Says we must make reducing fatigue both a personal and system priority.
Chief nursing officer turned academician collaborates with colleague in researching occupational fatigue among nursing staff and chief nurse leaders.
Throughout my nursing career, I have been passionate about leadership, policy, and innovation, focusing specifically on today’s healthcare system and workforce challenges. My experience as chief nursing officer of three Wisconsin healthcare systems and as a vice president of clinical informatics has provided a lens that gives me a unique worldview for my teaching, scholarship, and workforce-policy efforts.
When I served as president of the Wisconsin Center for Nursing (WCN), the state’s nursing workforce center, I was actively involved in developing workforce policy and implementing key recommendations of the Institute of Medicine’s report The Future of Nursing: Leading Change, Advancing Health. WCN has worked in partnership with the Wisconsin Action Coalition and the Center to Champion Nursing in America to position nursing to meet the future needs of our state’s citizens.
To academia
In 2014, I transitioned to a new role—clinical professor at the University of Wisconsin–Madison School of Nursing. I enjoy teaching at UW–Madison and have always believed in bridging nursing practice, education, and research. The School of Nursing’s mission to develop leaders for the profession and society aligns perfectly with my own mission, values, and beliefs. At this point in my career, it’s all about leadership development, and I welcome the opportunity to develop and mentor the future generation of nurse leaders. At UW–Madison, I leverage my experience, share my wisdom, and collaborate with other dedicated faculty members in one of the nation’s most technology-enhanced schools of nursing.
Leadership is about making a difference in new and innovative ways. It’s about being present, building trust across complex systems and networks, working collaboratively, and leading teams to improve individual and health system performance. Improving performance requires understanding the current state of things and innovatively implementing the best evidence-based strategies from nursing and other disciplines.
The most important responsibilities of a leader include establishing a shared vision, accelerating the pace of improvement, and assuring a healthy collaborative-practice environment. Developing nurse leaders and making a positive difference in our leadership systems are critical to transforming healthcare for the future and promoting a culture of health for both providers and patients.
Focus on fatigue
I am particularly focused at present on the problem of occupational fatigue—a major healthcare issue that impacts nursing leaders as well as nursing staff. Fatigue is associated with a number of quality-related and safety issues and significantly affects both staff and leader retention. In my CNO role, I experienced the impact of long hours, lack of sleep, a demanding job, and a long commute. Some of my colleagues who have multiple demands in their roles also struggle with fatigue and, as a result, have expressed intent to leave their positions in the near future. Fatigue negatively affects the capacity of nurses to lead. To deal with the significant challenges we face in healthcare, it’s important to have energized, resilient leaders. Decreasing fatigue can make a positive and profound difference in one’s life and career.
When I joined UW–Madison School of Nursing, I met Linsey Steege, PhD, a human factors system engineer and assistant professor of nursing. We developed a wonderful interdisciplinary DNP-PhD collaboration that evolved out of our shared interest in improving healthcare systems and nursing practice environments. Steege had completed a number of landmark studies on fatigue and work systems in nursing, and our alliance leverages the strengths of our experiences and expertise.
What about nurse leader fatigue?
As we studied the literature, we became aware of a clear research gap. There were many studies on fatigue in nursing staff members but very limited information on fatigue in leaders, especially nurse leaders. Our first collaboration resulted in the development and 2016 publication of the Multi-Level Fatigue Risk Management in Nursing Work Systems Model. A data-driven approach to reducing fatigue in healthcare systems at nurse, unit, and system levels, the model serves as a starting point for leaders to monitor the problem. We used insights gained from our initial collaboration to inform our research on fatigue in nurse leaders. In addition to dealing with their own fatigue, nurse leaders are responsible for implementing innovative systems to monitor and reduce fatigue in staff members. Through our research, we are seeking to address nurse leader fatigue and fatigue within nursing overall by learning from nurse leaders and sharing effective strategies.
For starters, we wanted to understand the current state of adopting national recommendations on fatigue and use of fatigue risk-management systems in healthcare. There are guidelines for mitigating fatigue. For instance, the American Nurses Association has published a position statement that says decreasing fatigue in the workplace is the joint responsibility of both nurse and employer. Little was known, however, about how well those recommendations were being implemented.
Wisconsin and beyond
Our collaboration continues to evolve, and we include graduate nursing students in our research and publications. In 2016, we launched a two-phase study on fatigue. Phase One looked at fatigue in Wisconsin nurse leaders. We found that nurse leaders at all levels report significant levels of fatigue, but sources of fatigue tend to vary by role. To learn about the current state of fatigue risk-management systems (FRMSs) in hospitals across the United States, Phase Two involved nurse leaders—executives, directors, and managers—from 29 states. Our findings are published in two parts in Journal of Nursing Administration.
Fatigue risk-management systems have been used in other industries, such as transportation, but are new in healthcare and require adaptation. From our research, we found that most hospitals do not have FRMSs in place, and data monitoring is usually limited to staffing and scheduling reports. Nurse leaders told us there is a significant need for better decision-support tools that can be implemented to address fatigue.
We have major culture work to do. We need to support each other in dealing with fatigue. Nurse leaders need to partner with other healthcare leaders to prioritize fatigue as a system issue. As leaders, we can champion adoption and implementation of innovative approaches that mitigate fatigue and make a difference for staff members as well as leaders.
If we are truly dedicated to the health and well-being of our nursing workforce, we need to address fatigue on multiple levels. We must make reducing fatigue both a personal and system priority. We must listen to our hearts, proactively identify mentors, pay attention to personal fatigue levels, decrease sources of fatigue, and take care of ourselves. Each of us needs to understand how to support our peers on their journeys to improved resiliency, and we need to foster an environment where it is OK to be healthy nurses and take care of ourselves. RNL
Editor’s note: Barbara Pinekenstein will present “Fatigue: Impact on Stability of Nurse Leader Role,” on Saturday, 28 October, at the 44th Biennial Convention in Indianapolis, Indiana, USA. See the Virginia Henderson Global Nursing e-Repository for additional information.
Barbara J. Pinekenstein, DNP, RN-BC, CPHIMS, is clinical professor at the University of Wisconsin–Madison School of Nursing and Richard E. Sinaiko Professor in Health Care Leadership.