The Nurse Unit Manager's Role in Fatigue Management Policy:
The Nurse Unit Manager sets the bar for the clinical framework within which the clinician delivers his or her service to the patient and operative service team.
Anthropologically speaking, there are three levels of service which extend from the clinical framework:
One is hierarchal, that is, to the anaesthetist or surgeon.
The second is horizontal, to self and peers.
And the third, which is paramount, is to the patient.
In order to successfully traverse these clinical trajectories, a clinical nurse must rely on the standards of practice which are culturally embedded in the work place.
That is, rather than what the KPI statistics, the ACORN Standards, the EBA or any other formal or informal accord say, the clinical framework for each workplace is the one that happens in the here and now.
The difference between where we are now and where we want to be is reliant on the vision of the Nurse Unit Manager, since it is the skill of the leader that dictates the major agenda items, the future focus and the level of engagement of the staff.
If the Nurse Unit Manager does not believe in the significance of fatigue as a safety denominator both for staff and patients collectively, then there is little hope that any change will be mediated, let alone advocated for.
Thus it is important that the Nurse Unit Manager identifies and respects the definitive boundaries to fatigue intoxication and psychomotor performance: that is, that 17 hours of continued wakefulness equals a performance equivalent of Blood Alcohol level of 0.05 g/DL, and that greater than 12.5 hours of work per day increases error risk by 2-3 times.
Once we've got that out of the way, the rest falls into place.
Given that the boundaries exist and are significant, it is therefore contingent upon the leadership that managerial methods are found to set up a system of work that exacerbates compliance (as much as is reasonable possible).
Of course, the Nurse Unit Manager has managerial skills to this effect, and is well placed to execute them.
The Nurse Unit Manager must aspire to, acquire and employ leadership skills to communicate and implement organisational and departmental fatigue safety strategies as handed down to them from the executive.
But that is not all.
They are also well placed, in fact, ideally placed, to advocate to the executive on behalf of their staff and patients.
Even if the executive do not come on board, all is not lost.
After all, the Nurse Unit Manager has been employed to supervise the operation of the clinical coal face, a place they have intimate understanding of, or at least have immediate access to people who have an intimate understanding of it.
Plus, they are personally acquainted with the relevant standards (all 55 of them!) in which they are fluent and must desire to attain without fear.