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Related Experiment Video

Updated: Jul 1, 2025

Collecting Sleep, Circadian, Fatigue, and Performance Data in Complex Operational Environments

Collecting Sleep, Circadian, Fatigue, and Performance Data in Complex Operational Environments

Published on: August 8, 2019

Examining the Relationship Between Nurse Fatigue, Alertness, and Medication Errors.

Amany Farag¹, Jacob Gallagher², Lucas Carr²

¹College of Nursing, The University of Iowa, Iowa City, IA, USA.

Western Journal of Nursing Research

|March 8, 2024

Summary

Nurse fatigue significantly reduces alertness and increases medication errors. Implementing mid-shift fatigue interventions, particularly for night shifts, is crucial for patient safety.

Keywords:

ecological momentary assessment fatigue medical errors medication error nurse fatigue nurses nurses’ alertness

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Area of Science:

Nursing Science
Occupational Health
Patient Safety Research

Background:

Nurses face occupational fatigue due to demanding work hours.
Limited research exists on nurse fatigue, alertness changes during shifts, and their link to medication errors.

Purpose of the Study:

To assess the relationship between nurse fatigue and alertness.
To evaluate changes in nurse fatigue and alertness throughout shifts.
To examine the connection between nurse fatigue, alertness, and medication errors/near misses.

Main Methods:

Prospective study using a convenience sample of 90 nurses.
Wearable actigraphy measured alertness; ecological momentary assessment (EMA) via text messaging measured fatigue.
Data collected over 14 work and non-workdays.

Main Results:

Increased fatigue correlated with decreased alertness (β = -1.06, p < .01).
Night-shift nurses showed a 31-point alertness drop during their shift.
Nurse fatigue, not alertness, was linked to medication errors and near misses (OR = 1.26, p = .01).

Conclusions:

Mid-shift fatigue mitigation, especially for night-shift nurses, can reduce fatigue and improve alertness, enhancing patient safety.
EMA-captured fatigue is a stronger predictor of medication errors than device-measured alertness.