Commentary: Factors correlating with prolonged fatigue among emergency department nurses

The reviewed study describes the relationship between characteristics of the nursing work environment and occupational fatigue on nurse outcomes in emergency nurses in hospitals of Jordan. This is in acknowledgment of the rationale that the nursing work environment and the workforce of nurses are important factors for reaching high nursing performance and ensuring patient safety as well as nurse safety and nurse retention. In the light of this background, occupational fatigue also plays an important role in the context of strategies to ensure workplace attractiveness and against nursing shortages (Kunaviktikul et al., 2015; Witkoski and Vaughan Dickson, 2010).

The factors influencing fatigue are culturally and contextually dependent. They also depend on the role of professional nursing in the multi-professional working environment (Alahmadi and Alharbi, 2018; Taylor and Barling, 2004). According to the authors, there is a lack of studies examining fatigue in the context of the nursing work environment in Jordan hospitals.

Hence, the innovation of this study is that it addresses this important issue in an under-researched nursing topic in Jordan. It is a step towards the aim, to strengthen the professional and political discussion about fatigue among nurses in this working environment. Nevertheless, the results of this study also contribute to the general knowledge about occupational fatigue in nurses and helps consolidate it.

Previous studies have shown that visualising fatigue is an important first step in reducing occupational fatigue (Steege et al., 2017).

Because of the clinical relevance that occupational fatigue has, in literature it is recommended to set up monitoring systems that help observe the state and developmental trends of fatigue in the professional working environment (Kant et al., 2010; Liu et al., 2016).

Particularly supportive are multilevel monitoring models, in which fatigue is also an explanatory variable with regard to outcomes of interest (Lerman et al., 2012; Steege and Pinekenstein, 2016). In this way, the monitoring data also provide a basis for evaluating the effectiveness of fatigue-related interventions in relation to desired outcomes.

Such monitoring may also be an essential element of a Fatigue Risk Management System (FRMS) that helps track the causes and effects of occupational fatigue across multiple escalation levels and minimises the associated risks with appropriate interventions (Lerman et al., 2012). Also in the domain of nursing work, such FRMSs have been described as helpful for leaders to implement and evaluate evidence-based measures to reduce fatigue and its impact (Gardner and Dubeck, 2016; Steege and Pinekenstein, 2016).

Actually, first studies on the introduction of a FRMS in the nursing work environment have already been published, in which the experiences with such a system and corresponding guidelines in this work environment are described (Dara et al., 2015; Martin-Gill et al., 2018). These publications provide additional empirical knowledge that may support the development of appropriate systems and policies in other nursing work environments.

Accordingly, it is a declared concern of the authors of this article to support the discussion about minimising occupational fatigue in the nursing work environment of interest by the results of their study.

Biography

Michael Kleinknecht-Dolf, PhD, RN works as a clinical nurse scientist at the University Hospital Zurich. His research interest is nursing environment quality and its impact on the nursing workforce as well as on its related outcomes.