Stronger Collaboration between RNs, Employers Encouraged to Reduce Risks from Nurse Fatigue

Stronger Collaboration between RNs, Employers Encouraged to Reduce Risks from Nurse Fatigue

The American Nurses Association (ANA) calls for stronger collaboration between registered nurses (RNs) and their employers to reduce the risks of nurse fatigue for patients and nurses associated with shift work and long hours, and emphasizes strengthening a culture of safety in the work environment in a new position statement. 

ANA contends that evidence-based strategies must be implemented to proactively address nurse fatigue and sleepiness. Such strategies are needed to promote the health, safety, and wellness of RNs and ensure optimal patient outcomes.

“Research shows that prolonged work hours can hinder a nurse’s performance and have negative impacts on patients’ safety and outcomes,” says ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN. “We’re concerned not only with greater likelihood for errors, diminished problem solving, slower reaction time, and other performance deficits related to fatigue, but also with dangers posed to nurses’ own health.”

Research links shift work and long working hours to sleep disturbances, injuries, musculoskeletal disorders, gastrointestinal problems, mood disorders, obesity, diabetes mellitus, metabolic syndrome, cardiovascular disease, cancer, and adverse reproductive outcomes.

ANA offers numerous evidence-based recommendations for RNs and employers to enhance performance, safety, and patient outcomes, such as the following suggestions:

•Involve nurses in the design of work schedules and use a regular and predictable schedule so nurses can plan for work and personal responsibilities.

•Limit work weeks to 40 hours within seven days and work shifts to 12 hours.

•Eliminate the use of mandatory overtime as a “staffing solution.”

•Promote frequent, uninterrupted rest breaks during work shifts.

•Enact official policy that confers RNs the right to accept or reject a work assignment based on preventing risks from fatigue. The policy should include conditions that a rejected assignment does not constitute patient abandonment, and that RNs should not suffer adverse consequences in retaliation for such a decision.

•Encourage nurses to manage their health and rest, including sleeping seven to nine hours per day; developing effective stress management, nutrition, and exercise habits; and using naps in accordance with policy.

The position statement was developed by a Professional Issues Panel, established by the ANA Board of Directors. The panel was comprised of 15 ANA member nurses with expertise on the issue, with additional input from an advisory committee of about 350 members who expressed interest in participating. The statement was distributed broadly for public comment to nursing organizations, federal agencies, employers, individual RNs, safety and risk assessment experts, and others, whose suggestions were evaluated by the panel for incorporation in the statement. The new position statement replaces two 2006 position statements—one for employers and one for nurses. The statement clearly articulates that health care employers and nurses are jointly responsible for addressing the risks of nurse fatigue.

Source: American Nurses Association


Social Media Profile May Win or Lose You Jobs

Social Media Profile May Win or Lose You Jobs

 Looking for a job? Before applying for a new position, examine your social media profile. 

Make sure that what you find will help and not hinder your opportunity with a prospective employer. If your public face is unflattering, clean it up. Failure to do so may cost you a coveted position. Employers are increasingly searching social media sites to look for potential hires with a professional image and good qualifications. Anything less and you may be rejected on the spot.

In a survey by CareerBuilder of some 2,100 hiring managers and human resource professionals, 43% rejected job applicants as a result of what they found on social media sites. Some of the reasons they said that knocked candidates out of the running for jobs include sharing racy or inappropriate photos (50%), poor communication skills (30%), bad-mouthing a previous employer (33%), and, discriminatory remarks relating to race, gender or religion (28%).

On the flip side social media gave some prospective employees an edge. One out of five respondents found social media information that led them to hire a candidate. At least half of the respondents said the profiles conveyed a professional image, revealed a well-rounded candidate and supported the candidate’s qualifications. 

The 2013 survey found more employers are using social media to weed out candidates compared to last year.

Make sure your online persona reveals positive clues about your character, image and personality. Keep your social media presence positive by taking these steps:

•Search yourself. Google your name and check out other sites. Clean up any digital dirt. 

•Update your LinkedIn profile and make sure it is accurate.

•Check your privacy settings regularly as they may change. Never post anything that would be unsuitable on the front page of a newspaper. 

•Consider creating a profile that is strictly for business.

•Use good grammar. When commenting online, avoid typos and keep the content clean. 

•Avoid ranting about an employer and co-workers.

•Post content that shows you are sociable and well-rounded.

