By Laura Unger

Operating room nurse John Kauchick says he's worked 17-hour shifts and once stayed on the job for 23 hours straight – risking fatigue that could lead to medical mistakes.

Now the American Nurses Association seeks to reduce such risks with a new set of recommendations spelling out the dangers of nurse fatigue and ways employers can reduce it. The group is spreading the word to nurses and health care facilities across the USA.

"With truck drivers and airline pilots, they'll pull the driver out of the truck or the pilot out of the plane" to avoid fatigue, says Kauchick, a traveling nurse who works mostly in Texas and New Mexico. "If you're a nurse, (long hours) are what you sign up for," he says he's been told by managers when he has complained about the issue.

Hospital officials say they are committed to changing that, and ANA President Pam Cipriano says she's optimistic the new recommendations "will focus much more attention on the issue."

Among them is that employers limit shifts to 12 hours or fewer and work weeks to 40 hours or fewer; eliminate mandatory overtime; keep consecutive night shifts to a minimum for nurses working both days and nights; and provide sleep rooms or transportation when nurses are too tired to drive. The group also says employers should give nurses the right to reject work assignments to prevent fatigue.

Nurses, the group says, are responsible for getting enough sleep, arriving at work well-rested and taking necessary breaks. "If a nurse is fatigued, it is possible that a mistake could be made or someone could forget to pass along an important fact, or the person could be more on edge" when dealing with patients, Cipriano says.

A steady stream of studies link fatigue to errors, increased risk-taking, declines in short-term memory and a reduced ability to learn – with researchers likening the performance of someone awake for at least 17 hours to that of a drunk person.

A groundbreaking study in the journal Health Affairs in 2004, which looked at 393 nurses over more than 5,300 shifts, found that those who worked shifts 12.5 hours or longer were three times more likely than others to make an error in patient care. And a 2014 study in the American Journal of Critical Care found that nurses who were fatigued, lost sleep, or couldn't recover between shifts were much more likely to regret a medical decision they had made.

Fatigue has also been linked to health problems such as diabetes, cardiovascular disease and injuries.

While nurse tiredness has been a problem for many years, some nurses say it got worse during the economic downturn, as hospitals across the nation laid off staff and depended more on nurses who remained, or contract nurses such as Kauchick.

Kauchick says he's lucky he's never made an error at work because of tiredness, but "I can remember driving to work and missing my turn" because of fatigue.

Lisa Oliver, a night-shift nurse in an intensive care unit at a Bangor, Maine, hospital, says she generally works two 12-hour shifts a week, but sometimes picks up extra shifts to cover pediatric ICU or stays at work for mandatory daytime meetings.

Although she makes sure to get enough sleep, she acknowledges she gets tired sometimes, especially during her 40-minute commute to the hospital. To prevent errors at work, she says nurses at her hospital use a "buddy system" in which they keep an eye on each other and check one another's work.

"This is critical care," she says. "If you make one little mistake, you have lives in your hands. "

Cipriano says protecting nurses from fatigue is largely up to these sorts of voluntary actions by employers and nurses, since national labor law only goes so far – requiring breaks after a certain number of hours, for example.

Elizabeth Lietz, a spokeswoman for the American Hospital Association, says policies designed to prevent nurse fatigue vary by hospital to meet the needs of each unique workforce. At KentuckyOne Health in Louisville, for example, Chief Nursing Officer Velinda Block says ensuring nurses are well-rested involves not only limiting the length of shifts and work weeks but also letting nurses know not to take on too much work.

KentuckyOne also has a pool of "flex nurses," who are are paid a premium for their flexibility and can work shifts in various settings, as needed, so that other nurses don't have to put in too many hours.

"Our employees are our most valuable resource," Block says. "We have to take good care of them so they can take good care of our patients."