Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Haeok Lee

Second Advisor

Ling Shi

Third Advisor

Sun Kim


Fatigue is common among nurses and has detrimental effects on their health and job performance. Fatigued nurses commonly experience adverse physiologic and psychological consequences, work-related injuries, motor vehicle collisions and near collisions, and lower job satisfaction and retention.

Nurse fatigue also affects patients. Fatigued nurses demonstrate impaired performance, decreased vigilance, and higher rates of medical errors. National health-related agencies and nurses’ associations have released statements about nurse fatigue in an effort to raise awareness, promote error reduction, and improve patient safety.

Critical care nurses experience greater fatigue compared with generalist nurses due to the nature of their work. Pediatric intensive care units are further specialized and complex. The paucity of literature on pediatric critical care nurse fatigue is inadequate in measuring work-related fatigue comprehensively and evaluating the associations of this fatigue as well as health and safety outcomes. In this study, a repeated measures, descriptive, and correlational design was used to comprehensively evaluate work-related fatigue among pediatric critical care nurses. Participants completed pre-shift and post-shift fatigue measurements over two consecutive shifts utilizing the subjective Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) and the objective Psychomotor Vigilance Test (PVT). Data collection also considered the associations of internal environment factors (sleep deprivation and disruption), external environment factors (workload and environmental demands), and adaptation (nurse safety and patient safety) with pediatric critical care nurse fatigue. One hundred and twenty-one pediatric critical care nurses participated in this study. Participants experienced clinically significant increases in fatigue from pre-shift to post-shift and across consecutive shifts, which was assessed utilizing both subjective and objective fatigue measures. Chronic sleep disturbance, acute poor sleep quality, longer shifts, consecutive shifts, and higher patient acuity were associated with higher fatigue levels. The MFSI-SF demonstrated small to moderate convergence with the PVT.

Future studies should further investigate the impact of sleep on fatigue utilizing objective measures such as polysomnography or actigraphy. Additionally, various scheduling strategies, which manipulate external environment factors, may be used to compare their influence on fatigue. Finally, the impact of fatigue on adaptation should be further investigated utilizing a focused timeframe.


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