Examining the Association Between Shift Length, Fatigue, and Perceived Safety in NNP Practice

Background: Neonatal nurse practitioners (NNPs) often work extended shifts to support continuity of care in neonatal intensive care units (NICUs). Prolonged shift length has been associated with fatigue and safety risks in other healthcare populations; however, evidence specific to NNP practice remains limited. Purpose: The purpose was to examine associations between shift length, self-reported fatigue, and safety-related outcomes among NNPs, and to evaluate how these outcomes vary by demographic and practice characteristics. Methods: This cross-sectional survey examined shift characteristics, self-reported fatigue, and safety-related outcomes among board-certified NNPs. Using a national certification mailing list, 6717 NNPs were invited; 623 initiated the survey, with analytic sample size varying by item. Quantitative data were analyzed using descriptive statistics, chi-square tests, and logistic regression. Results: More than half of respondents (n = 190, 51%) preferred 24-hour shifts despite reporting fatigue-related concerns. Most respondents (n = 435, 85%) reported that unit census and acuity influence fatigue. Nearly half (49%) reported feeling unsafe to drive home at least once after working an extended shift (>16 hours). Years of experience, rather than age, were associated with fewer reported safety concerns. Safety perceptions varied by NICU level, with less experienced NNPs reporting greater impairment. Implications for Practice and Research: Fatigue-related safety concerns varied by NICU level and clinical experience, while most respondents continued to prefer 24-hour shifts despite these concerns. These findings highlight the tension between workforce sustainability, provider preference, and safety within neonatal practice.