What is Alarm Fatigue in Nursing? (With Factors, Consequences, & How to Reduce)
Written By:
Darby Faubion
Darby Faubion RN, BSN, MBA
Darby Faubion is a nurse and allied health instructor with over 20 years of clinical experience. Darby lives in Louisiana and loves exploring the state’s rich culture and history. Darby has a passion for caring for veterans and a special interest in those affected by post-traumatic stress disorder. In her quest to make a difference for veterans, she founded a non-profit called “Operation Battle Buddy.” Read Full Bio »» RN, BSN, MBA
If you are a nurse, you know many things at work can lead to stress, anxiety, and fatigue. Alarm fatigue in nursing is something that many nurses experience. Maybe you have heard of alarm fatigue but wonder, "Can someone tell me exactly what is alarm fatigue in nursing?" As a nurse with more than 25 years of experience, I have experienced alarm fatigue and witnessed other nurses who have, as well.
In this article, I will share insight about alarm fatigue and why it is such an important issue in nursing. As you read, you will learn about different types of alarms that lead to alarm fatigue, as well as find information about the consequences of alarm fatigue, strategies to overcome it, and common factors that lead to its occurrence.
What Exactly is Alarm Fatigue in Nursing?
Alarm fatigue in nursing is a nurse’s response to sensory overload that occurs due to exposure to excessive alarms. The sensory overload results in a desensitization to the sound of alarms. The alarm sounds may be true patient events or false alarms caused by other factors. The effect of the alarms is the same, nonetheless.
Why is Alarm Fatigue a Critical Issue in Nursing?
Alarms are time-sensitive notifications that communicate an immediate patient need. Some alarms signal a life-threatening situation. Alarm fatigue in nursing is a critical issue for a few reasons. First, because alarm fatigue is caused by over-sensitization to alarms, it is associated with delays in response time, which could result in negative consequences for patient outcomes. Depending on a patient's status or individual situation, delayed care could have dire consequences, even leading to death.
Additionally, in cases where alarm fatigue is not remedied, there is a higher rate of burnout among nurses, which leads to high nurse turnover. The high turnover rate creates more tension and stress as the remaining nurses must take up the slack caused by the nursing staff shortage.
How Prevalent is Alarm Fatigue in Nursing?
Alarm fatigue in nursing is prevalent and poses a serious risk to everyone. In one study conducted among critical care nurses, approximately
81% of nurses in intensive care units report experiencing alarm fatigue.
What Types of Alarms Cause Fatigue in Nurses?
Any number of alarms may trigger alarm fatigue in nursing. The most common types of alarm associated with alarm fatigue include the following.
Type #1: Medication Pumps
Medication pumps typically have two types of alarm signals. One alarm indicates mechanical issues with the device, such as a low battery, occlusion of tubing, or air in the line. The other alarm alerts nurses if a programmed medication dose exceeds the prescribed safety limit.
Type #2: Vital Sign Monitors
Vital sign monitors are designed to assess vital signs continuously or at set intervals. The alarm is triggered when one or more vital signs drop or spike. Some machines are set so the alarm changes pitch or becomes louder and faster until a nurse manually turns the alarm off.
Type #3: Sequential Compression Devices
Sequential compression devices are used to improve blood flow in the legs as a preventive measure to reduce the risk of patients developing DVTs. The device may alarm if the tubes need to be reconnected or become kinked. The sound of SCD alarms is quite common on post-surgical floors.
Type #4: Ventilators
Ventilators monitor several patient and machine variables constantly. The machines monitor airway pressure, volume, flow rate, and respiratory rate. The ventilator alarm is a safety mechanism designed with a preprogrammed set of parameters to alert nurses when there is a problem.
Type #5: Telemetry Monitors
Patients who require cardiac monitoring for an extended period may be put on a telemetry monitor. The monitor checks for abnormal heart activity that could indicate a setback or a new or serious problem. While the monitors are effective at identifying abnormalities quickly, low batteries, disconnected electrodes, or wires that rub together could also cause the machines to alarm. I know how stressed I felt when only five or six alarms sounded each hour. Nurses who work on a telemetry floor may have several patients to care for each shift, all with multiple devices and alarms sounding off, which is quite stressful.
5 Major Consequences of Alarm Fatigue in Nursing
If you or someone you know has experienced alarm fatigue in nursing, you know that it is no laughing matter. Alarm fatigue affects not only nurses but patients, other healthcare team members, and the healthcare facilities where we work. Recognizing the signs and doing our part to reduce the risks is important. If we do not, some major consequences result, including the following.
Consequence #1: Nurse Burnout
The endless beeping and buzzing of alarms are enough to make anyone feel frustrated. A major consequence of alarm fatigue in nursing is that it can lead to nurse burnout. When nurses experience burnout, it leads to emotional exhaustion, poor work performance, and lack of motivation, which affects patients, staff, and healthcare organizations.
