The American Nurses Association (ANA) has developed its approach concerning working hours of medical attendants as a joint responsibility of nurses and employers in minimizing the risks incurred by sleepiness and fatigue. It is an ethical duty of registered nurses and their employers to ensure that there is the need for sufficient sleep during the fulfillment of voluntary and mandatory assignments (American Nursing Association, 2014). It is evident that nursing services are required twenty-four-by-seven in health care centers. The American Nurses Association has identified threats associated with drowsiness and tiredness, which include reduced job performance, health and safety risks, weakened motivation and physiological changes (Rogers, 2008). Therefore, ANA has adopted a firm position in securing that the safety of nurses and patients is not jeopardized but rather safeguarded by interventions from medical attendants and their employers.

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ANA Position Regarding Working Hours of Nurses

ANA places focus on working hours and suggest the appropriate arrangement of working time to nurses and employers. The dissatisfaction of patients rises gradually because of the longer shifts that negatively affect the performance of healthcare providers (Stimpfel, Sloane, & Aiken, 2012). Recent studies show that 20% of nurses who work night shifts permanently struggle to stay awake at work (Stimpfel et al., 2012).The working shifts are recommended to last 12 hours or less during the day and not more than 40 hours for a week (Brown, 2015). The working hours approved by ANA include both paid and unpaid activities, which embrace meetings, conferences, and mandatory training.

Employers’ call for obligatory overtime work is unwarranted, and nurses have the right to refuse from additional load when they feel fatigued. Besides, such a denial is protected and an employee is not subjected to penalties or any form of retaliation (American Nursing Association, 2014). In the given recommendation by ANA, employers are strictly advised to adopt an official policy that nurses have the right to reject some assignments in order to prevent the risks posed by exhaustion. However, in nursing practices, patient abandonment is not an option.

The American Association of Colleges of Nursing (AACN), which aims at ensuring a sustainable, healthy working environment, stresses that cooperation creates uniqueness among medical staff because everyone’s views and abilities are respected. Hence, this promotes the achievement of safe and quality care for patients during the delivery of healthcare services. Professional communication supported by optimism, trust, knowledge, respect, and shared responsibility are the pillars to result in oriented collaboration (Tschannen & Lee, 2012). ANA advises employers to involve nurses in designing, developing and implementing work schedules for the accommodation of challenging personal tasks, capabilities and work resources.

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The predictability and regularity schedules are encouraged so that the nurses could plan their duties and personal obligations. Frequent reviews of the pros and cons of varying shift lengths by the employer are necessary in order to address the arising issues. ANA suggests that promotion of frequent and uninterrupted breaks in between shifts is effective in reducing fatigue. Sometimes when work is physically demanding, it is important to examine the length of shifts to secure that the risk of exhaustion by healthcare providers is minimized.

Sometimes nurses may want to get additional load even though they may be too tired. Thus, this can be avoided by the implementation of organizational policies that cover the arrangement of work schedules, which limit extra hours. The strategies should include the potential actions of the employer in case a nurse is too fatigued to fulfill his/her duties, or just tired. In the event of emergencies caused by natural occurrences, specific policies should be adopted to protect both the nurse and the patient.

In faced with accidents and errors, ANA recommends an anonymous reporting system for nurses to create an avenue for reporting on such events so that the following investigations could determine whether fatigue was a contributing factor. Therefore, the system of corrective action should be successfully applied. Inadequate sleep affects a nurse’s ability to deliver services optimally, and this may result in drowsiness. ANA gives their reasons and strongly encourages medical attendants to express their concerns about sleep. However, the code of ethics for nurses is not subject to any discussions; hence, every medical professional must uphold and ensure full adherence to ethical issues for the sake of personal and patient safety.

Unethical Practices of My Employer

My employer has invalidated the position of ANA with regard to working hours and has not implemented the necessary organizational policies to ensure that working hours are appropriately scheduled. Safety concerns are questionable, and the executives seem to neglect the problem of working hours and fatigue-related risks. ANA (2014) states that working hours should not exceed 12 hours per day, and this claim is supported by the Institute of Medicine. However, ANA recommends 8-hour shifts, and changes should be adopted by the creation of schedules that consider personal responsibilities and work duties.

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My employer assigns tasks event after more than 8 hours of work and allocates a takeaway job, which results in fatigue and anxiety of his subordinates. Even though suggestions regarding some changes were forwarded to the managing board the attempts to introduce required reformswere not successful. Nevertheless, this is worrying because a similar incident led to the death of a nurse, as Dominique Debucquoy-Dodley reported to CNN (Debucquoy-Dodley, 2013). Moreover, understaffing is an issue that is yet to be addressed.

Responsibilities of Nurses: Dealing with Bad Practices of an Employer

The Nursing Code of Ethics has four provisions that deal with the obligation of nurses to maintain patient and personal safety (International Centre for Human Resources in Nursing, 2007) . Nurses advocate for health and safety that makes them accountable during their practice; however, an additional ethical responsibility incorporates the prevention of fatigue and sleepiness in working environments with the aim to avoid harming the medical professionals themselves and the patients (Rogers, 2008). Therefore, medical attendants have the mandate to exhibit healthy behaviors that will protect both healthcare providers and healthcare consumers. The former have the right to take some breaks and reject obligatory overtime hours.

Nurses are primarily committed to the sick. They promote health and safety for the patients because it is the indispensible right of the latter. Responsibility in service delivery as well as various strategies to improve the well-being of the patients may only be achieved through proper collaboration between employers and their subordinates.

According to ANA (2014), nurses are accountable for creating avenues for negotiations with the purpose to avoid risks related to fatigue and sleepiness. Medical attendants are allowed to refuse from anything that compromises the time available for sleep and recovery from daily work duties. Since the rights of caregivers are protected when they deny mandatory additional load and any other assignments that may compromise their ability to have enough sleep, healthcare providers also have the responsibility of ensuring that they get sufficient number of hours for sleeping. Moreover, they have to make certian that they rest before shifts, have an opportunity to improve their health and report on accidents in the workplace related to drowsiness and weariness.

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In conclusion, there is no doubt that sleepiness and fatigue are directly proportional to patient dissatisfaction. Nursing practice requires great support from the employer in order to guarantee that the accidents resulting from the lack of sleep are avoided. ANA advocates for the fact that nursing is a very delicate profession that demands from both employers and nurses to cooperate so that the patients’ health and safety are not put at risk. Working shifts should not last more than twelve hours so that medical attendants could fulfill personal duties and get enough sleep because it rejuvenates the body and enhances health. Furthermore, it is important to address the concerns of collaboration, which promote professional communication to tackle the issues of fatigue and sleepiness. Nursing professionals are supposed to interact with each other, share ideas and plan together to provide quality health care. The role of the employer is to secure the conducive working environment so that everyone could feel comfortable with personal and patient safety. However, patients are the most significant individuals in health care; therefore, a patient should not be abandoned as part of the rejection of mandatory overtime work.

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