There are a few full-time RNs who volunteer to work overtime hours when the scheduler and I have exhausted every other option. I worry about them becoming so fatigued that this might become unsafe for the clients and the RNs. What is their responsibility in this situation? What is mine as the manager?
RN and RN Manager Responsibility
- RNs maintain their fitness to practice. If they are aware that they do not have the necessary physical, mental or emotional capacity to practice safely and competently, they withdraw from the provision of care after consulting with their employer or, if they are self-employed, arranging that someone else attend to their clients’ health care needs. RNs then take the necessary steps to regain their fitness to practice (1).
- RNs are attentive to signs that a colleague is unable, for whatever reason, to perform their duties. In such case, RNs will take the necessary steps to protect the safety of persons receiving care (1).
- RNs are accountable and accept responsibility for their own actions and decisions (2).
- RNs practice in accordance with current CNA Code of Ethics for Registered Nurses (2017) and the accompanying responsibility statements (3).
- Managers who suspect that inadequate staffing levels are perpetuating this situation are obligated to examine and address staffing levels.
Non-RN Manager Responsibility
- Depending on your professional designation and background, you may have responsibilities or obligations outlined by a regulatory body. All managers have an obligation to promote safety and to address safety concerns.
- Managers who suspect that inadequate staffing levels are perpetuating this situation are obligated to examine and address staffing levels.
If I suspect that staffing levels are inadequate and contributing to the issue, what evidence might help me address the issue?
Incident reports, complaints from families and colleagues, overtime statistics, position vacancy rates, use of sick time, recruitment and retention rates, and general staffing levels may be valuable data to assist in determining staffing levels as well as to facilitate conversations with individual staff’s acceptance of overtime. This data can be measured against similar care settings and may show patterns that can assist in decision-making. It can also be utilized to discuss quality of care issues and factors that may be contributing. As well, it can be used when advocating for changes in staffing models.
Is there a specific number of hours of work that are unsafe for RNs?
No, each RN can work a different number of hours before they become fatigued. There are many variables to consider, both internal and external to the work environment but RNs are responsible for monitoring their own level of competence and fitness to practice. They must collaborate with the manager, charge nurse or supervisor if they, their colleagues or supervisors believe that they are unable to provide safe care. They then must plan and take action to avoid future cases of fatigue and fitness to practice issues.
CRNS Resources
Registered Nurse Practice Standards (2024)
CNA Code of Ethics for Registered Nurses (2017)
External Resources
RNAO Best Practice Guidelines - Preventing and Mitigating Nurse Fatigue
| Resource Key | ||
| Number | Resource | Reference |
| 1 | CNA Code of Ethics for Registered Nurses (2017) | G5 and G6, page 17 |
| 2 | Registered Nurse Practice Standards (2024) | Indicator 1, page 4 |
| 3 | Registered Nurse Practice Standards (2024) | Indicator 26, page 5 |