Keeping Patients Safe Transforming the Work Environment of Nurses (2004) / Chapter Skim
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Appendix C: Work Hour Regulation in Safety-Sensitive Industries
Appendix C: Work Hour Regulation in Safety-Sensitive Industries
Pages 384-436
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From page 384... ...
The second section examines how various health care and non-health care industries have attempted to address consumer and public safety issues by restricting work hours through regulations or administrative guidelines. Since fatigue countermeasures programs are often recommended, a brief overview of these programs and their efficacy is included.
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From page 385... ...
A person who is not sleep deprived performs tasks more efficiently after prolonged wakefulness and can cope better with nonstandard work hours (nights or rotating shifts) than someone with a sleep deficit (Dinges et al., 19961.
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From page 386... ...
. Finally, night shifts longer then 12 hours and day shifts longer than 16 hours have consistently been found to be associated with reduced productivity and more accidents (Rosa, 19951.
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From page 387... ...
The lack of adequate rest periods between workshifts can also exacerbate fatigue. Sleep loss is likely to occur when there are only short clurations between work shifts.
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From page 388... ...
Although the work hours of truck drivers, locomotive engineers, and pilots are regulated to protect the public from fatigue-related errors, hospitalized patients lack similar protections. At present, there are no restrictions on the number of hours a nurse may voluntarily work in a 24-hour or a 7-day period in the United States.
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From page 389... ...
Scheduled shifts may be 8, 10, or 12 hours, and may not follow the traditional pattern of day, evening, or night shifts. Although 12-hour shifts usually start at 7 p.m.
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From page 390... ...
reported being forced to work voluntary overtime (ANA, 20011. Decisions about mandatory overtime are usually made at the last minute, and nurses may receive less than 60 minutes' notice that they will not be allowed to go home at the end of their scheduled shift (author's unpublished data)
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From page 391... ...
Congress that would prohibit mandatory overtime for nurses and other licensed health care providers (Golden and Jorgensen, 20021. The first bill2 would amend Title XVIII of the Social Security Act (Medicare Act)
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From page 392... ...
The work hours of resident physicians have been the subject of research and frequent debate over the past 20-25 years. Although errors made by a sleep-deprived resident in a New York City hospital are believed to have caused a patient's death, few studies have shown a direct link between fatigue and patient safety (Asken and Raham, 1983; Friedman et al., 1971; Parker, 1987; Poulton et al., 19781.
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From page 393... ...
, there is significant resistance to limiting the hours worked by resident physicians. Concerns have been expressed about reduced learning opportunities if resident work hours are curtailed (Greenfield, 2001; Hoffman and Barnett, 2000; Suk, 2001)
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From page 394... ...
In a survey conducted almost 10 years after the Bell Regulations were enacted, residents in all New York teaching hospitals reported working an average of 95 hours per week (Anonymous, 19981. In 1998, a surprise investigation conducted by the New York State Department of Health found all 12 hospitals visited to be violating resident work hour limits.
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From page 395... ...
The ACGME has recommended that all residency programs limit resident work hours to 80 hours/week and have a maximum shift length of 24 hours (although a resident could be required to put in an additional 6 hours for transfer of patient care responsibilities, educational debriefing, didactic activities, and seeing patients in a post-call continuity clinic) , and that night call be limited to every third night.
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From page 396... ...
OTHER PUBLIC SERVICE PROVIDERS Police and Firefighters Although the services of police officers and firefighters are required 24 hours a clay, 7 clays a week, their typical work scheclules are quite different. Firefighters in many jurisdictions work for 24-hour periods followed by 48 hours off, whereas police officers are often subjected to rotating shifts, must put in extra hours to appear in court anchor complete paperwork, and may moonlight to supplement their income.
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From page 397... ...
During normal conditions at post, camp, and duty stations where personnel can go home at night, work hours are quite similar to those of civilians. When personnel are deployed in the field or at sea, they tend to work about 70 hours per week (U.S.
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From page 398... ...
The Army specifies both the maximum amount of time pilots are allowed to fly and their maximum duty periods. Flight times are adjusted for such factors as time of day (flying 1.0 hour at night is considered the same as flying 1.4 hours during the day)
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From page 399... ...
. However, actual conditions dictate the nature and scheduling of rest periods during combat conditions, reinforcement operations, and special operations.
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From page 400... ...
. Combat conditions, which require the entire crew of a ship to remain on duty without relief or rest periods, can induce significant acute fatigue, especially after 1 or 2 days.
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From page 401... ...
plant administrative procedures follow the revised work hour guidelines" (Eisenhut, 1982) , plant owners cannot be compelled to follow those recommendations.
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From page 402... ...
Rather than imposing absolute limits on the number of hours an individual could work in any 48-hour period, specific restrictions on 16-hour shifts, or annual limits on work hours, the NRC opted to "establish thresholds for work hour controls." However, no specific thresholds were set or recommended in the NRC's rulemaking plan (U.S. Nuclear Regulatory Commission, 2000b)
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From page 403... ...