Source: CareerBuilder

Healing from the Bitter Pill of Incivility

Not long ago, I was facilitating a workshop on fostering civility in nursing education when a faculty member approached me during the break. The soft-spoken professor related her thoughts in a quiet voice, her eyes reflecting a certain sadness as she spoke. She said, “Please think about us—the clinical faculty, I mean—when you are speaking about incivility in nursing education. I am a member of the clinical faculty, and I can tell you, unequivocally, that we are a marginalized group. We are not considered part of the ‘real faculty’ and are often referred to as ‘minions and underlings.’ We are frequently told that we have no clout nor can we provide input into the theoretical courses or exams.” I asked the faculty member how she responded to these incivilities. She said, “I just take it—it’s like swallowing a very bitter pill.”

What I call the in-group and the out-group of nursing faculty teams—and I use the word “team” lightly—is further illustrated by a story described in a study I recently conducted to examine faculty-to-faculty incivility and ways to effectively address the problem. Approximately 13% of the respondents reported experiencing racial, ethnic, sexual, gender, or religious slurs within the past 12 months. One respondent wrote, “During a faculty workshop, faculty members were asked to work in small groups. One group contained four minority faculty members. A non-minority faculty member asked, ‘Do I have to paint my face black to be in this group?’”

Another faculty member related the incivility of perceived ageism that exists in her nursing program. She explained that when she met with her dean to seek advice about returning to graduate school to complete her doctoral degree, the dean laughed and said, “Are you kidding, at your age? You can’t be serious. By the time you finish your degree, you’ll be ready to retire. We prefer to invest in younger faculty.” Other forms of discrimination are also apparent: a student recently commented on faculty bias in the classroom, saying, “Students are often subjected to religious, racial, and anti-gay/lesbian content. We [students] feel vulnerable and do not know how faculty and administrators will react if they complain. It’s appalling and inexcusable.”

Regardless of their origin, uncivil encounters are an affront to human dignity and an assault on a person’s intrinsic sense of self-worth. The effects can be devastating and longlasting. Incivility may come from myriad sources; it is complex, disordered, and multidimensional. Taking time to engage, communicate, and listen with intention has a profound effect on preventing and healing the effects of incivility.

I often refer to incivility as a dance, an expression of feeling and social interaction that gets articulated through a variety of movements, gestures, and actions.1 Each observer and participant interprets the dance within the context of his or her personal experiences, through the lens of his or her own world-view. Because of this individual perception and interpretation, it becomes essential to actively listen, consider the intent of the action, and engage in meaningful and solutionbased conversation.

More than two decades ago, Ernest Boyer asserted that institutions of higher education play a vital role in helping students develop a sense of civic and social responsibility, and become productive citizens of the academy and the community.2 The promotion of civility and good citizenry is especially important in nursing and other health-related disciplines where the risk assumed by not addressing uncivil behavior reaches well beyond the college campus and can negatively impact patient safety, recruitment and retention, and commitment to the nursing profession. Because nursing programs are places where students and faculty provide direct care to patients through clinical experiences, uncivil and disruptive acts must be addressed so that such behaviors do not spiral into aggression and jeopardize the learning and practice environment.

While promoting civility is one of the primary functions of higher education, in some respects the system is failing. This failure may be related to a lack of understanding about the topic in general, and ways to prevent and address incivility in particular. I define incivility as rude or disruptive behaviors that often result in psychological or physiological distress for people involved, and if left unaddressed, may progress into threatening situations.3 Exposure to uncivil behaviors can result in physical symptoms such as headaches, interrupted sleep, and intestinal problems and can cause psychological conditions like stress, anxiety, irritability, and depressive symptoms. Thus, it is important to foster civility—an authentic respect for others requiring time, presence, a willingness to engage in genuine discourse, and an intention to seek common ground.4

Similarly, it is important to raise awareness about the importance of fostering a civil and healthy academic work environment. According to researchers, a healthy academic environment consists of a number of factors, including a clear mission with shared values and norms; high morale, job satisfaction, and an esprit de corps; competitive salaries and benefits; reasonable workloads; positive employee recruitment and retention; policies to eliminate incivility; respectful communication, teamwork, and shared decision making; organizational support and collegial relationships; and competent, honest leaders who collaborate with faculty to share decision making.5,6,7

