Call-shift fatigue and use of countermeasures and avoidance strategies by certified registered nurse anesthetists: a national survey

This study surveyed Certified Registered Nurse Anesthetist (CRNA) members of the American Association of Nurse Anesthetists (AANA) on their frequency of call-shift fatigue, fatigue symptoms, medical errors associated with fatigue, and use of fatigue countermeasures and avoidance strategies. A secondary aim was to identify predictors of call-shift fatigue. An invitation to complete an anonymous electronic survey was sent to 2,500 randomly selected AANA members. Data were collected on CRNAs' fatigue experience, call-shift length and frequency, errors in patient care, and use of fatigue countermeasures and avoidance strategies. Analysis included descriptive and inferential statistics. Logistic regression was used to identify predictors of call-shift fatigue. Of 325 CRNAs who provided data, 82% reported experiencing call-shift fatigue, 87% used fatigue countermeasures, 77% used fatigue-avoidance strategies, and 28% reported committing a medical error because of fatigue. Predictors included hours to recovery from a call shift (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 1.04-1.12), working 5 to 6 calls per month (OR = 3.78, CI = 1.17-12.23), working 7 or more calls per month (OR = 4.87, CI = 1.93-12.33), use of fatigue countermeasures (OR = 5.44, CI = 2.15-13.77), and fatigue symptoms (OR = 2.19, CI = 1.03-4.67). Call-shift fatigue is a common problem among CRNAs and is associated with medical errors and negative health consequences.