Fatigue and Fitness to Practice

A few full-time RNs almost always volunteer to work overtime hours when the scheduler and I have exhausted every other option. I worry about them becoming so fatigued that this might become unsafe for the clients and the RNs. What is their responsibility in this situation?  What is mine as the manager?

RN and RN Manager Responsibility

• RNs maintain their fitness to practice. If they are aware that they do not have the necessary physical, mental or emotional capacity to practice safely and competently, they withdraw from the provision of care after consulting with their employer or, if they are self-employed, arranging that someone else attends to their clients’ health care needs. RNs then take the necessary steps to regain their fitness to practice (1).
• RNs are attentive to signs that a colleague cannot perform their duties for whatever reason. In such cases, RNs will take the necessary steps to protect the safety of persons receiving care (1).
• RNs are accountable and accept responsibility for their own actions and decisions (2).
• RNs practice in accordance with the current CNA Code of Ethics for Registered Nurses (2017) and the accompanying responsibility statements (3).
• Managers who suspect inadequate staffing levels perpetuate this situation are obligated to examine and address staffing levels.

Non-RN Manager Responsibility

• Depending on your professional designation and background, you may have responsibilities or obligations outlined by a regulatory body. All managers of facilities, departments or units where direct client care occurs, have an obligation to promote safety and to address safety concerns.
• Managers who suspect inadequate staffing levels perpetuate this situation are obligated to examine and address staffing levels.

Is there a specific number of hours of work that are unsafe for RNs?

No. Each RN is capable of working a different number of hours before they become fatigued. There are many variables to consider, but essentially RNs are responsible for monitoring their own level of competence and fitness to practice. In the short run, they must work with the manager, charge nurse or supervisor if they believe that they are unable to provide safe care. They then must take action in the future and make decisions that enable them to consistently be safe.

CRNS Resources

Registered Nurse Practice Standards (2019)

CNA Code of Ethics (2017)

External Resources

RNAO Best Practice Guidelines - Preventing and Mitigating Nurse Fatigue