The perception of nurses as superheroes is a barrier to addressing fatigue among nursing staff in hospital settings, according to US researchers.
They highlighted that fatigue reduced job satisfaction, but increased turnover and negative patient outcomes, and that addressing it was a recognised priority for promoting safety and staff wellbeing.
“The supernurse costume is solely an illusion of strength and invulnerability”
The study authors, from the school of nursing at the University of Wisconsin, set out to explore “barriers and facilitators” to nurses coping and fatigue within hospitals.
They interviewed 22 nurses working in intensive care and medical-surgical units within a large academic medical centre.
The interviews, which lasted between 30 and 60 minutes, included questions about personal experience of fatigue, its causes, barriers to avoiding it and coping mechanisms, as well as its potential consequences.
All nurses in the study experienced fatigue, said the authors, yet they had varying perspectives on the importance of addressing it as a problem.
“Nurses also expressed guilt if they did not come to the aid of their unit or their colleagues”
Nurses also frequently identified fatigue as dependent on other health system challenges, such as staffing and scheduling, which made it difficult to address, noted the researchers.
Due to this interrelatedness, participants questioned the ability to address fatigue without also addressing some of the other issues that they considered “part of nursing”, said the researchers.
However, the study authors – Linsey Steege and Jessica Rainbow – noticed in particular a range of cultural factors within nursing itself that exacerbated fatigue, which they collected under the term “supernurse”.
They viewed these aspects of nursing professional culture as potentially acting as barriers to fatigue risk management programs and achieving safety culture in hospitals.
The aspects contributing to the “supernurse” theme included feelings of responsibility for patients, guilt at not helping out colleagues and tiredness being viewed as a sign of weakness – all of which led to nurses failing to take breaks or rest adequately.
Source: Dana Heinemann
For example, the study authors said nurses in the study described feeling a “complete responsibility to care for their assigned patients”.
“Participants described a sense of duty to take care of patients, even at their own potential expense,” they said in the International Journal of Nursing Studies.
In addition, the researchers found nurses viewed themselves as having “unique knowledge” about their patients that differentiated them from other staff who may be able to step in and help.
“Further, she describes a sense of guilt if she does not use this knowledge to help the patient even when she herself may need a break,” stated the study authors.
“Nurses also expressed guilt if they did not come to the aid of their unit or their colleagues when called upon,” they said. “Multiple participants described their personal obligation to sacrifice themselves and work overtime or an extra shift, likely increasing their own fatigue level, if the unit was short-staffed.
Study participants also described the importance of appearing to be “invulnerable” to fatigue because it was viewed as a “sign of weakness”, while also acknowledging that it had consequences.
For example, nurses accepted that fatigue contributed to back pain or urinary tract infections, meant they were not fully able to perform their role and might take unsafe personal risks, such as being sleepy while driving home.
‘Supernurse culture’ is barrier to addressing fatigue
“The supernurse costume is solely an illusion of strength and invulnerability; it does not actually offer any protection against fatigue risks,” noted the researchers.
The researchers concluded that some values and behaviours “inherent in nursing professional culture, may act as important barriers to effectively managing fatigue and achieving a safety culture in nursing work systems”.
Specifically, they highlighted their concept of the “supernurse” as providing insight into how nursing professional culture itself may contribute to fatigue and inhibit efforts to tackle it.
They added: “Future work is needed to identify and evaluate innovative culture change models and strategies to target these barriers.”