Nursing Project: Initiative to Reduce Stress & Fatigue in Nurses

This nursing project explores strategies to reduce stress and fatigue among nurses working long shifts in a public hospital in Australia. It uses the Wadula workbook to develop an initiative from its conceptual stage, focusing on addressing the puzzle of how to help nurses overcome fatigue and stress at work due to long working hours. The project justifies the need for change with evidence of increased clinical errors, burnout, and reduced job satisfaction among nurses. It identifies key stakeholders, including nurses, supervisors, doctors, and hospital administration, and proposes solutions such as stress management activities, time management, adequate sleep, and improved staffing. The project aims to improve nurse productivity, well-being, and patient care by mitigating the negative impacts of extended shift timings. Desklib provides access to this and many other solved assignments for students.

Running head: Nursing Project
Nursing Project
Name of the Student
Name of the University
Author Note

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Contents
Introduction:...............................................................................................................................2
My Employment:.......................................................................................................................2
Name of Agency where I am employment:...............................................................................3
Main focus of my job role:.........................................................................................................3
What I want to change:..............................................................................................................3
Purpose Behind the proposal:.....................................................................................................4
Justification or Rationale:..........................................................................................................4
Stakeholders:..............................................................................................................................6
Context in which the project is implemented:............................................................................8
Mobilising cooperation and engagement in the project:............................................................9
Facilitation of the project:........................................................................................................10
Scoping the project:..................................................................................................................11
Developing a practice change idea that is aligned to the clinical setting:................................12
Broader scope of the project:...................................................................................................15
Conclusion: Towards a well justified practice change.............................................................15
References:...............................................................................................................................17

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Introduction:
In the profession of nursing, long shift hours or extended shifts are not an uncommon
thing. Due to the high amount of stress on healthcare professionals to address the healthcare
needs of the patients and also due to frequent inadequacies in the number of skilled and
experienced nurses, extending the shift timings to assist more patients or other healthcare
professionals, nurses often have to work 10 to 12 hours at a stretch (Caruso 2014). This
causes significant fatigue and stress among the nurses and also adversely affects their
productivity and competency (Kivimäki et al., 2015).
The aim of this study is to develop a project aimed to reduce stress and fatigue among
nurses due to long shift hours. For this purpose, the Wadula workbook is used in order to
develop an idea or initiative from its conceptual stage to a point where it can be proposed to
others and engage them in the development of the idea or concept in a cooperated fashion.
The workbook involves the following important steps: step 1: identifying the puzzle, step 2:
clarifying the purpose, Step 3: Looking at the evidence, Step 4: Engagement of people, Step
5: Identifying contexts, Step 6: Evaluation of the outcomes, Step 7: Facilitation of the
implementation process and Step 8: Implementing the project (Uche et al. 2017). These steps
helps to develop a logical flow between the conception and development of the idea to
address a particular situation or challenge, identify strategies to address those challenge,
identify how these strategies can address the challenges or context, how to evaluate its
success and how these strategies can be used and implemented in an effective manner to
ensure it addresses the challenges.
My Employment:
I am currently employed in emergency nursing department where I have to treat patients
in the emergency ward. Every day several new patients are admitted to this department, all in

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need of significant care and often require nurses to extend their shift timings to compensate
for staff shortage or to provide comprehensive care for the patient. Previously I also worked
in the critical care unit, which was also a very stressful job.
Name of Agency where I am employment:
I am working in a public hospital in Australia.
Main focus of my job role:
My main responsibilities in the emergency department is to assist the doctors to treat the
patient, administration of medications as prescribed by doctors, cleaning of wounds, setting
intravenous channels. I am also responsible to develop a therapeutic relation with the patient
and their family or caregivers and help in the early recovery of the patient. Additionally, I
have the responsibility of preparing care plan for the patients, and providing them instructions
for their recovery and long term care.
What I want to change:
Identifying the puzzle: The initiative that I want to implement is to support the nurses to
manage their stress caused due to extended shift timing. The idea is to help them overcome
this stress in order to prevent a loss of productivity or incidences of clinical errors due to
fatigue and provide support to the nurses to prevent the necessity for extending their shift
timings and overcome stress and fatigue at work. The puzzle question is “how can we help
the nurses to overcome or prevent fatigue and stress at work due to their long working
hours?” This provides a Generative opportunity to identify strategies through which stress
and fatigue can be avoided or prevented and improve the productivity and clinical
competency of the nurses. This helps to identify more than one possible solution and select

