1224 Scheduling Practices, Sleep, and Medication Administration Errors: Perspectives from Staff Nurses and Nurse Leaders

Abstract Introduction Long hours and rotating shifts often leave nurses insufficient sleep for cognitive recovery, increasing fatigue and medication administration errors (MAEs). Although sleep loss impairs attention and decision-making, its role in patient safety among nurses is understudied. This study explored, from the perspectives of bedside nurses and nurse leaders, how nurses' sleep, shaped by scheduling practices and home environments, interacts with workplace safety climate (perceptions of organizational commitment to safety) to impact MAEs. Methods Nineteen bedside nurses and 14 nurse leaders from inpatient units across two Veterans Health Administration hospitals were recruited. Semi-structured interviews with bedside nurses explored how work schedules influence their sleep and, reciprocally, how sleep impacts their work performance. Nurse leader interviews explored the need for nursing scheduling policies grounded in sleep science to reduce MAEs and challenges/supports for implementation. Matrix-based rapid qualitative analysis identified within-and across-group similarities and differences. Results Bedside nurses were on average 46.9 years old, White (90%), female (63%), held a bachelor’s degree (58%), worked in acute care (47%), and had 10 years nursing experience. Nurse leaders were on average 52.4 years old, White (79%), female (93%), held a master’s degree (71%), and had 10 years nursing leadership experience. Five key concepts emerged relating to (1) alignment of work schedules with recovery needs, (2) perceived effects of fatigue on performance and patient safety, (3) barriers to implementing sleep-informed scheduling policies, (4) perceptions of current scheduling policies, and (5) opportunities to improve safety climate. Both groups recognized fatigue impairs performance and increases errors, consecutive/rotating shifts worsen fatigue, breaks are important but difficult to take, scheduling flexibility is valued, and adequate recovery time plus culture change to support sustainable and health-promoting scheduling practices are essential. Perspectives diverged on responsibility and feasibility for change; bedside nurses highlighted the need for scheduling flexibility and fairness, while nurse leaders emphasized organizational, contractual, and operational barriers that limit flexibility. Both groups identified distinct opportunities for improvement in promoting a culture of rest and recovery for nurses. Conclusion Evidence-based scheduling policies balancing autonomy with recovery time, supported by cultural change, are essential for nurse/patient safety and workforce well-being. Support (if any) Gordon and Betty Moore Foundation