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American Society of PeriAnesthesia Nurses
ASPAN Fatigue Evaluation Checklist**

ASPAN recognizes fatigue among nurses as a potentially dangerous situation. Evidence reports personal and professional contributors to nurse fatigue that can affect the nurse’s health and job performance and patient safety.

Nationally recognized nurse researchers of fatigue among nurses, Dr. Alison Trinkoff and Dr. Ann Rogers, presented evidence on fatigue to an ASPAN strategic work team in August 2007. The Nursing Organization Alliance (NOA) recommended that every specialty nursing organization educate their members about nurse fatigue and its effects on nursing practice. The American Nurses Association (ANA) developed a position statement which recommends every nurse, as an ethical responsibility, should “carefully consider” her/his fatigue level and has the duty to evaluate personal “readiness to provide competent care”.1

Factors related to nurse fatigue include:
  Professional (scheduling)1 factors: on-call hours,2,3 required (mandatory) overtime,2,4-6 few or no breaks during shift,2,4,5 high number of total hours worked in a week,2,3,5,6 shift length >12 .5 hours,2-7 number of weekends worked per month,3,4 working non-day shifts,3,4,8 worked when scheduled off,4,5 inadequate numbers of staff.6
  Personal factors: age,7 working more than one job,2 voluntary overtime,2,4-6 home and family responsibilities,7 working while sick,4 inadequate rest.2,4,7,9
  Job performance: struggle to remain awake,5,7,8 fell asleep at work,5,7 and some effects on decision-making and critical-thinking: decreased vigilance,4 increased risk of errors,5,6 lapses of attention,8 delayed reaction time.5
  Nurse health: musculoskeletal injury (MSD),2,4 injury by needlestick,2,3 psychological strain,9 sleep impairment/deprivation,8,9 “spillover” of work strain into non-work time,9 “unhealthful” behaviors (excessive caffeine or alcohol, smoking, inadequate diet, no exercise),2 drowsy driving.7

ASPAN offers an evidence-based checklist to healthcare providers for purposes of personal education and self-assessment. All of the factors on the checklist can be used in your self-assessment. Some of these fatigue factors are objective and can be assessed by peers and managers. Those factors are indicated with an (O). Research has shown that a person can recover from sleep deprivation after two consecutive nights of adequate sleep (6-8 hours), even after several days of working 12-hour shifts.10 Consider that evidence as you complete the checklist.


To assess fatigue risks and consequences, recall your most recent work experience, then circle each factor that applies to your current situation:

 Yes  No More than 12.5 concurrent hours in a 24 hour period. (O)
 Yes  No More than my scheduled hours in the past 48-72 hours. (O)
(Overtime is defined as a worked shift/actual hours worked as exceeding scheduled hours, whether voluntary or mandated.)
 Yes  No More than 40 hours in the week. (O)
 Yes  No “On-call” hours during which I returned to work for patient care. (O)
(On-call hours are an addition to regularly scheduled hours and may result in overtime, evening or night shift work, weekend hours, and significantly increase the total number of hours worked each week.)
 Yes  No An evening or night shift. (O)
 Yes  No Returned to work after fewer than 10 hours off since my last shift. (O)
 Yes  No Work without breaks. (O)
 Yes  No Work at a high pace.
(Work pace is the speed at which decisions and nursing. Assessments are made and actions are planned.)
 Yes  No Experience of psychological strain while at work.
(Psychological strain includes emotional demands of work, mental effort, and relationships with peers and/or supervisors.)
 Yes  No Work when I was scheduled OFF. (O)
 Yes  No Difficulty staying awake while at work.
 Yes  No Falling asleep during work.
 Yes  No Difficulty staying awake while driving home from work.
 Yes  No  Sleeping fewer than 6-7 hours before returning to work.
 Yes  No Working while sick in the past few days.
 Yes  No Experience of mood changes at work.
 Yes  No Working more than 1 job.

**Intended for educational purposes only. Though evidence-based, this checklist is neither designed nor validated as a research tool.


  1. American Nurses Association Board of Directors. Position Statement: Assuring Patient Safety: Registered Nurses’ Responsibility in All Roles and Settings to Guard Against Working When Fatigued. Washington, DC: ANA; 2006.
  2. Trinkoff A, Geiger-Brown J, Brady B, Lipscomb J, Muntaner C. How Long and How Much Are Nurse Now Working? AJN. 2006;106(4):60-71.
  3. Trinkoff A, Le R, Geiger-Brown J, Lipscomb J. Work Schedule, Needle Use, and Needlestick Injuries Among Registered Nurses. Infect Control Hosp Epidemiol. 2007;28(2):156-164.
  4. Trinkoff AM, Rong L, Geiger-Brown J, Lipscomb J, Lang G. Longitudinal Relationship of Work Hours, Mandatory Overtime, and On-call to Musculoskeletal Problems in Nurses. Am J Indust Med. 2006;49:964-971.
  5. Scott LD, Rogers AE, Hwang W, Zhang Y. Effects of Critical Care Nurses’ Work Hours on Vigilance and Patients’ Safety. Am J Crit Care. 2006;15:30-37.
  6. Rogers AE, Hwant W, Scott LD, Aiken LH, Dinges DF. The Working Hours of Hospital Staff Nurses and Patient Safety. Health Aff. 2004;23(4):202-212.
  7. Scott LD, Rogers AE, Hwang W, Dinges DF. The Relationship between Nurse Work Schedules Sleep Duration and Drowsy Driving. Sleep. 2007;30(12):1801-7.
  8. Lockley SW, Cronin JW, Evans EE, Cade BE. Effect of Reducing Interns’ Weekly Work Hours on Sleep and Attentional Failures. New Eng J Med. 2004;351(18):1829-1838.
  9. Winwood PC, Lusgington K. Disentangling the Effects of Psychological and Physical Work Demands on Sleep, Recovery and Maladaptive Chronic Stress Outcomes Within a Large Sample of Australian Nurses. J Adv Nurs. 2006;(56)679-689.
  10. Page A. Keeping Patients Safe: Transforming the Work Environment for Nurses. Institute of Medicine. Washington, DC: National Academies Press; 2004.
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