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the most appropriate solution or combination of solutions to address the problem (Phillips
and Miltner 2015).
Purpose Behind the proposal:
The purpose of the proposal is to identify strategies that can be used to help the nurses to
overcome the effects of long shift hours and maintain their productivity and performance.
The significance of these strategies is implied through the impact of long shift hours on the
health, wellbeing, productivity and efficiency of the nurses in healthcare. In healthcare
organizations, nurses often have to work on extended shift timings in order to compensate for
a lack of skilled and experienced workforce or due to increases in patient admissions. Also a
lack of effective clinical governance can lead to nurses working for long shift hours as the
nurses get unequal share of workload which they have to manage themselves and inadequate
support to help them properly take care of their responsibilities. According to Han et al.
(2015) these long shift timings, the nurses often experience fatigue, which adversely affects
their performance as well their health, and lead to dissatisfaction in patients due to poor care
delivery (Liu et al., 2016).
What would be better for the nurses? Our services can help the nurses to manage their
stress and fatigue between work to overcome the effects of extended working hours, provide
support to the nurses to manage their time in a more effective manner, helping them identify
the early warning signs of burnout, support healthy lifestyle and adequate sleep and also
propose the need for additional staffing to address the need for extra workforce (van der Riet
et al. 2015; Delaney et al. 2016).
Justification or Rationale:

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Evidence that suggests that change is needed: Studies show that working in long shift
timing can cause fatigue among the nurses which can increase the risks of clinical errors.
Such as aspect has been supported by other studies that show most of the clinical errors are
caused mostly due to fatigue (Caruso 2014; Hayes et al. 2015). The long shift and its
associated stress and fatigue also results in burnout syndrome, which can affect the job
satisfaction of the nurses. Burnout and the resultant clinical errors can also cause
dissatisfaction among the patients. Fatigue can also adversely affect the health of the nurses
as it can lead to loss of sleep, sleepiness during work, decision regret as well as negative
cognitive emotions. These studies suggest that the long shift hours can have overall negative
impact on both the healthcare professionals as well as the service users (Interests 2015; Bae
and Fabry 2014).
What is happening now? Currently due to a shortage of skilled and experienced nurses, the
experienced nurses often have to take up multiple responsibilities such as mentoring new
nurses, supervising and collaborating the duties of other nurses and from time to time cover
for other nurses who did not show up for work. Also, there is an uneven distribution of work
across the various departments, due to which some nurse ends up having more work to tend
to compared with other nurses. Due to this many nurse have to work more than 10 or 12
hours in a single day, with every experienced and skilled nurse doing more than 20 hours of
extra work every week in average (Caruso 2014).
Evidences that support a need for change: Recently the rate of clinical errors has increased
even from experienced and skilled nurses, and complaints of fatigue, burnout and reduction
in productivity have been made by the healthcare professionals. Almost 73% of the nurses
complained that they work more than 10 hours every day since the last 2 years, and the rate
of clinical errors have increased by more than 57% in this time. 89% of these nurses have
stated that fatigue was the main reason for the clinical errors, while 34.5% of the nurses were