Consequence #2: Decreased Quality of Patient Care
One of the most significant consequences of alarm fatigue in nursing is that patient care quality suffers. Because alarm fatigue often leads to missed or ignored alarm signals, patients may not receive care promptly, which means poor quality of care.
Consequence #3: Poor Patient Satisfaction Rates
Do you receive surveys in the mail or via email and discard them? I used to see surveys and automatically put them in the garbage or hit the delete button in my email...Until I realized how important they truly are. Hospitals and other healthcare facilities use patient surveys to determine patient satisfaction with services and to measure the quality of care they receive. Satisfied patients are key to positive clinical outcomes, reimbursement claims, and patient retention. When patients receive poor quality care, it results in poor patient satisfaction ratings on post-care surveys and, unfortunately, alarm fatigue in nursing may be part of the blame.
Consequence #4: Increased Risk of Illness Among Nurses
I know you probably wonder how hearing alarms can cause illness, but it is not as far-fetched as you may think. When you experience prolonged periods of stress, like that caused by alarm fatigue in nursing, the
endocrine system responds by releasing stress-related hormones like cortisol, which suppress the immune system.
Consequence #5: Poor Patient Outcomes
Nurses experiencing alarm fatigue are more likely to respond to alarms slowly (or ignore them), which often leads to missing critical patient events. As a result, situations that could be remedied by rapid response to alarms are not, resulting in poor patient outcomes. In severe situations, the nurse's failure to respond could even lead to serious health consequences for the patient, including death.
7 Main Factors That Contribute to Alarm Fatigue in Nursing
Many factors contribute to alarm fatigue in nursing. If we can understand what causes alarm fatigue and recognize symptoms before the issue becomes a problem, it is possible that we can decrease its occurrence. The following are seven main factors that contribute to alarm fatigue among nurses.
Factor #1: Alarms Are Not Individualized to a Specific Patient
One of the main factors contributing to alarm fatigue in nursing is that most devices are preprogrammed with one set of parameters that signal alarms to go off. For example, let us consider Ms. Elliott, a patient whose blood pressure usually measures around 100/60. She has been admitted to the medical-surgical floor for an unrelated diagnosis.
Suppose Ms. Elliott has a continuous blood pressure cuff applied. Chances are that, although her blood pressure generally runs low, her monitor will continuously alarm if her blood pressure is below the preset norm. The continuous alarm sounds can lead to alarm fatigue for the nurse.
Factor #2: Inadequate Nurse Training
My friend, Lee Ann, is a nursing instructor, and I asked her what she thinks is a contributing factor to nurses developing alarm fatigue. Lee Ann told me that she observes nurses in hospitals and critical care units become overwhelmed because they are not properly trained to deal with multiple alarms sounding simultaneously. I can relate to that, and you probably can, too. I remember thinking at times that if I heard one more alarm, I would scream!
Although it is frustrating to have several alarms beeping and blaring noise, often simultaneously if we train nurses adequately on how to use equipment, what each alarm means, and the best way to respond to alerts, I believe we can reduce the risk of alarm fatigue in nursing.
Factor #3: Malfunctioning Devices or Faulty Alarms
Another common factor that contributes to alarm fatigue in nursing is when devices are faulty or alarms malfunction. Machine errors can cause excessive alarms to sound, which puts attentive nurses on high alert, increasing stress, which leads to alarm fatigue.
Factor #4: Long Hours
I am happy to say the days of me working 12 and 16-hour shifts are long gone! When I worked in clinical nursing, it was nothing for me to work long shifts and extra prn shifts for nurses who called in sick. One thing I remember is that the more hours I worked in a day, the more susceptible I became to becoming ill or experiencing compassion fatigue and alarm fatigue. While not all nurses who work shifts with long hours develop alarm fatigue, the physical and emotional strain of working long hours certainly contributes to the possibility of it occurring.
Factor #5: Heavy Workload
Nursing is a wonderful profession, but the work can also be stressful, especially if your facility is short-staffed. One factor I have found that increases the risk of developing alarm fatigue in nursing is having heavy workloads. Being responsible for several patients in one shift is enough to cause stress or anxiety. When you add what seems to be the never-ending sound of alarms going off, the stimulation can be too much for some to handle.
Factor #6: The Amount and Types of Noise Produced by Alarms
Any alarm sounding is enough to leave you feeling frustrated, but when you work with multiple devices, the noise can be overwhelming. One machine may have several alarms, with each one signaling something different. Because alarm fatigue is caused by sensory overload, the amount of noise produced by alarms with various pitches and frequencies is one factor that leads to alarm fatigue in nursing.
