To the best of our knowledge, no systematic review and meta-analysis has been published that focuses on the level and risk factors of work-related fatigue among clinical nurses. The phenomenon of nurses’ work-related fatigue is crucial in today’s 7/24h healthcare system. We conducted this meta-analysis and systematic review to: (1) evaluate the level of work-related fatigue among clinical nurses; (2) systematically identify the factors associated with work-related fatigue using the 24-Model.
The Occupational Fatigue Exhaustion Recovery (OFER) questionnaire consists of 15 items rated on a 7-point Likert scale, ranging from strongly disagree (0) to strongly agree (6). The questionnaire includes three subscales: chronic fatigue (items 1–5), acute fatigue (items 6–10), and inter-shift recovery (items 11–15). Respondents' scores can be interpreted as low (0–25), low-moderate (26–50), moderate-high (51–75), and high (76–100)[64]. Thus, the study demonstrated that clinical nurses exhibited moderate-high levels of acute and chronic fatigue, as well as low-moderate levels of inter-shift recovery. This underscores the pervasiveness of acute and chronic fatigue as an occupational issue among clinical nurses.
Due to extended working hours, heavy workloads and other factors, nurses experience mental and physical fatigue that is challenging to alleviate[66]. Nevertheless, the recovery period between shifts is insufficient to restore nurses to their optimal working state[67]. Research has demonstrated that the level of work fatigue among clinical nurses varies within and between shifts, and builds up after consecutive shifts[68]. Insufficient recovery, coupled with high-intensity work demands and the absence of relief and reduction in work fatigue among clinical nurses, can result in an increasing level of work fatigue, which in turn can lead to a reduction in work happiness, an increase in nurse turnover intention, and an elevated risk of patient safety incidents[69].
The adverse effects of work fatigue among clinical nurses have a profound impact on their individual physical and mental health, patient safety, and the overall working atmosphere and environment of the organization[69]. The identification and detection of work fatigue are of paramount importance in the management of clinical nurse fatigue. Currently, there is no unified standard for measuring work fatigue among clinical nurses, with various types of questionnaires or scales in use[4, 71, 72]. In this meta-analysis, data from 14 articles using the OFER questionnaire were used to classify work fatigue into acute fatigue, chronic fatigue, and inter-shift fatigue, which was also widely accepted by most studies. However, some scholars have classified work fatigue into physical fatigue, mental fatigue, and emotional fatigue[4].
Furthermore, we observed considerable heterogeneity not only in the measurements employed but also in the subscale scores among the studies. The measurement of different tools may result in varying degrees of bias in the research results. Consequently, further exploration and research are required to identify and monitor work fatigue in clinical nurses.
In the post-epidemic era, it is of the utmost importance that the impact of various risk factors on nurses' health be subjected to a more systematic and comprehensive evaluation. It is essential to classify these factors in a systematic and explicit manner. In doing so, it is important to distinguish between occupational and non-occupational factors. The 24-Model provided an accurate classification framework for us, advocating the concept of “from organization to individual”. This is divided into four subcategories: organizational culture, management system, personal capability and individual act.[11].
Organizational culture may be defined as the set of norms, values, and basic assumptions that drive both the quality of work life and the quality of care within an organization.[73]. In the current context of mounting pressure within the healthcare industry, it is imperative that we advocate for the transformation of a culture of fatigue into a culture of health.[74]. The findings of the study indicate that positive relationships with colleagues, sufficient social support, a positive work environment, a positive safety atmosphere, perceived organizational support, and fair and impartial superiors play an indispensable role in reducing the work fatigue of nurses.[75] Consequently, nursing managers are encouraged to foster the creation of an optimal organizational culture environment and to provide a supportive working atmosphere for clinical nurses.
The management of shift work, the daily overload of workload, the remuneration received in the form of salary, the number of hours worked each month, and the nature of the work itself all contribute to the level of work fatigue experienced by clinical nurses[22, 23, 34]. The term ‘management system’ is used in this context to describe a system of management practices, policies and procedures related to shift work, personnel salary management, and other aspects that are relevant to the organization’s operations.[76]. The quantity of shift work, the duration of working hours, the extent of the workload, and the recovery period between shifts can have a considerable impact on the rest and sleep patterns of nurses[77]. This, in turn, is linked to the phenomenon of work fatigue.
In light of the aforementioned considerations, it is recommended that hospitals and nursing managers allocate human resources in a reasonable manner, establish a fair compensation mechanism, and implement a fatigue risk management system[78–80]. A conceptual model of multi-level fatigue risk management in the nursing work system was proposed by another researcher based on the hierarchical fatigue risk management model in the fatigue risk management system[79]. This model is founded upon empirical evidence and is informed by systems engineering methodologies and informatics. System engineers and clinical analysts can transform data related to recorded nursing intensity and other needs in the work environment into meaningful information to guide nursing leaders in monitoring, decision-making, and developing strategies for managing employee fatigue.
A number of personal factors can influence the onset of work fatigue. These include work experience, work control, coping strategies, health status, professional title and status, family function, and psychological stress resistance[81]. Consequently, hospitals and nursing managers should prioritize the provision of educational programs designed to mitigate occupational fatigue among employees[78]. These programs should cultivate the capacity of nurses to proactively prevent and respond to fatigue.