Nurse Fatigue and Its Influence on Decision-Making Accuracy and Work Performance among Operating Room Nurses

Nurse fatigue among operating room (OR) nurses may influence decision-making accuracy and work performance by affecting cognitive functioning, efficiency, and the delivery of safe patient care in high-pressure clinical environments. This study examined the levels of nurse fatigue, decision-making accuracy, and work performance, as well as their relationships among 120 OR nurses from two government hospitals in Misamis Occidental, Philippines, using a descriptive-correlational research design. Data were gathered through a researcher-developed questionnaire and analyzed using mean, standard deviation, and Pearson’s r. Findings revealed that OR nurses experienced severe nurse fatigue, very high decision-making accuracy, and excellent work performance. Results further showed that nurse fatigue had generally no significant relationship with decision-making accuracy, except for a significant relationship between physical fatigue and clinical judgment accuracy. In terms of work performance, nurse fatigue showed selective significant relationships, particularly between physical and mental fatigue and efficiency and productivity, while most other relationships were not significant. It is concluded that despite high levels of fatigue, nurses maintained strong decision-making accuracy and overall performance, although fatigue had some influence on efficiency-related outcomes. Therefore, it is recommended that hospital administrators and nursing managers implement targeted fatigue management strategies, such as adequate staffing, regulated workloads, and structured rest periods, while continuing professional development initiatives to sustain and enhance nurses’ performance and the quality of patient care.

decision-making accuracy, nurse fatigue, operating room nurses, work performance, workplace efficiency

1. Alanmi, B., Alharazi, R., & Almutary, H. (2025). Night shift and occupational fatigue among nurses who work 12 hours in Jeddah. Journal of Education and Health Promotion, 14(1), 308. [Google Scholar] [Crossref]

2. Alharbi, A., Alkubati, S. A., Albaqawi, H., Ali, A. Z., Hamed, L. A., Mohammed, S., … Cornejo, L. T. O. (2025). Relationship between nursing work environment and clinical decision-making among Saudi nurses: Psychological empowerment as mediator. BMC Nursing, 24(1), 682. [Google Scholar] [Crossref]

3. Ali, R. S., & Mosadeghrad, A. M. (2023). The influence of work fatigue on cognitive performance and clinical errors among healthcare providers: A systematic review. BMC Health Services Research, 23(1), 457. [Google Scholar] [Crossref]

4. Bakker, A. B., & Demerouti, E. (2017). Job demands resources theory: Taking stock and looking forward. Journal of Occupational Health Psychology, 22(3), 273–285. [Google Scholar] [Crossref]

5. Barker, L. M., & Nussbaum, M. A. (2011). Fatigue, performance and the work environment: a survey of registered nurses. Journal of Advanced Nursing, 67(6), 1370–1382. [Google Scholar] [Crossref]

6. Baumeister, R. F., Bratslavsky, E., Muraven, M., & Tice, D. M. (2007). Ego depletion: Is the active self a limited resource? Journal of Personality and Social Psychology, 74(5), 1252–1265. [Google Scholar] [Crossref]

7. Bell, T., Sprajcer, M., Flenady, T., & Sahay, A. (2023). Fatigue in nurses and medication administration errors: A scoping review. Journal of Clinical Nursing, 32(17-18), 5445–5460. [Google Scholar] [Crossref]

8. Brown, T., & Hart, J. (2021). Cognitive impairment and its role in operating room errors: A review of the literature. Journal of Surgical Nursing, 26(4), 45–52. [Google Scholar] [Crossref]

9. Cho, H., & Steege, L. M. (2021). Nurse fatigue and nurse, patient safety, and organizational outcomes: A systematic review. Western Journal of Nursing Research, 43(12), 1157–1168. [Google Scholar] [Crossref]

10. Cochran, K. R. (2021). An examination of work characteristics, fatigue, and recovery among acute care nurses. JONA: The Journal of Nursing Administration, 51(2), 89–94. [Google Scholar] [Crossref]

11. Creswell, J. W. (2014). Research design: Qualitative, quantitative, and mixed methods approaches. Sage. [Google Scholar] [Crossref]

12. Davis, A. L. (2019). Nurse decision-making in critical care environments: Factors and outcomes. Critical Care Nursing Quarterly, 42(1), 15–23. [Google Scholar] [Crossref]

13. Demerouti, E., Bakker, A. B., Nachreiner, F., & Schaufeli, W. B. (2001). The job demands resources model of burnout. Journal of Applied Psychology, 86(3), 499–512. [Google Scholar] [Crossref]

14. Ghaffari, M., Abbasinia, M., & Ghanbarzadeh, A. (2023). Association of cognitive fatigue with clinical reasoning and information processing efficiency among emergency nurses. Journal of Clinical Nursing, 32(9-10), 1785–1794. [Google Scholar] [Crossref]

15. Gou, Y., Li, X., Zhang, J., & Liu, D. (2024). Intensive care unit nurses’ job demands, personal resources, and fatigue: An application of job demands–resources theory. Journal of Nursing Management, 32(4), 478–488. [Google Scholar] [Crossref]

16. Goudarzian, A. H., Hatkehlouei, S. A. T., Taebi, M., Ghazanfari, M. J., Abbasi Dolatabadi, Z., & Nabi Foodani, M. (2025). Decision Fatigue in Nursing: An Evolutionary Concept Analysis. Health Science Reports, 8(8), e71166. [Google Scholar] [Crossref]