Factor #7: A Previous History of Trauma or Emotional Stress
When we think of alarm fatigue in nursing, we typically think of contributing factors such as those listed above. However, another factor that increases the chance of nurses developing alarm fatigue is a history of previous trauma or emotional stress. For example, I once worked with a nurse who had a history of post-traumatic stress disorder from his days in the military. The loud buzzing of alarms, including the noise from medical devices and overhead alarms, caused him to feel increased anxiety. Although he handled most stressful situations well, he preferred working in our hospital's outpatient clinics, with fewer machines with alarms.
5 Effective Strategies to Reduce Alarm Fatigue in Nursing
Are you familiar with the old saying, "The best defense is a good offense?" While the adage is usually used in a context related to sports or military, it is also suitable in this discussion. One of the best ways for us to handle alarm fatigue in nursing is to try to
reduce factors that lead to its occurrence. The following are five strategies I have found to be effective in reducing alarm fatigue in nursing.
Strategy #1: Keep All Equipment in Proper Working Order
I learned early on that having equipment in good working order can make all the difference in how your day plays out. In addition to saving time that you would otherwise spend looking for good equipment, keeping equipment in proper working order is one of the easiest ways to reduce alarm fatigue in nursing. When medical devices are kept clean and in working order, they are less likely to sound off false alarms. With fewer alarms going off unnecessarily, nurses experience less sensory stimulation, reducing the risk of alarm fatigue.
Strategy #2: Disengage or Silence Alarms that Are Not in Use
Some medical devices monitor several patient functions, and these devices may have different settings for each thing they monitor. Nothing was more frustrating to me than hearing alarms sounding endlessly when there was nothing wrong with my patient, especially when the alarm had nothing to do with their health issue. One way to decrease alarm fatigue in nursing is to determine which alarms are necessary or critical to a patient's care and then disengage those that are not. In cases where disengaging an alarm is not allowed, some devices can be silenced and set to notify the nurse's desk directly if it picks up on an abnormal reading.
Strategy #3: Adjust Default Parameters Based on the Patient Population
Medical device alarms come with preset or default parameters, which means the alarms could sound even if the patient’s status does not merit a warning signal or alarm. Healthcare facilities may reduce the risk of alarm fatigue in nursing by adjusting default parameters based on the patient population. In hospitals that use the same type of monitor in all departments, adjusting the alarm settings based on the department's patient population may be possible. For example, cardiac intensive care units and outpatient clinics do not serve the same patient populations, allowing for variation in device settings.
Strategy #4: Use Measures that Route Alerts to the Appropriate Nurse
Most hospitals and healthcare facilities utilize smart devices, such as tablets or cell phones, for nurse use. By implementing measures that route alarms to a patient’s assigned nurse, we decrease the number of alarms or alerts other nurses receive.
Strategy #5: Set Device Parameters to Individual Patients
In addition to adjusting preset default parameters in units, we can further reduce unnecessary alarms and alarm fatigue in nursing by setting devices to align with a patient’s individual needs. By setting device parameters based on the expected outcomes outlined in their care plan, nurses will receive alerts only if their patient’s vital signs or other monitored values fall out of the desired range and preset parameters.
My Final Thoughts
Many nurses experience anxiety at work but cannot seem to pinpoint whether there is one cause of it. Some nurses feel stress because of external stimulation, such as those that cause alarm fatigue in nursing. I believe by addressing the question, “What is alarm fatigue in nursing,” we can identify factors that lead to its development and reduce associated consequences. If you feel you are experiencing alarm fatigue, or see signs of it within your team, I encourage you to talk with peers and team leaders and work together to find solutions. With good communication and teamwork, it is possible to reduce the risk factors of alarm fatigue.
List Of Sources Used For This Article
1. Making Healthcare Safer III: A Critical Analysis of Existing and Emerging Patient Safety Practices (
Chapter 13: Alarm Fatigue; Agency for Healthcare Research and Quality)
2. Determining Factors of Alarm Fatigue Among Nurses in Intensive Care Units (
National Library of Medicine)
3. How Does Stress Affect Your Immune System? (
Medical Life Sciences News)
4. Reducing the Safety Hazards of Monitor Alert and Alarm Fatigue (
Patient Safety Network; Agency for Healthcare Research and Quality)
Darby Faubion, RN, BSN, MBA
Darby Faubion is a nurse and allied health instructor with over 20 years of clinical experience. Her work history includes clinical experience in pediatrics, mental health, addiction and behavioral disorders, geriatrics, wound management, and communicable disease. Darby has worked in hospitals, long-term care facilities, and home health and hospice agencies. Darby also has experience as a nursing and allied health educator at both community college and university levels. Her love for nursing and nursing education led to her becoming a test-taking strategist and NCLEX prep coach.