AACN News—April 2005—Practice

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Vol. 22, No. 4, APRIL 2005

Practice Alert: Dye in Enteral Feeding

The goal of the AACN Practice Alerts is to help nurses and other healthcare practitioners carry their bold voices to the bedside to directly impact patient care. Practice alerts are directives from AACN that are supported by authoritative evidence to ensure excellence in practice and a safe and humane work environment.

Expected Practice: Dye should not be added to enteral feeding as a method for identifying aspiration of gastric contents.
Supporting Evidence:
• Research and case reports of aspiration have shown that dye in enteral feedings is not visually detectable in situations similar to aspiration pneumonia.1-4 A recent consensus statement on methods for identifying aspiration in critically ill patients recommended that dye be eliminated from enteral feeding because it lacks sensitivity for identifying aspiration of gastric contents.5
• The addition of dye to enteral feeding has been associated with several adverse events, including gastric bacterial colonization and diarrhea, systemic dye absorption and death.6-9 The FDA recently issued a Public Heath Advisory based on reports of toxicity and death associated with dye in enteral feeding, though a direct causal relationship has not yet been definitively confirmed.9 The majority of reported cases of toxicity and/or death occurred in patients with sepsis.
• Use of glucose testing of tracheal aspirates,1,10 once proposed as a method for identification of gastric aspiration, is no longer recommended as a viable strategy.5

What You Should Do:
• Do not use dye in enteral feedings as a method for identifying pulmonary aspiration.
• If your current practice includes use of dye in enteral feedings, consider forming a multidisciplinary task force (nurses, physicians, dieticians, respiratory therapists, clinical pharmacists) or a unit core group of staff to address the need for removing dye from enteral feedings at your institution.
• Assure that written practice documents (e.g., policies, procedures or standards of care) about enteral feeding do not include the addition of dye.
• Educate staff about the reasons for removal of dye from enteral feedings.
Need More Information or Help?
• Call the AACN Practice Resource Network at (800) 394-5995, ext. 217. Practice Alerts are online at www.aacn.org.

1. Potts R, Zaroukian M, Guerrero P, Baker C. Comparison of blue dye visualization and glucose oxidase test strip methods for detecting pulmonary aspiration of enteral feedings in intubated adults. Chest. 1993;103:117-121.
2. Thompson-Henry S, Braddock B. The modified Evan’s blue dye procedure fails to detect aspiration in the tracheostomized patients: five case reports. Dysphagia. 1995;10:172-174.
3. Metheny N, Dahms T, Stewart B, et al. Efficacy of dye-stained enteral formula in detecting pulmonary aspiration in intubated adults. Chest. 2002;122:276-281.
4. McClave S, Lukan J, Stefater J, et al. Poor validity of residual volumes as a marker for risk of aspiration in critically ill patients. Crit Care Med. 2005;33(2):324-330.
5. McClave S, DeMeo M, DeLegge M, et al. North American Summit on Aspiration in Critically Ill Patients: Consensus statement. JPEN. 2002;26:S80-85.
6. File T, Tan J, Thomson R, et al. An outbreak of pseudomonas aeruginosa ventilator-associated respiratory infection and the significance of gastric colonization preceding nosocomial pneumonia. Infect Control Hosp Epidemiol. 1995;16:417-418.
7. Maloney J, Halbower A, Fouty R, et al. Systemic absorption of food dye in patients with sepsis (letter). N Engl J Med. 2000;343:1047-1048.
8. Bell R, Fishman S. Eosinophilia from food dye added to enteral feedings (letter). N Engl J Med. 1990;322:1822.
9. Acheson D. FDA Public Health Advisory: Reports of blue discoloration and death in patients receiving enteral feedings tinted with the dye, FD&C Blue No. 1. FDA Web site. Accessed September 29, 2003. Available at: http://www.cfsan.fda.gov/~dms/col-ltr2.html.
10. Metheny N, St John R, Clouse R. Measurement of glucose in tracheobronchial secretions to detect aspiration of enteral feedings. Heart Lung 1998;27:285-292.

Suggested Reading
1. Maloney J, Metheny N. Controversy in using blue dye in enteral feedings as a method for detecting pulmonary aspiration. Crit Care Nurse. 2002;22:84-86.
2. Aschenbrenner D. Drug Watch: blue dye No. 1 advisory. Am J Nurs. 2004;104:71.
3. Maloney J, Ryan T, Brasel K, et al. Food dye use in enteral feedings: a review and a call for a moratorium. Nutr Clin Pract. 2002;17:169-181.