17. Hur, Y., & Hickman, R. L. (2024). Psychometric evaluation of the Decision Fatigue Scale among Korean registered nurses. Healthcare (Basel), 12(15), 1524. [Google Scholar] [Crossref]

18. Hwang, S., Lee, M. H., & Kwon, S. Y. (2023). The impact of cognitive load on nurse decision-making: A quantitative review of cognitive workload in healthcare. Journal of Nursing Research, 31(2), 144–153. [Google Scholar] [Crossref]

19. Kim, S., & Lee, H. (2022). The effects of nurse fatigue on clinical performance: An integrative review. International Journal of Nursing Studies, 131, 104158. [Google Scholar] [Crossref]

20. Levitt, C., & Pineda, T. (2022). Decision fatigue and its effect on clinical outcomes in high-pressure environments. Journal of Health Psychology, 39(4), 472–484. [Google Scholar] [Crossref]

21. Lu, Y., Xie, H., & Zhang, D. (2021). Decision fatigue and healthcare professionals: Examining its causes and impact in nursing practice. Journal of Advanced Nursing, 77(12), 2846–2857. [Google Scholar] [Crossref]

22. Mayhob, M. M., & AbdelSalam, M. (2023). Nurses’ perception regarding their role for maintaining patients’ safety inside the operating room. American Journal of Nursing Research. [Google Scholar] [Crossref]

23. Muraven, M., & Baumeister, R. F. (2000). Self-regulation and depletion of limited resources: Does self-control resemble a muscle? Psychological Bulletin, 126(2), 247–259. [Google Scholar] [Crossref]

24. Peng, J., Lu, H., Zhang, J., Shao, Y., Wang, L., & Lv, J. (2022). Need for cognition moderates the impairment of decision making caused by nightshift work in nurses. Scientific Reports, 12(1), 1756. [Google Scholar] [Crossref]

25. Pignatiello, A., Tsivitse, E., O’Brien, J., Kraus, N., & Hickman, R. L. (2022). Decision fatigue among clinical nurses during the COVID-19 pandemic. Journal of Clinical Nursing, 31(7–8), 869–877. [Google Scholar] [Crossref]

26. Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice. Wolters Kluwer. [Google Scholar] [Crossref]

27. Sagherian, K., Clinton, M. E., Abu-Saad Huijer, H., & Geiger-Brown, J. (2017). Fatigue, work schedules, and perceived performance in bedside care nurses. Workplace Health & Safety, 65(7), 304–312. [Google Scholar] [Crossref]

28. Singh, B. C., & Arulappan, J. (2023). Operating Room Nurses' understanding of their roles and responsibilities for patient care and safety measures in intraoperative practice. SAGE Open Nursing. [Google Scholar] [Crossref]

29. Smith, R., & Jones, P. (2020). The impact of shift length on nurse fatigue and patient safety. Nursing Research and Practice, 12(2), 234–240. [Google Scholar] [Crossref]

30. Thompson, H., & Willis, C. (2018). The operating room environment: Unique challenges in healthcare. Journal of Clinical Nursing, 27(5-6), 980–986. [Google Scholar] [Crossref]

31. Turner, K. L. (2023). Resource depletion and its consequences for nurse decision-making accuracy: A systematic review. Nursing Science Quarterly, 36(1), 67–75. [Google Scholar] [Crossref]

32. Udushirinwa, A. P., Amenyo, C. A., & Mensah, Q. H. (2022). Exploring job demands and resources in healthcare assistants: Work environment influences on burnout and performance. BMC Nursing, 21(136). [Google Scholar] [Crossref]

33. Verweij, L. M., van der Hoeven, A., van der Voort, P. H. J., & Sabbe, B. G. C. (2024). Cognitive workload and information processing among critical care nurses: An observational study. Intensive and Critical Care Nursing, 81, 103457. [Google Scholar] [Crossref]

34. Wilson, P. (2022). Fatigue, stress, and cognitive decline: Implications for nurses in high-pressure environments. Healthcare Journal of Nursing Studies, 18(2), 120–134. [Google Scholar] [Crossref]

35. Wright, M. I., & Sha, S. (2025). Relationship of the perioperative nurse work environment with a culture of safety and high reliability. Journal of Perianesthesia Nursing. [Google Scholar] [Crossref]

36. Zainal, N. H., Islam, M. A., Rasudin, N. S., Mamat, Z., Hanis, T. M., Rodzlan Hasani, W. S., & Musa, K. I. (2025). Critical thinking and clinical decision making among registered nurses in clinical practice: A systematic review and meta-analysis. Nursing Reports, 15(5), 175. [Google Scholar] [Crossref]

• Migrant Health in Morocco: Between Law and Reality
• CaknaMinda: An Educator-Centred Mobile App for Early Screening of Mental Health and Schizophrenia Risks
• Health System and Nursing Strategies for Enhancing Male Participation in Family Planning: Evidence from Tema General Hospital, Ghana.
• From Īśvara-Praṇidhāna to Parā-Bhakti: Convergent Paths of Aṣṭāṅga Yoga and Bhakti Yoga
• Evidence-Based Psycho-Oncological Interventions: A Multimodal Approach to Supportive Care