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diagnosed of burnout syndrome and compassion fatigue. 43.6% of the nurses also complained
that they do not get adequate sleep or do not get enough time to spend with their family,
friends or relaxing (Caruso 2014; Wickwire et al. 2017; Conway et al. 2017).
Where these evidences can be sourced: These evidences can be sourced to the clinical
management and clinical governance teams to support my proposal.
Evidences that can support the proposal: In order to support my proposal adequately and
persuasively, information related to the increase in clinical errors, amount of additional shift
timing the nurses have to work for, shortage of staffing, diagnosis of fatigue and burnout
syndromes among nurses, reduced job satisfaction of nurses, patient dissatisfaction, poor staff
retention rates and nurses not getting enough rest and sleep (Caruso 2014; Acton et al. 2017).
Strength of the evidence: All the evidences are empirical and quantitative in nature and are
therefore very strong and convincing
Thoughts about the evidence can support the given problem: These evidences can help to
understand the relation between long shift hours and fatigue of the nurses and its effect on the
performance and job satisfaction (Clinton 2017).
Stakeholders:
Key partners I need to work with directly as a part of the engagement process: Nurses,
Nursing supervisors, doctors/physicians, hospital administration, psychologists, lifestyle
consultants and occupational safety advisors.
Individuals who needs to be engaged in consultation process: Lifestyle consultant,
occupational advisors, doctors and physicians and hospital administration and governance.

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Individuals who need to be kept informed and communicated with: Nurses, Nursing
supervisors, doctors/physicians, hospital administration, psychologists, lifestyle consultants
and occupational safety advisors (Clinton 2017).
Any exclusions and reasons for exclusion: None
People who might be supportive to the proposal: Nurses, nursing supervisors,
doctors/physicians, patients, and advisors.
People who might react negatively to the proposal: Hospital administration.
Who will be interested in the puzzle? All the stakeholders
Will the parties approach the engagement with the intention to succeed? The involved parties
are most likely to approach being engaged in the project with the intention to succeed in it
and allow the nurses to overcome stress and fatigue due to long working hours.
Any precondition for engagement: The project won’t be supported if additional resources and
expenses are needed for the solution. The nurses would also expect that the program can help
them to alleviate stress and fatigue at work.
Do I have a solution in mind? The main solutions I have in my mind are: stress management
activities, time management, getting adequate sleep, breaks and relaxation between work,
provisions for vacations, improve lifestyle and eating habits, helping nurses to balance work
and personal life, involving meaningful activities in the spare time and develop positive
thinking (Caruso 2014; Acton et al. 2017; Clinton 2017).
Whether I already tried to engage around this problem or similar issues? I have previously
tried to address the issue related to the understaffing of the nurse which caused increase in the
stress on the healthcare professionals, causing them to work extra hours.

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Other questions that might be related to engagement? Questions related to the engagement
includes, “how time management can help to prevent long shift hours”, “how improving
staffing can prevent long shift hours” and ‘how adequate breaks can help the nurses to relax
between work” (Clinton 2017)
Positive and negative aspects: The positive aspects of this program are that it can prevent
fatigue and burnout in nurses working in long shift hours. The negative aspect of the program
is that it can be challenging for the administration to ensure effective management of the care
delivery while avoiding the nurses having to extend their shift timing (Lacy and Chan 2018).
Context in which the project is implemented:
Readiness for change: There is an adequate readiness for change among the nurses, as they
realise how the long shift timing is affecting their productivity and health.
Time and energy that needs to be contributed or devoted for the process: The nurses need to
take at least one hour from their work schedule to participate in the program. The
administrators also have to give an equivalent amount of time every day.
Do the involved people have the emotional and cultural competency to cope up with the
problem? No, the nurses are unable to cope up with problem on their own; they need
additional support from administration and consultants. However they are emotionally and
culturally competent to participate in the program.
Will the evidence/proposal be considered applicable to the context? The evidences are all
applicable to the context and the proposals are also applicable to address the problems.
 Feasibility: The identified strategies are feasible to be implemented in the
given environment.