Practice Alert Audits
Demonstrate the Value of Your Contribution

By Joanne M. Kuszaj, RN, MSN, CCRN, and Sherill Nones Cronin, RN, PhD, BC
AACN Research Work Group

Your unit has made a commitment to evidence-based practice. You’ve set as your goal implementing the recommendations of each of the AACN Practice Alerts. But how do you know if you’re reaching your goal? AACN now provides the tools to help you determine just that.

The Practice Alert audit tools are designed to assist you in measuring compliance with the key elements of the research-based recommendations. Developed as Excel spreadsheets, these handy tools identify the specific practice criteria that should be reviewed for each Practice Alert. If necessary, you can individualize the tool to meet your unit’s needs. Your audit data can be entered directly into the spreadsheet. Formulas built into the spreadsheet will automatically calculate counts, percentages and averages. You can also generate charts and graphs for display. It’s as easy as that!

The head-of-bed elevation audit tool that accompanies the Ventilator-Associated Pneumonia Practice Alert is currently available on the Web site (www.aacn.org). To download, simply click on the “Performance Improvement Toolbox” link. An accompanying guide includes step-by-step instructions for conducting the audit. Tools to monitor compliance with the other Practice Alerts will be added over the next few months. With this set of tools, you’ll be ready to start your own unit-based performance improvement program.

On some units, conducting the audit may be the responsibility of the unit’s quality committee representative or members of the unit-based quality improvement council. On others, each staff member may be expected to conduct one or more audits. Pick an approach that works best for your unit, as long as audits are conducted in a consistent manner. This will increase the reliability of the data and ensure that comparisons made over time will be meaningful.

Results of the audits should be shared with the entire staff. This can be accomplished through postings on your unit’s quality board, messages sent through your in-house email system, and announcements at other unit-based committee meetings and monthly unit staff meetings. Use all means available to share the data so that everyone knows where you are with achieving unit goals. Through discussions of the results, you can determine if incidents of noncompliance with the practice recommendations are the result of an education deficit, a system problem or simply not enough “peer pressure” to do the right thing.

Over time, your ongoing audit findings should show that practice on your unit is becoming standardized as more staff members begin consistently following the Practice Alert recommendations. You should also be evaluating your unit’s patient-centered outcomes to determine the effectiveness of these interventions. For example, unit compliance with the head of bed elevation recommendations from the VAP Practice Alert should also lead to lower VAP rates, shorter intubation times and reduced ICU length of stay. By showing the impact of your practice on patient outcomes, you can truly demonstrate the value of “Living Your Contribution.”

Joanne Kuszaj is clinical manager of the medical-surgical ICU at Rex Healthcare, Raleigh, N.C. Sherill Nones Cronin is a professor at Bellarmine University, Louisville, Ky.

ACNP Competencies Are Guide for Program Development

By Marilyn Hravnak, RN, PhD, ACNP-BC, CCRN
Advanced Practice Work Group

The recently released Acute Care Nurse Practitioner Competencies1 represent a significant contribution to ACNPs and education.
Development of these national, consensus-based practice competencies followed publication in 2002 of the Domains and Core Competencies of Nurse Practitioner Practice.2 The document describes practice competencies for all nurse practitioners regardless of specialty area, as well as two other documents describing practice competencies for the primary care nurse practitioner specialties (adult, family, gerontological, pediatric, and women’s health)3 and psychiatric-mental-health NPs.4

Initial development of competencies specific to the ACNP was carried out by the National Organization of Nurse Practitioner Faculties ACNP Special Interest Group. Once the draft document was completed, NONPF followed its established process for competency development and formed a multi-organizational national panel. This panel consisted of representatives of seven national nursing organizations whose foci include advanced practice nursing education, ACNP practice, and certification for the ACNP, spanning the specialty areas of neonatal, pediatric and adult. A subgroup of the NONPF ACNP Special Interest Group, along with several AACN national office staff members, participated.

After the national panel reached consensus on the draft competencies, nominations were sought from national nursing organizations and employers for individuals to serve on the external validation panel. This panel included 54 individuals who were identified as having expertise relative to ACNP practice and education and who had not served on the national panel.

Based on the results of the validation process, the national panel incorporated changes and reached consensus on the competencies. Endorsements were sought from the nursing community nationwide, with 15 organizations now providing endorsements.