Awareness may be raised by describing specific rationale for establishing and sustaining healthy academic work environments. First, the costs of incivility are vast. Uncivil behavior adds to employees’ stress level, erodes self-esteem, damages relationships, and threatens workplace safety and quality of life.8 Incivility also lowers morale, causes illness, and leaves workers feeling stressed, vulnerable, and devalued. The human and financial costs of these behaviors may be disastrous.9 Second, the recent Institute of Medicine Report10 includes several recommendations that call for nurses and other health care workers, such as physicians, to collaborate to advance the nation’s health. To fulfill these recommendations, we must establish civil and respectful relationships and interactions. Third, the American Nurses Association Code of Ethics for Nurses with Interpretive Statements Provision 1.5 promotes a civil, healthy work environment by requiring nurses to treat colleagues, students, and patients with dignity and respect, and states that any form of harassment, disrespect, or threatening action will not be tolerated.11 Similarly, the American Nurses Association Standards of Practice reinforce the need for objective standards such as collaboration, ethical conduct, and communication for nurses to be accountable for their actions, their patients, and their peers.12 These rationales and fostering a healthy academic work environment are difficult, if not impossible to achieve in the absence of skilled, ethical leadership. Successful change requires both formal and informal leadership—leaders who hold formal positions as well as individuals without a formal title or authority, but who have significant influence with members throughout the organization.

Once awareness is raised and leaders agree that changes are needed to foster a civil workplace, it is highly desirable to use empirical measures to determine levels, types, and frequency of civil and uncivil factors, and to reveal strategies for fostering a healthy workplace. Some examples of empirical measures include the Organizational Civility Scale (OCS)13 and the Culture/Climate Assessment Scale (CCAS).14 Other data sources are also helpful, such as formal and informal reports, evaluations, satisfaction surveys, performance evaluation information, regulatory reports, and information from focus groups and open forums. Once a comprehensive organizational assessment has been conducted, strategies can be implemented to improve areas of concern and to reinforce efforts already in place to enhance areas of strength and excellence.

Specific strategies include aligning the organizational mission and values with a focus on civility and respect. Successful organizations intentionally focus their vision for the future so that employees are able to meet organizational objectives as well as achieve personal satisfaction in their work. Organizational values undergird the formulation and implementation of norms of decorum. Without functional norms, desired behavior is ill defined and thus, members of the campus community are left to “make things up as they go along.”

Healthy academic work environments do not occur by accident—creating them requires intentional and purposeful focus. Unfortunately, many faculty, students, and administrators are unaware of how their behaviors affect others, and many are ill equipped to deal with incivility. Thus, strategies to prevent and address incivility must be taught, practiced, reinforced, and supported. We must make civility a priority. Faculty and staff meetings are excellent venues to raise awareness, discuss acceptable and unacceptable behaviors, establish norms of behavior, and practice and role-play civil interactions. When faculty and staff collectively co-create norms for behavior, they are more likely to approve of and conform to these behaviors. Once the norms are agreed upon, they become the standard for faculty and staff interactions. It is also important to establish, implement, and widely disseminate confidential, non-punitive policies and procedures for addressing incivility. This includes enforcing sanctions if indicated, and perhaps more importantly, to reward civility and collegiality. Although positive motivators are preferred, the consequences for violating the agreed-upon norms must be clearly stated and enforced. Ignoring or failing to address the uncivil behavior damages the organization as much, if not more, than the incivility itself.

Acting civilly and respectfully isn’t always easy, especially in a high-stress learning environment where constant change is the norm, and where faculty and students experience complex and demanding workloads. Yet, we must make civility a priority for our students, colleagues, practice partners, and ourselves. Incivility takes a tremendous toll on everyone throughout the campus and practice community. In a fast-paced work environment, patience is often in short supply, yet it remains a virtue we should value and uphold. Each individual must set a positive example to lead the transformation for cultivating civility in nursing education.


