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Objective: The role of nurses’ shift-rotations in predicting adverse patient events has received little attention. The effect of fatigue on patient safety as a primary factor and the impact of shift-working on fatigue as a secondary factor in hospital-based nurses was investigated in the present study. Methods: In this cross-sectional study set in Iraqi Kurdistan in 2018, 71 nurses (Range: 20-44 years) were recruited purposively who worked in rotating shifts, in four multi-specialty hospitals. Results: The mean age of the nurses was 30.24 years ( SD : 4.81; range: 20-44 years). The majority of nurses worked in the public sector (63.4%). The nurses worked in morning shift (26.8%) and shift-rotations (39.4%) for between 7.75 and 9.13 hours. In addition, 59.4% and 18.3% of nurses reported that they injured “sometimes” and “frequently” (respectively) patients in their care either directly or indirectly. Similarly, 19.7% of them reported that these were medication errors “sometimes” and “frequently.” Patient information was recorded incompletely or incorrectly sometimes by 18.3% and frequently by 35.2%. Also, 36.6% and 31.0% of them reported that they delayed care to patients frequently and sometimes, respectively. The mean values of physical and psychological fatigue were 8.77 of 21 and 3.42 of 12, respectively. The physical and psychological fatigue were escalated in case of lower total psychological well-being ( p = .009 and  p = .018, respectively). The study showed that single-shift working is a predictor of delayed patients care; 95.3% vs. 60.7%; p < .001). Conclusions: Hospital administrators must be aware that nurses are not able to work effectively on short roosters or extended shifts. Protocols for better nurse health surveillance and social support in respect to 24 hours shift work must be prioritized in order to avoid mental and physical significant impairment on nurses and adverse outcomes for their clients.

Fatigue as a primary and secondary factor in relation to shift-rotating and patient safety in nurses