The final Acute Care Nurse Practitioner Competencies document describes entry-level competencies for graduates of
master’s and postmaster’s programs that prepare ACNPs. The competencies can be used by educational programs to structure curricula and guide mechanisms for valid evaluation of student performance. They also set the consensus-derived national standard for guiding ACNP program development. In addition, the document provides information to clinical preceptors of ACNP students regarding clinical practice and role expectations.

Ruth M. Kleinpell, RN-CS, PhD, FAAN, ACNP, CCRN, was the panel facilitator. Representing AACN were Professional Practice and Program Director Justine Medina, RN, MS, and AACN Certification Corporation Director Carol Hartigan, RN, MS. Judy Verger, RN, MSN, CRNP, CCRN, a member of the AACN Board of Directors, represented the Association of Faculties and Pediatric Nurse Practitioners. I also served on the panel and was a member of the NONPF Special Interest Group.

Other panel members were Terri A. Cavaliere, RNC, MS, NNP (National Association of Neonatal Nurses). Nancy Denke, RN, MSN, FNPC, CCRN (Emergency Nurses Association), Cathy Haut, RN, MS, CPNP, CCRN (Pediatric Nursing Certification Board), Elizabeth Howard, RN, PhD, ACNP (NONPF ACNP Special Interest Group), Mary Smolenski, EdD, APRN, BC (American Nurses Credentialing Center), Joan Stanley, RN, PhD, CRNP, FAAN (American Association of Colleges of Nursing), Jan Towers, RN, PhD, CRNP, FAANP (American Academy of Nurse Practitioners), Janet Wyatt, PhD, CRNP (Pediatric Nursing Certification Board).

“These competencies, in addition to the core competencies for all nurse practitioner practice, reflect the current knowledge base and scope of practice for ACNPs,” said Kleinpell.

The Acute Care Nurse Practitioner Competencies are available online at http://www.nonpf.com/ACNPcompsfinal2004.pdf.

1. National Panel for Acute Care Nurse Practitioner Competencies. Acute Care Nurse Practitioner Competencies. Washington, DC. National Organization of Nurse Practitioner Faculties; 2004.
2. National Organization of Nurse Practitioner Faculties. Domains and Core Competencies of Nurse Practitioner Practice. Washington, DC; 2000.
3. National Panel for Nurse Practitioner Primary Care Competencies in Specialty Areas. Nurse Practitioner Primary Care Competencies in Specialty Areas. Washington, DC: National Organization of Nurse Practitioner Faculties; 2002.
4. National Panel for Psychiatric-Mental Health NP Competencies. Psychiatric-Mental Health Nurse Practitioner Competencies. Washington, DC: National Organization of Nurse Practitioner Faculties; 2003.


July 1 is the deadline to apply for the following AACN nursing research grants:

Clinical Inquiry Grant
This grant provides awards up to $500 to qualified individuals carrying out clinical research projects that directly benefit patients and/or families. Interdisciplinary projects are especially invited. Ten awards are available each year.

End-of-Life/Palliative Care Small Projects Grant
This grant provides awards of $500 each to qualified individuals carrying out a project focusing on end of life and/or palliative care outcomes in critical care. Examples of topics are bereavement, communication issues, caregiver needs, symptom management, advance directives and life support withdrawal. Two awards are available each year.

Medtronic Physio-Control AACN Small Projects Grant
Cosponsored by Medtronic Physio-Control, this grant funds an award up to $1,500 to a qualified individual carrying out a project focusing on aspects of acute myocardial infarction, resuscitation or sudden cardiac death, such as the use of defibrillation, synchronized cardioversion, noninvasive pacing, or interpretive 12-lead electrocardiogram. Examples of eligible projects are patient education programs, staff development programs, competency-based educational programs, CQI projects, outcomes evaluation projects, or small clinical research studies.

To find out about AACN’s research priorities and grant opportunities, visit the Research area of the AACN Web site or e-mail research@aacn.org.

Practice Resource Network


We recently changed our leadership model to a “manager model,” in which each ICU (medical, surgical, neuro, burn/trauma) has a unit-based manager who reports directly to the director of critical care. Can we, as an ICU “team” of units, apply for the Beacon Award Excellence, or must we submit separate applications for each unit?


