A practical nurse has been asked to work an extra 4 hours after a 12-hour shift. The nurse has worked four 12-hour shifts in a row and is fatigued. Which of the following is the most appropriate action?

A practical nurse has been asked to work an extra 4 hours after a 12-hour shift. The nurse has worked four 12-hour shifts in a row and is fatigued. Which of the following is the most appropriate action?

• A. The practical nurse cannot refuse to work the additional 4 hours as his manager has made the request and there are no other replacements.
• B. The practical nurse has no obligation to work the additional 4 hours, and he should report his decision to his union representative.
• C. The practical nurse must be offered time and a half for the extra 4 hours.
• D. The practical nurse's first priority in deciding to work the extra 4 hours is whether he is competent to provide safe care.

Answer: (D)

The crucial idea is that patient safety comes first, and fatigue directly affects your ability to provide safe, competent care. After four back-to-back 12-hour shifts, fatigue can impair concentration, memory, judgment, and reaction time. Because of that, the immediate priority is to assess whether you can still perform safely. If you’re not confident you can provide safe care, you should not take on the extra hours and should seek relief or arrange coverage, coordinating with your supervisor. Compensation, union issues, or contractual terms don’t override the obligation to ensure safe nursing care. In practice, you would communicate openly that fatigue is affecting your ability to perform safely and request staffing support or a different arrangement to protect patient safety.

The crucial idea is that patient safety comes first, and fatigue directly affects your ability to provide safe, competent care. After four back-to-back 12-hour shifts, fatigue can impair concentration, memory, judgment, and reaction time. Because of that, the immediate priority is to assess whether you can still perform safely. If you’re not confident you can provide safe care, you should not take on the extra hours and should seek relief or arrange coverage, coordinating with your supervisor. Compensation, union issues, or contractual terms don’t override the obligation to ensure safe nursing care. In practice, you would communicate openly that fatigue is affecting your ability to perform safely and request staffing support or a different arrangement to protect patient safety.