title: Fatigue, performance and the work environment: a survey of registered nurses.
abstract: OBJECTIVE
  This paper is a report of a study of perceived levels of mental, physical and total fatigue, and also acute and chronic fatigue states, among registered nurses. Relationships between dimensions of fatigue and performance were investigated, as were differences in fatigue across levels of several demographic and work environment variables.
  
  
  BACKGROUND
  Fatigue is a factor that has been linked to performance decrements in healthcare workers. As a result of the nature of their work, nurses may be particularly susceptible to multiple dimensions of fatigue, and their performance is closely linked to patient safety.
  
  
  METHODS
  An online survey was used to measure mental, physical, and total fatigue dimensions, acute and chronic fatigue states, and performance. Participants were recruited via convenience sampling in cooperation with professional nursing organizations; 745 registered nurses completed the survey between February 2008 and April 2009.
  
  
  RESULTS
  Reported mental fatigue levels were higher than physical fatigue levels, and acute fatigue levels were higher than chronic fatigue levels. All fatigue dimensions and states were negatively correlated with perceived performance. Longer shift lengths and hours worked per week were associated with increases in physical and total fatigue levels. Mental, physical and total fatigue levels also differed with shift schedule.
  
  
  CONCLUSIONS
  Fatigue levels were negatively correlated with performance, further supporting the role of fatigue in nurse performance. Work environment variables were strongly associated with differences in perceived levels of fatigue. By altering the work environment, it may thus be possible to reduce fatigue levels and the rates of medical errors.
authors.affiliation: Department of Industrial and Manufacturing Systems Engineering, University of Missouri Informatics Institute, University of Missouri, Columbia, Missouri, USA. barkerl@missouri.edu
authors.forename: Linsey M
authors.initials: LM
authors.lastname: Barker
authors.forename: Maury A
authors.initials: MA
authors.lastname: Nussbaum
mesh_terms: D000208:Acute Disease; D000328:Adult; D002908:Chronic Disease; D004812:Epidemiologic Methods; D005221:Fatigue / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D019300:Medical Errors / Q000451:nursing / Q000706:statistics & numerical data; D008875:Middle Aged; D009740:Nursing Staff / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D009784:Occupational Diseases / Q000453:epidemiology* / Q000523:psychology; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration / Q000706:statistics & numerical data; D012449:Safety / Q000592:standards; D012890:Sleep / Q000502:physiology; D014940:Work Schedule Tolerance / Q000502:physiology* / Q000523:psychology; D016526:Workload; D017132:Workplace / Q000458:organization & administration* / Q000706:statistics & numerical data; D055815:Young Adult