The AACN Beacon Award for Critical Care Excellence was developed to consider the attributes of individual units. Having multiple units report their data together as an ICU “team” would make it difficult to review each unit. The staff and leadership for each unit are different, the patient populations are different, and the outcomes will vary between units. Aggregate data can be skewed by including one or more units. Although the questions may seem fairly simple in terms of numbers and data, the texture given in the supporting documentation is what truly tells us the story of excellence for a unique unit.

For more information about the AACN Beacon Award for Critical Care Excellence, visit the AACN Web site.

ANA Code of Ethics for Nurses: Provision 2 Emphasizes Commitment to Patients

Editor’s note: The ANA Code of Ethics for Nurses provides the ethical framework and the foundation of professional nursing practice. It defines what registered nurses must know about their ethical responsibilities and informs the public about the ethical commitments expected of nurses. This code serves as a basis to advocate for the delivery of safe, competent and ethical nursing care.1 Following is the second in a series of articles applying the provisions of the ANA Code of Ethics to critical care nursing practice. This article highlights the second provision and its underlying principles.2

By Cynda Rushton, RN, DNS, PhD, FAAN, Chair
John F. Dixon, RN, MSN, CNA, BC,
Board Liaison
and Teresa A. Wavra, RN, MSN, CCRN, CCNS
Staff Liaison
AACN Ethics Work Group

Provision 2: The nurse’s primary commitment is to the patient, whether an individual, family, group or community.2

The nurse’s primary commitment is to the patient who is the recipient of nursing care. According to the interpretive statements, the term “patient” is broadly understood to include individuals, families, groups or communities on which nursing care focuses. The AACN Synergy Model for Patient Care states that each patient and family, clinical unit and system is unique and has a varying capacity for health and vulnerability to illness.3 This focus on patients recognizes the inherent or potential vulnerability of individuals who need healthcare, protection and advocacy.

Critical care nurses are responsible to apply this standard by directing nursing care that meets the comprehensive and unique needs of the individual patient and his or her family. Based on the ethical principle of “respect for persons,” nurses are also responsible for understanding the patient’s values and wishes, ensuring that patients and their families have opportunities to participate in goal setting and care planning.

In critical care, scheduling recurring meetings to discuss and update goals of care incorporating values and preferences can facilitate this participation. When conflicts arise, nurses must act as advocates in addressing issues and working toward solutions. Assessing the patient’s needs and preferences, a tenet of the Synergy Model, helps to focus family members and healthcare professionals on the centrality of respect for people. Mechanisms to assist patients, families and the healthcare team to constructively address concerns include ethics consultations, interdisciplinary team meetings and mediation. Because of the complexity of critical care, a greater chance exists for patients and families to have limited or no decision-making capacity. During this time, the nurse’s responsibility is to work on the patient’s behalf and serve diligently as a moral agent and advocate providing safe passage through the healthcare continuum.3

Comprehensive, quality patient care requires collaborative practice with other members of the healthcare team. True collaboration is a complex process that requires intentional knowledge sharing and an exchange of views and ideas that consider the perspectives of the collaborator.4 Integral to successful collaboration is skilled communication, trust, knowledge, shared responsibility and mutual respect. Collaboration requires constant attention and nurturing, including formal processes and structures to foster joint communication and decision making.5

Research indicates that healthy, collaborative relationships between nurses and physicians are directly linked to optimal patient outcomes. True collaboration is vital not only for the benefit of patients, but also for the workplace environment and nursing satisfaction. The AACN Standards for Establishing and Maintaining Healthy Work Environments states that nurses must never settle for less than true collaboration.5

Conflict of Interest
Critical care nurses have the responsibilities to conduct themselves with honesty and to protect their own integrity in all professional interactions.2 Nurses have specialized knowledge and skill, and access to confidential information.6 With this knowledge comes the responsibility to examine the conflict that may arise between their personal and professional values, and the values and interests of others. The therapeutic relationship that exists between critical care nurses and their patients requires the needs of the patient and the interests of the nurse not be in conflict. Respect for people requires that privacy be protected. Critical care nurses must safeguard information learned in the context of the professional relationship and adhere to federal laws such as HIPPA.6 Even Florence Nightingale recognized this when she wrote Notes on Nursing:

“And remember every nurse should be one who is to be depended upon, in other words, capable of being a ‘confidential’ nurse. She does not know how soon she may find herself placed in such a situation; she must be no gossip, no vain talker; she should never answer questions about her sick except to those who have a right to ask them …”

