3 Ways to Fight Fatigue in the OR

Fatigue in health care today has become an epidemic and it’s not just a matter of being tired. “Fatigue can present as sleepiness, but also with a lack of energy and feeling of exhaustion associated with impaired physical and cognitive functioning,” cautions Dr. Jo Lichten, PhD, RDN, CSP, an expert in wellness and change management.

For perioperative nurses, Dr. Jo says fatigue can be caused by a number of reasons, including long work hours without adequate breaks, on-call and shift work that disrupts a nurse’s circadian rhythm, excessive stressful demands both at home and work, and inadequate nutrition, hydration, and movement during work hours.

Research suggests that each of these factors can negatively influence patient care through slowed reaction time and reduced attention and processing speeds. Fatigued individuals may also be impulsive and prone to misunderstandings that can potentially contribute to accidents and medical errors, she says. “According to the World Health Organization, the risk of patient death occurring due to a preventable medical accident, while receiving health care, is estimated to be 1 in 300. This includes medication errors, diagnostic errors or delays in diagnosis, and hospital infections.”

Achieving Peak Performance
Avoiding fatigue to be your best for yourself and your patients is possible, but it takes a few important steps, Dr. Jo advises.

1. Get adequate, high-quality sleep.

Prolonged periods of wakefulness (18 hours without sleep) can produce performance decrements equivalent to a blood alcohol concentration of 0.05 percent. She suggests leaders can assist by limiting on-call hours and overtime, scheduling eight or ten hour shifts instead of twelve, and considering how shifts rotate.

“Individuals working nights and rotating shifts obtain 1 to 4 hours less sleep than normal when they were working nights. Since sleep loss is cumulative, by the end of the workweek, the loss may be significant enough to impair decision-making,” Dr. Jo explains. “These effects are measurable, but not often recognized by the sleep-deprived individual.”

2. Find time for adequate rest and recovery.

Encouraging and assisting nurses to take breaks throughout the shift can make a difference, Dr. Jo advises, noting that research suggests breaks every 90-120 minutes.

3. Hydrate regularly and get adequate nutrition.

It’s common for nurses and other medical staff to not eat breakfast (because they’re not hungry or watching their weight), to skip lunch (because “who has time?”) but they must realize that food is fuel for physical movement, as well as brain function, she cautions.

While much of our brain can run on fat stores, the brain and red blood cells (requiring more than one-third of our body’s calorie needs) requires glucose coming from food. “We only have a 300-calorie storage of glycogen in our liver, which is mostly expended by the time we wake in the morning),” she advises.

For hydration, Dr. Jo says to remember that the human body is 60% water and dehydration of just 1-2% can negatively impact performance and mood.

Quick Fixes on the Go
So, what do you do when you haven’t followed these rules and you feel burnout creeping in or you see your staff showing signs of fatigue? Dr. Jo has solutions.

First, rehydrate. She says to check your urine. If it’s dark, you’re likely dehydrated. Grab a tall glass of cool water around 55 degrees, which will be absorbed quickly.

Second, take microbursts of movement such as a quick walk down the hall or up the stairs. “Even some jumping jacks can increase alertness,” she suggests.

Third, caffeinate carefully. Try for 50-100mg of caffeine (about the size of a cup of tea or a short cup of coffee). Research suggests that large doses aren’t needed to increase focus and attention, and instead can increase anxiety and prevent quality sleep at bedtime. “People often overconsume caffeine because it takes 30-45 minutes to reach peak levels in the bloodstream. That’s why it’s a good idea to drink this small dose and then take a short break or even a nap to allow the caffeine to kick in.”

Want to learn more from Dr. Jo to fight fatigue and increase performance at work? Don’t miss her presentation at AORN Global Surgical Conference & Expo, March 28–April 1 or check out her website for more tips to find your energy.

Free Resources for Members

Periop Perks: Improve your selfcare with savings on travel, retailers, insurance programs, and much more!

AORN Career Center: Take the stress out of staying ahead in your career with expert advice and career resources, including a 90-minute career coaching session.

Guideline Essentials: Improve work/life balance by utilizing easy-to-use Guideline implementation tools, including gap analysis tools, quick views, competency verifications tools, and more.

AORN Journal: Nurses and Health‐Promoting Behaviors: Knowledge May Not Translate Into Self‐Care