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Balancing work fatigue and client safety

Case study about ethical decision making

​​Mia logs off the computer and sighs . It has been a long, busy day and she is tired. They'd worked one nurse short again and everyone felt the pressure.


Mia glances at the clock and then at the list of things to do before the end of shift. As she turns to get started, the nurse in charge stops her. “We’ve had a sick call for nights again” she reports , her frustration evident. “I haven't found anyone to come in yet, so I’m looking for a volunteer to stay until I can find someone. We need everyone tonight―we’re swamped.”

Mia takes a deep breath and replies , "I’m not sure I can do that. I’m pretty exhausted. Give me a few minutes to think about it.”

“Could you let me know as soon as possible?" the nurse in charge wearily asked. “Everyone's tired but we need someone to stay until we find a replacement,” she says, walking away.

Walking down the hall, Mia considers the situation. The unit is having difficulty finding staff. There are rumblings from others about being short-staffed and working overtime. Everyone is stressed. She’d expected to be asked to work overtime today, but that didn’t make the decision any easier.

Mia’s dilemma

Mia goes into the nurses' lounge for a minute and tries to sort out what is important. C lients' safety and well-being are her primary concern. As a professional, she is accountable for her decisions and actions, including determining whether she can continue to practise safely.

Would working extra hours put her clients at risk? Could it put her at risk? Could she stay and safely provide some care? Could she stay for a few hours? Mia recognizes there is no ideal solution to the dilemma. What is her best option?

She thinks about what she must consider:

  • the clients, care needed and its complexity
  • where was she in her set of shifts
  • how many hours she had been awake already and her level of alertness now
  • whether she'd had appropriate breaks and nutrition over her shift
  • her commute home

If you were Mia, what would you do?

Stay and work extra hours

Mia takes stock. She’d slept well last night and is off tomorrow. She’d managed to take    out of the lounge and finds the nurse in charge, “I’m off tomorrow and feel reasonable right now. I can stay for three hours,” she says. “I think it’s safest if I help out as part of a team rather than taking on an assignment.”

Together the nurse in charge and Mia work out a plan of the first part of the next shift. As she leaves the unit for home a few hours later, Mia thinks about her decision. She’s glad she’d been clear about her limits and how long she could stay. “Tonight,” she says to herself, “staying for a few hours was the best choice.”

Leave at the end of the shift

Mia takes stock. It is her first of four shifts and she’d not slept well the night before. She hadn’t had dinner and was feeling exhausted. She was already having problems concentrating and still had to drive home. Mia heads out of the lounge and finds the nurse in charge. “I can’t stay,” she tells the nurse in charge. “I don’t think I can safely manage working extra tonight. I have a couple of suggestions that might help for nights though.”

As she leaves the unit to go home, Mia thinks about her decision. She knows her limit and she had reached it. “Tonight,” she says to herself, “leaving was the best choice.”

What do the Standards say?

Mia must balance her duty to provide care with a duty to ensure her own fitness to practice. If her fitness to practice is compromised by fatigue or other factors, she has the right and a duty to decline to work extra hours. Her duty to provide safe client care outweighs her desire to help out her coworkers.

In this situation, either option would be appropriate.

Mia’s next steps

On her next shift, Mia discusses the situation with her manager and shares some ideas for dealing with similar situations. Reflecting back, Mia thinks she had been professionally accountable, used an ethical decision-making process and considered the circumstances to decide the best option.​

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