HealthDay News — Sleep disturbances and related fatigue are associated with clinical-decision regret among critical care nurses, survey findings show.

Nurses who reported decision regret also reported significantly more acute fatigue, daytime sleepiness, poor sleep quality and less intershift recovery compared with peers who reported no decision regret, Linda D. Scott, RN, PhD, from the University of Illinois at Chicago College of Nursing, and colleagues reported in the American Journal of Critical Care.

“Registered nurses play a pivotal role as members of the health care team, but fatigued and sleep-deprived critical care nurses put their patients and themselves at serious risk,” the researchers wrote. “Both critical care nurses and their employers must not only acknowledge the impact of fatigue, sleep deprivation, and excessive daytime sleepiness on clinical performance and patients’ outcomes but also engage in strategies to mitigate these impairments.”

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Scott and colleagues surveyed 605 critical care registered nurses to examine the correlation between selected sleep variables, fatigue-related impairment, clinical-decision self-efficacy and regret. Within a five-day period, almost three-quarters of the study participants were sleep-deprived, losing at least a day (eight hours) or more of sleep.

Overall, 546 participants (90%) answered the question on decision regret, which was defined as a negative emotion that occurs when actual outcomes differ from the desired or expected outcome.

Among respondents, 157 (29%) reported experiencing decision regret. Compared to those without decision regret, those with decision regret also reported more fatigue, more daytime sleepiness, less intershift recovery and worse sleep quality. Clinical-decision regret was also significantly associated with male gender and working a 12-hour shift or longer (C statistic, 0.719).

“Evaluation of the effects of naps during longer shifts is needed to determine how taking a nap affects sleep parameters, decision regret, and patients’ outcomes,” the researchers wrote.

Other potential interventions that warrant further investigation include implementing scheduling models that maximize management of fatigue, ensuring that support resources for clinical decisions are available, and encouraging the use of relief staff to provide completely relieved work breaks and strategic naps.


  1. Scott LD et al. Am J Crit Care. 2014;23(1):13-23.