  1. C.M. Clark, “The Dance of Incivility in Nursing Education as Described by Nursing Faculty and Students,” Advances in Nursing Science (2008), 31(4), E37–E54.
  2. E. Boyer, Campus Life: In Search of Community. Princeton: The Carnegie Foundation for the Advancement of Teaching, 2009.
  3. C.M. Clark, “Faculty Field Guide for Promoting Student Civility,” Nurse Educator, 34(5),194–197.
  4. C.M. Clark and J. Carnosso, “Civility: A Concept Analysis,” Journal of Theory Construction and Testing, 12(1), 11–15.
  5. C.M. Clark (in progress), “Pathway for Fostering Organizational Civility.”
  6. M. Brady, “Healthy Nursing Academic Work Environments,” OJIN: The Online Journal of Issues in Nursing (2010), 15(1),Manuscript 6.
  7. National League for Nursing. “Healthful work environments for nursing faculty.” Retrieved February 26, 2012,
  8. P.M. Forni, The Civility Solution, New York, NY: St. Martin’s Press, 2008.
  9. C. Pearson and C. Porath, The Cost of Bad Behavior: How Incivility is Damaging Your Business and What to do About it. New York, NY: Penguin Group, Inc, 2009.
  10. Institute of Medicine Report (2010). “The future of nursing: Leading change, advancing health,” Robert Wood Johnson Foundation Publisher.
  11. American Nurses Association. (2001). Code of Ethics for Nurses With Interpretive Statements. Washington, D.C.: American Nurses Association.
  12. American Nurses Association. (2010). Nursing Scope and Standards of Practice. (2nd ed). Silver Spring, MD: American Nurses Association.
  13. C.M. Clark and R.E. Landrum, “Organizational Civility Scale.” Retrieved February 26, 2012,
  14. C.M. Clark, M. Belcheir, P. Strohfus, and P.J. Springer, “Development and Description of the Culture and Climate Assessment Scale, Journal of Nursing Education (2012), 51(2), 75-80.

Working at the Centers for Disease Control and Prevention

Have you ever received an email about how that can of cola sitting on your desk is (supposedly) tainted and potentially life threatening? Or how about the one alleging scores of women across the country are dying from inhaling free perfume samples sent to them in the mail? Do you ever scratch your head at these anonymous messages (after promptly sending them to the “recycle bin”) and wonder—could they be true? The best way to find out is to contact the ever-trusty Centers for Disease Control and Prevention (CDC). It’s their job, after all, to separate the truth from the fiction, and they make such information known on their Web site at

The CDC, an agency of the Department of Health and Human Services, located in Atlanta, Ga. , does far more than just de-bunk urban legends, however. In actuality, they do exactly what all people in allied health do everyday—they work hard to make people in the U.S. safer and healthier.

The CDC is made up of 12 centers, institute and offices: National Center on Birth Defects and Developmental Disabilities; National Center for Chronic Disease Prevention and Health Promotion; National Center for Environmental Health; Office of Genomics and Disease Prevention; National Center for Health Statistics; National Center for HIV, STD and TB Prevention; National Center for Infectious Diseases; National Center for Injury Prevention and Control; National Immunization Program; National Institute for Occupational Safety and Health Epidemiology Program Office; Public Health Practice Program Office; and Office of the Director.

Enhancing the Health and Well Being of U.S. Citizens

Since 1946, the CDC, working closely with other health and community organizations, has been tackling health problems. According to their Web site (, the center develops and applies disease prevention and control programs. They also create environmental health promotion programs as well as education activities.

The mission of CDC is to “promote health and quality of life by preventing and controlling disease, injury and disability.” The center is currently the leading federal agency protecting the health and safety of U.S. citizens by “providing credible information to enhance health decisions and promoting health through strong partnerships.” Most importantly, the CDC plays a critical role in protecting the public from the most widespread, deadly and mysterious threats against our health today and tomorrow. And in our post-9/11 world, with increasing concerns about bioterrorism like anthrax outbreaks and smallpox, the CDC job is even more important.

Sound Like a Job for You?

Today the CDC employs over 8,500 people across the country in fields from medicine to engineering to science and other health professions. Interested in joining their ranks? Most of CDC’s staff is employed through the Federal Civil Service system where salary is determined by position and qualification. Benefits, however, are stellar and include health and life insurance, vacation and sick leave, retirement plan and social security coverage.

In addition, the CDC offers special benefits to all employees including, continuing education; lifestyle activities (exercise, fitness testing, weight management, smoking cessation, cholesterol screening); child care center; medical clinic; employee assistance program; credit union; and an employee organization for recreational and community events.

In order to meet the public health challenges of the future, the CDC needs scientists and health professionals to staff new or expanding program areas: breast and cervical cancer prevention, immunization, environmental concerns, injury prevention, occupational safety and health, infant health, preventive medicine, lead poisoning prevention, health statistics and others.

And as an employee of the CDC, you have more living options then just the headquarters in Atlanta, Ga. There are also offices in the Washington, D.C.; Anchorage, Alaska; Cincinnati; Fort Collins, Colo.; Morgantown, W. Va.; Pittsburgh; Research Triangle Park, N.C.; San Juan, Puerto Rico; and Spokane, Wash., as well as quarantine offices and local health agencies in other U.S. states and other countries.