The aerospace industry, which developed during the latter half of the twentieth century, has no statutes or regulations limiting work hours. Despite the Department of Transportation's acknowledgment that current work hour rules are outdated and that fatigue remains a significant factor, none of the regulations or statutes limiting hours of service have been modified since 1989.
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From page 404... ...
It is not known how Congress arrived at these limits on railroad employee work hours; there were no studies of fatigue and railroad safety to guide their decision-making process. Perhaps they had read some of the accounts referred to by Munsterberg (1913 as cited in Intermodal Transportation Institute, 2000a)
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From page 405... ...
As a result, most railroads now offer training modules in fatigue countermeasures for all employees, scheduled days off, confidential screening for sleep apnea, and improved sleeping facilities at railroad terminals (Intermodal Transportation Institute, 2000a,b)
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From page 406... ...
8101-8104, added specific hours-of-service limitations for licensed individuals and seamen; provisions forbidding deck officers to combine both navigation and cargo watch duties using a 6 hours on, 6 hours off schedule; and a requirement that officers on watch during departures from port be sufficiently rested. Work hours in port as well as at sea are spelled out in the regulations.
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From page 407... ...
Individual mariners are expected to obey work hour limitations and to report suspected watchkeeping and work hour violations to the Coast Guard. Tips are kept confidential, and those who report code violations are protected from discrimination, including discharge, by 46 U.S.C.2114 (Clifton, 20021.
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From page 408... ...
Long-Haul Truck Drivers Work hours of long-haul truckers have been regulated since the 1930s, when Congress passed the Motor Carrier Act of 1935. This act authorized economic regulation of the trucking industry and directed the Interstate Commerce Commission (ICC)
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From page 409... ...
Total work hours per week remained capped at 60 and 70 hours (3 FR 18751. In 1938, the Hours of Service regulations were modified again, this time allowing an extra 2 hours of driving if drivers encountered "unfavorable weather conditions." Other exceptions such as emergency conditions, driver-salespeople, oilfield operations, 100 air-mile radius drivers, retail store deliveries, sleeper berths, operations in Alaska and Hawaii, and nondriving travel time were later granted (Federal Motor Carrier Safety Administration, 19991.
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From page 410... ...
allow "weekends" of sufficient length to ensure safety and provide adequate protection for driver health and safety; and (6) increase operational flexibility by offering a menu of hours-of-service options customized to different major or distinct operational segments while maintaining an appropriate level of safety (Federal Motor Carrier Safety Administration, 19991.
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From page 411... ...
Congress Office of Technology Assessment, 199131. Domestic air carriers are not permitted to issue, and pilots are not permitted to accept, an assignment for a flight if the crew member's total flight time will exceed 100 hours in a calendar month, 30 hours in 7 consecutive days, or 8 hours between required rest periods (U.S.
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From page 412... ...
Aviation Safety Reporting System (ASRS) , a confidential self-reporting system for flight crews and others to report difficulties and incidents, are fatigue related (NTSB, 2002a)
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From page 413... ...
The air traffic controllers studied by Rhodes and colleagues (1996) obtained only about 6-6.5 hours sleep on day shifts and only about 5 hours sleep when working on night shifts.
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From page 414... ...
illustrate the attention paid to the sleep/wake patterns of astronauts during a mission: After just a day or so in translunar drift, the astronauts got accustomed to the constant flickering and went about their sleep-wake, work-rest schedules as if the sun were rising and setting outside their craft just as it did outside their homes in Houston. As long as the crew maintained that schedule, NASA's flight surgeons had learned, their circadian rhythms would remain largely undisturbed.
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From page 415... ...
(Lovell and Kluger, 1994:318) FATIGUE COUNTERMEASURES PROGRAMS Fatigue countermeasures programs usually consist of an educational component (Comperatore and Kingsley, undated; Comperatore et al., 2001; Intermodal Transportation Institute, 2000a; NASA Ames Research Center, 1997; Smith-Coggins et al., 1997)
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From page 416... ...
found that, although resident physicians in = 6) reported increased subjective alertness after using the suggested strategies for 1 month, there were no improvements in their performance, mood, or amount of sleep obtained when working night shifts.
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From page 417... ...
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.
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From page 418... ...
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From page 425... ...
1988. The effects of acute sleep deprivation during residency training.
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From page 426... ...
2002b. NJ Assembly passes bill to limit resident work hours.
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From page 427... ...
. Federal Motor Carrier Safety Administration.
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From page 428... ...
. Petition requesting a limit on medical resident work hours through a standard issued under the authority of the Occupational Safety and Health Administration.
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From page 429... ...
. Residents' work hours termed excessive in hospital study.
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From page 430... ...
2000. Fatigue in Air Traffic Controllers: Literature Review.
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From page 431... ...
1983. Sleep loss and nap effects on sustained continuous performance.
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From page 432... ...
2001. Legal considerations of sleep deprivation among resident physicians.
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From page 433... ...
Rosekind MR, Buccino KR, Dinges DF, Moser RP.1997. Rotating shiftwork schedules: Can we enhance physician adaptation to night shifts?
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From page 434... ...
Groton, CT: U.S. Coast Guard Research and Development Center.
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From page 435... ...
2002. Sleep deprivation and clinical performance.
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