach to educate the staff and leadership about the health issue, for which it is crucial to have an effective plan of action ready. After careful consideration of all the prevalent factors and aspects, the recommendations and suggested approach to address the issue of fatigue have been highlighted. It is anticipated that if materialized properly, it will provide a long-lasting benefit to the organization.
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