For those in the field of allied health, the CDC offers the perfect opportunity for learning and professional growth. The Center has a vital continuing education program, both in-house and off-site, for all employees and brings in experts in the allied health fields for lecture series. Visiting scientists from around the world meet with CDC employees to learn and share their expertise as well.


As a health professional, you may be eligible for the Public Health Service (PHS) Commissioned Corps, an all-officer organization. For more information, contact U.S. Public Health Service Recruitment at (800) 279-1606 or email them at [email protected].

For further information about health careers in the CDC, and to find out about current employment opportunities, you can call their 24-hour job line, which has a recorded message that is updated weekly: (888) CDC-HIRE.

For a complete listing of positions with CDC and other Federal agencies. Or call the Job Information Center at the Koger Center/Stanford Building, (770) 488-1725.

Applications for specific vacancies can be sent to: Centers For Disease Control and Prevention, Human Resources Management, Office Mail Stop K-16, 4770 Buford Highway , Atlanta , GA 30341-3724.

Working at the U.S. Navy

If you’re interested in a career in health care, joining the U.S. Navy could be just the stepping-stone you are looking for to launch your health care education and career. There are abundant opportunities for success with the Navy, thanks to its incentive programs, which will help pay for some or all of your medical training. You will also have the chance to study and work in state-of-the-art medical facilities around the world and will enjoy all the benefits afforded to Navy officers.

According to the Navy’s Web site, as a health care professional, you will be commissioned as an officer, which means you will be awarded competitive pay, 30 days paid vacation annually, free or low-cost travel, benefits for you and your family, a generous retirement package, and other benefits.

If you’ve already completed training, the Navy can help you pay back your loans. Similarly, if you’re in school or about to start, the Navy has programs to assist you in paying for your education. And once you’re part of the Navy, you will belong to a “culture devoted to continuing training and professional development and the unparalleled chance to help others and your country.”

According to the Web site, within the Navy’s ranks you will be given the unique opportunity to do what you do best: “You’ll have the chance to practice within your specialty-almost all specialties are represented in the Navy medical corps. You’ll be working with other highly skilled professionals on some of the world’s most modern equipment. You’ll get to focus on providing care and will have the chance to advance your career and even teach other health care professionals if that’s what interests you.”

Medical Service Corps

If you’re interested in the medical field, but not quite sure what exactly it is you want to do, the Navy advises you to check out the Medical Service Corps (MSC). In the MSC, you have your choice of over 22 different specialties, some working directly with patients, some behind the scenes.

Diversity is an appealing aspect of the MSC. There are over 250 Navy and medical facilities around the globe, from carriers in the Mediterranean to Naval hospitals in Japan, so you could wind up serving almost anywhere! And as an Officer in the MSC, you’ll become part of a highly diversified medical team consisting of Clinical Care Providers, Health Care Administrators and Health Care Sciences.

Clinical Care Providers

As a Clinical Care Provider, you might be prescribing contact lenses to the Admiral as an optometrist, or managing the buying, storing and distribution of drugs and medicines as a pharmacist. Some specialties found within the Clinical Care Providers field include:
Physician Assistant



Physical Therapy



Occupational Therapy

Health Care Administration

In Health Care Administration you could find yourself evaluating the medical and humanitarian needs after a natural disaster, or you might be in charge of managing the proper construction of a new medical facility at an air base. Once on active duty, the Navy offers specialized training in these areas:
General Health Care Administration

Plans, Operations, and Medical Intelligence

Financial Management

Medical Logistics

Patient Administration

Information Management

Manpower Systems Analysis

Education and Training Management

Medical Construction Liaison

Operations Research

Health Care Sciences

In Health Care Science, you could become a radiologist and study the thermal stress and magnetic force of a submarine’s nuclear reactor, or you could become an aerospace physiologist, correlating the aerodynamics of a new super jet. Some specialties found within the Health Care Sciences field include:
Industrial Hygiene

Environmental Health

Medical Technology

Aerospace Physiology

Radiation Health




Officer Indoctrination School

To become part of the Medical Service Corps, you will need to attend Officer Indoctrination School or OIS. This is a five-week program that includes a full schedule of academic studies, military indoctrination and physical fitness training.

Educational Benefits

Several career fields within this section have their own separate career training, scholarships and/or assistance programs. To find out which are available to you, contact your local recruiter by logging onto this Web page: