ANA Says Nurse Fatigue Is a Patient Safety Crisis, Not a Nurse’s Personal Failing

The American Nurses Association (ANA) says nurse fatigue is a patient safety crisis, not a personal failing, and its updated guidance puts responsibility squarely on employers, while calling prevention a job nurses and employers share.

On September 1, the ANA released an updated position statement titled Addressing Nurse Fatigue to Promote Health, Safety, and Well-Being for All. According to the ANA, it is the first major revision of its fatigue guidance since 2014.

If you’ve ever finished a 12-hour shift that turned into 14, then got called to pick up another shift, this is for you. The statement openly rejects the idea that tired nurses just need to push harder.

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“Fatigue isn’t a matter of willpower. It’s a systems problem, and it requires systemic solutions,” said Brad Goettl, DNP, DHA, APRN, FAAN, FACHE, Chief Nursing Officer of the American Nurses Enterprise.

The ANA says the update reflects new evidence and post-pandemic workforce realities. The statement itself describes nurse fatigue as both a “nurse and patient safety crisis” and a public health issue, and cites decades of epidemiologic evidence linking fatigue to more medical errors.

The ANA is calling on healthcare employers and leaders to put evidence-based measures in place, including:

• Enough recovery time between shifts
• Limits on excessive and consecutive work hours
• Predictable scheduling
• Nonpunitive environments where nurses can report fatigue

The full statement also sets a target of “expected work hours of no more than 40 hours/week.” It asks employers to ensure appropriate staffing, realistic workloads, and fair pay, and to let nurses report fatigue “without fear and punitive consequences.”

In an interview with Oncology Nursing News, ANA President Jennifer Mensik Kennedy, PhD, MBA, RN, NEA-BC, FAAN, talked about what the shift toward organizational accountability means in practice. The outlet reported that ANA guidelines advise:

• Capping work weeks at 40 hours
• Limiting 12-hour shifts to three consecutive days
• Providing 10 to 12 hours of rest between shifts

Mensik Kennedy also pointed to some familiar problems, according to the outlet: 12-hour shifts that often stretch to 14 or 15 hours, and nurses working five or six shifts in a row without adequate breaks. Other strategies discussed included:

• Getting rid of quick-return shifts and mandatory overtime
• Protected nap breaks on night shift
• Quiet recovery spaces

She also said health system leaders and hospital boards should track nurse well-being alongside financial performance, and shared that 25 years in nursing contributed to her developing two autoimmune conditions.

The statement doesn’t let individual nurses off the hook entirely. It frames fatigue prevention as a shared responsibility and lists steps nurses can take:

• Prioritizing sleep hygiene
• Planning non-work obligations around rest when possible
• Taking structured breaks during shifts when possible 
• Monitoring their own fatigue, hours worked, and readiness to practice safely

The release comes as mandatory overtime is getting more attention in Congress. Nurse.org recently covered a bipartisan federal bill, endorsed by the ANA, that would bar Medicare-participating facilities from mandating nurse overtime. It remains in committee.

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An ANA position statement is not a law or a regulation, and hospitals aren’t required to follow it. It still carries weight. It gives you a nationally recognized, evidence-based standard to point to when you push back on unsafe scheduling, back-to-back shifts, or pressure to stay late.

Here’s how you can use it:

• Bring it to shared governance and staffing committees. The 40-hour cap on expected weekly hours and the call for limits on consecutive hours give you specific language for scheduling proposals.
• Know that reporting fatigue should be safe. The ANA says employers should let nurses report fatigue without punishment. If your facility doesn’t have a clear process for that, ask why.
• Use it at the bargaining table. Unions and nurse advocates can cite the statement in contract talks over overtime, rest periods, and staffing.
• Protect your own recovery time. The statement treats rest as part of practicing safely. Declining an extra shift when you’re exhausted is a patient safety decision.

The main point is that the ANA now says, in plain terms, that nurse fatigue is a result of how work is organized. If fatigue contributes to a mistake, the statement gives nurses and their advocates a national standard to cite in arguing that the system around the nurse shares responsibility. 

🤔 Does your hospital give you a safe way to report that you’re too tired to work? Tell us what scheduling change would make the biggest difference for you in the comments below.