Critical care nurses must be vigilant to assess for and identify instances in which conflict of interest may arise, avoiding situations that can give rise to actual or perceived conflicts of interest. Some examples of conflict of interest are:
• Actions that result in financial benefit to the nurse or personal loss to the patient.
• The use of confidential information to exploit or coerce the patient.
• Engaging in behaviors or making remarks toward patients that are perceived as demeaning, seductive, insulting, exploitive, disrespectful or humiliating.7

Professional Boundaries
Respect for the integrity of patients, families and nurses requires attention to the tenor of patient-nurse therapeutic relationships. Establishing and maintaining appropriate professional boundaries when caring for and interacting with patients and families is an important dimension of this relationship. Nurses who consciously or unconsciously violate personal, emotional or spiritual boundaries with patients either misuse the power in the relationship to meet personal needs or behave in an unprofessional manner with the client.7 “Some boundaries are absolute while others may require careful consideration and professional judgment.”6 Nurses must be aware of the ethical implication of their actions and establish and maintain professional boundaries so that they may provide safe and effective competent care to patients and families. Critical care nurses should seek guidance from their nursing colleagues, managers and educators when confronted with situations that raise questions about the ethically appropriate level of involvement in patient care situations.

Respect for the uniqueness of patients is central to the ANA Code of Ethics. Critical care nurses can find support in their efforts to advocate for patients by being knowledgeable about the contents of the second provision of the Code.

1. Canadian Nurses Association. Position Statement: Code of Ethics for Registered Nursing. Available at: http://www.cna-nurses.ca
_ethics_RN_June_2004_e.pdf. Accessed March 4, 2005.
2. ANA Code of Ethics for Nursing With Interpretive Statement. Available at: http://www.nursingworld.org/ethics/code/ethicscode150.htm. Accessed January 22, 2005.
3. The AACN Synergy Model for Patient Care.
?opendocument. Accessed March 8, 2005.
4. Lindeke, L, Siekert A. Nurse-physician workplace collaboration. Online Journal of Issues in Nursing. Available at: http://www.nursingworld.org/ojin/topic26
/tpc26_4.htm. Accessed March 4, 2005.
5. American Association Critical Care Nurses Standards for Establishing and Maintaining Healthy Work Environments.
6. Alberta Association of Registered Nurses. Professional Conduct: Code of Ethics. Available at: http://www.nurses.ab.ca/profconduct
/ethics.html. Accessed March 4, 2005.
7. Registered Nurses Association of British Columbia. Policy statement: Nurse-Client Relationships: establishing professional relationships and maintaining appropriate boundaries. Available at: http://www.rnabc.bc.ca/pdf/389.pdf. Accessed March 4, 2005.

Public Policy Update

Bills Address Nurse Overtime, Medical Malpractice
Medical malpractice reform and nurse overtime limits have landed back on Congress’ agenda. A bill introduced in the House by Reps. Pete Stark (D-Calif.) and Steven LaTourette (R-Ohio), similar to laws passed in several states, would limit mandatory overtime for nurses to 12 hours in a 24-hour period and 80 hours over 14 days. Sen. Edward Kennedy (D-Mass.) also introduced legislation that would penalize hospitals for requiring nurses to work mandatory overtime after completing scheduled shifts. The bill calls for up to $10,000 in civil penalty fines against hospitals that violate the law, and nurses could file complaints about overtime violations to the Department of Health and Human Services. After investigating claims, HHS could impose fines on hospitals and raise fines against repeat violators. Nurses could work overtime voluntarily, and the law would not apply in a government-declared state of emergency.

Meanwhile, Budget Committee Chairman Judd Gregg (R-N.H.) and Sen. John Ensign (R-Nev.) introduced a bill that would cap noneconomic damages in medical malpractice cases at $250,000, mirroring past legislation that has repeatedly failed in the Senate. In addition, the bill would place a three-year statute of limitation on malpractice suits and set criteria for establishing malicious intent or deliberate failure to act by the provider in order to win punitive damages.

Mikulski, Collins Honored for Nursing Program Funds Effort
U.S. Sens. Barbara Mikulski (D-Md.) and Susan Collins (R-Maine) were honored for their successful efforts to increase funding for nursing programs necessary to reverse the nursing shortage. They were presented the first Americans for Nursing Shortage Relief Public Service Award during a Capitol Hill reception attended by representatives of numerous nursing organizations. AACN was a cosponsor of the event. Mikulski and Collins have been the driving force behind significant increases in funding for the Title VIII Nursing Workforce Development Programs.

JCAHO Joins Push for Medical Malpractice Reform
The Joint Commission on Accreditation of Healthcare Organizations has proposed a series of changes in the nation’s medical liability system as a major step in solving what officials describe as a crisis preventing physicians from providing the best patient care.

In a policy paper, the commission concluded that the current liability system fails patients because it does not deter negligence, provide justice or fairly compensate victims of medical errors. The commission’s report, “Healthcare at the Crossroads: Strategies for Improving the Medical Liability System and Preventing Patient Injury,” recommended several demonstration projects to test alternatives to the current system. Included are early settlement offers, “no-fault” administrative systems, health courts and the use of court-appointed, independent expert witnesses.

Report Examines Role of Healthcare in Voters’ Decisions
Candidates’ positions on healthcare issues had relatively little effect on voting behavior in the 2004 presidential election, either because the issues were not seen as salient enough or because the candidates’ positions were not articulated well enough, according to a Health Affairs report titled “Voters and Health Care in the 2004 Election.”

The report examined 14 national surveys and exit polls before and after the 2004 presidential election to determine the role health played in making up voters’ minds. With concerns about future presidential leadership and issues of moral values, the economy, terrorism and Iraq on their minds, most voters postponed their concerns about healthcare in considering their vote.

Healthcare Organizations Collaborate to Launch Nurse Radio
The New England School of Whole Health Education, in collaboration with several local and national healthcare and media organizations, recently launched Nurseradio.org, the first nurse-focused radio show.

Developed by the New England School of Whole Health Education and supported by the American Holistic Nurses Association, Nurseradio.org is a nonprofit organization dedicated to celebrating the global contributions of nurses in patient care and providing a voice for today’s nurses. Featured are inspiring, insightful and moving interviews with prominent nurse leaders and healers.

Bill Would Increase IT Support for Providers
A Department of Health and Human Services program would offer providers grants, revolving loans and tax credits to buy information technology and provide incentives, such as add-on Medicare payments, to use technology to improve patient care, under legislation introduced by Reps. Charlie Gonzalez (D-Texas) and John McHugh (R-N.Y.). The National Health Information Incentive Act would also direct the HHS health IT office to initiate a pilot program on national interoperability standards. President Bush’s proposed fiscal 2006 budget includes $125 million for health IT initiatives.

Statehealthfacts.Org Updates Women’s Health, Hospital Data
Updates at Kaiser’s statehealthfacts.org include the latest figures for pap smears and mammograms, as well as the number of states offering Medicaid waivers for family planning in 2005. Hospital data have also been updated in the Providers & Service Use category, including the number of emergency room visits and the expense per inpatient day. Statehealthfacts.org provides free data on more than 450 health topics for all 50 states.

CDC Guidelines Help States Track, Report Infections in Hospitals
The Centers for Disease Control and Prevention’s Healthcare Infection Control Practices Advisory Committee has released recommendations for policymakers who are seeking to create mandatory public reporting systems of healthcare-associated infections.
To date, Illinois, Pennsylvania, Missouri, and Florida have passed laws requiring hospitals to publicly report healthcare-associated infections. An additional 30 states are moving toward mandatory public release of this information.

The voluntary guidelines advise states to consult with disease experts, use established methods to track infections and practices that prevent infections, and to provide confidential feedback to healthcare providers on a regular basis.

Public Policy Snapshot

Extended Hours for Nurses

“Extended Hours Issues in Nursing: Exploring the Problems, Finding the Solutions” is the title of a new report that explores consequences of the current and future nurse shortage. The authors, representing the research and consulting firm CIRCADIAN, say “Consequences of this current and future shortage are further reaching than the economics of supply and demand.” Like 20% of American workers, nurses work long, irregular shifts. For nurses, employers and patients, this means a host of hazards, including:
• Healthcare shows the second-highest turnover rate of all “extended hours” industries.
• Nursing is one of the 10 industries with the highest levels of occupational injury or illness requiring days away from work.
• The most prevalent injuries are musculoskeletal disorders and needlesticks. In 89% of needlesticks, the needle was contaminated.
• Work-related fatigue is one of the top three job-related health and safety risks, with nearly 20% of nurses citing “having an accident while commuting back home.”
• Nurses show high instances of sleep disorders, severely affecting productivity.
• High fatigue and short staffing severely affect quality of patient care.

Additional information about this report is available online at www.circadian.com.

For more information about these and other issues, visit the AACN Web site.
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