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 Acceptability: The nurses are acceptable to the proposal if adequate support is
given from the administration.
 Meaningfulness: The proposed resolutions are all meaningful to the given
context and can help the nurses to overcome stress and fatigue.
 Effectiveness: The solutions can be very effective to address the problem.
Other questions related to current context: Can the relaxation strategies help to reduce
fatigue and improve clinical performance? Can reducing fatigue prevent clinical errors? Can
the long working hours be avoided by hiring new nursing staff?
(Hayes et al. 2015)
Mobilising cooperation and engagement in the project:
How will the change be measured?
How to identify the impact of the change/ Potential Outcomes:
 On Patients: Impact on patients can be seen in the form of improved patient
satisfaction, better therapeutic relations with healthcare providers and prevention of
adverse health effects due to clinical errors.
 On Staff: Impact on the healthcare staff can be identified through better productivity,
lesser clinical errors, improved job satisfaction, reduced diagnosis of burnout
syndrome and an improved well being of the healthcare professionals as well as
improvement in competency.
 On Service: Better accuracy, reliability, quality, compassion, timeliness and
appropriateness of care delivery and healthcare service. Better customer centricity of
care.
(Caruso 2014; Acton et al. 2017; Clinton 2017)

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Data that is needs to be collected to evaluate these outcomes: To evaluate the potential
outcomes identified above the following data are needed: patient satisfaction scores,
incidence of adverse health incidents due to clinical errors, staff productivity, number of
clinical errors, job satisfaction scales of the nurses, number of nurses diagnosed of burnout
syndromes, staff retention rates, the qualifications, skills and competencies of the nurses and
accuracy of care (Rhéaume and Mullen 2018).
Where these data can be collected: The data can be collected from the hospital administration
and management as well as from reports of external audits (Duarte and Pinto-Gouveia 2017).
What data is already being collected: Currently I am already collecting information related to
the rate and number of clinical errors, diagnosis of burnout syndrome, the job satisfaction of
the nurses and the extra shift hours the nurses have to work for.
Any new information that might be identified: There is a possibility to identify a relation
between the knowledge, experience and skills of the nurses with the rate of clinical errors.
Additional question related to the evaluation process: Additional questions that might be
relevant to the context include: Are the errors due to lack of expertise of the nurses? Can
staffing increase really address the problem of fatigue and clinical errors? (Rhéaume and
Mullen 2018)
Facilitation of the project:
Mobilising cooperation instead of resistance: It is important to attract cooperation from the
stakeholders to ensure their participation in the program.
How to facilitate the engagement process: The engagement of the nurses in the program can
be encouraged through the focus on improvement of their health and well being through
stress and fatigue reduction strategies, and also the possible improvement in their

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performance and reduction in clinical errors. The program can be facilitated through the
involvement of the nursing supervisors, administration and independent advisors.
How my team can respond to the proposed change? My team would be very receptive of the
change as it can support an overall improvement in the wellbeing of the nurses as well as
patients (Duarte and Pinto-Gouveia 2017).
Need for advice and whom to seek advice from: Advice can be very crucial for the success of
the program. Advice can be sought from the independent advisors on healthy lifestyle and
occupational health as well as sleep therapists, psychologists and physicians.
Best strategy to communicate the puzzle to others to mobilise support: The best strategy to
communicate the puzzle with the key stakeholders is to focus on how the problem of long
shift timing and fatigue is affecting the performance of the nurses, increasing clinical errors
and also adversely affecting the health and wellbeing of both the healthcare professionals as
well as the patients. The focus can be made on the benefaction of the healthcare professionals
through the program (Rhéaume and Mullen 2018).
Any other thoughts or questions related to the facilitation process: What can be the biggest
challenges to facilitate the program, and would the program hamper the productivity of the
nurses?
Scoping the project:
Timeline: The program will be conducted for one month, where the nurses will undergo one
hour sessions every alternative day (3 days a week)
Consultation: For the development of the program consultation from occupational health
advisors, sleep pathologist or therapist, psychologists, physicians and lifestyle consultants can