Stress and cortisol as predictors of fatigue in medical/surgical nurses and nurse leaders: A biobehavioral approach

Objective:High acuity and long work hours are significant contributors to nurses’ stress. Studies evaluating consecutive workdays with the use of biobehavioral methods are limited in the US. The aim of this study was to assess changes in and the relationship between stress, fatigue, and cortisol.Methods:In an observational within-subject design, we studied stress, fatigue and cortisol before and after 2 consecutive 12-hourday shifts in an acute care setting. Specifically, the study was designed to: (1) assess the effect of stress on fatigue; (2) examine the effect of stress on cortisol; (3) compare the levels of stress, fatigue, and cortisol; and (4) compare the responses of stress,fatigue, and cortisol between acute care, day shift staff nurses and nurse leaders.Results:Stress, fatigue, and cortisol increased significantly from baseline to Day 2 (p= .001, .004, and .010, respectively; paired t-test). In a comparison of nurses and nurse leaders, stress and fatigue at baseline were significantly higher in acute care nurses than in nurse leaders (p≥.00 and .05, respectively; independent t-test). At the end of 2 consecutive shifts, cortisol was significantly higher in staff nurses than in nurse leaders (p= .001). Conclusions: Competing initiatives pressure nurse leaders to work long hours to support organizational goals, sometimes at the expense of a healthy work environment. Nurses from direct care staff to executives should be educated in and demonstrate best practices in relation to endorsements from the American Nurses Association on fatigue and interventions to lessen the risks to patient safety.