Registered Nurses' Association of Ontario


  • Nurse fatigue has been documented in the literature as contributing to negative patient outcomes and poor job performance, both of which may compromise patient care and the health of nurses
  • The Institute of Medicine (IOM) calls for strategies to address the overall work environment as a comprehensive solution to mitigate and manage fatigue.
  • There is ample evidence to support the necessity to change current practices and promote a culture of safety, which recognizes nurse fatigue as an unacceptable risk to patient safety and nurse well-being, acknowledges the impact of fatigue and allows nurses to cite fatigue as a factor relevant to the inability to work.
  • The RNAO/CNA research paper on nurse fatigue and patient safety1 defines nurse fatigue as: “A subjective feeling of tiredness (experienced by nurses) that is physically and mentally penetrative. It ranges from tiredness to exhaustion, creating an unrelenting overall condition that interferes with individuals’ physical and cognitive ability to function to their normal capacity.”
  • The increasing acuity of patients and increased complexity of care, workload, shift work and overtime are all factors that may predispose nurses to fatigue and influence their ability to provide safe, competent and compassionate care.
  • Long shift durations significantly increase the risk for error and decrease levels of alertness and vigilance.
  • Faced with a growing demand for nursing care, an aging population and a shrinking supply of nurses, the number of hours worked by nurses is increasing.
  • Nurse fatigue is often associated with frequent shift rotation, and is further exacerbated by a culture that expects nurses and other health-care staff to work long hours and forego sleep.
  • Nurse fatigue is linked to patient safety risks, performance, errors, personal health, and recruitment and retention of nurses.
  • This guideline, which focuses on mitigating and preventing nurse fatigue, builds on the CNA/ RNAO report and provides clear recommendations (based on the best evidence) for action by governments, health-care systems, organizational administrations and nurses themselves to prevent and mitigate the causes of fatigue.
Healthy Work Environment
Preventing and Mitigating Nurse Fatigue in Health Care
Background Information