Alarm Fatigue in Nursing Students Undertaking Clinical Training in Intensive Care Units: A Multicenter Study

Main Article Content

Paolo Ferrara
Lara Carelli
Federico Ruta
Alessandro Delli Poggi
Milannie Marasigan
Barbara Pinna
Anne Destrebecq
Stefano Terzoni


Alarm fatigue, nursing students, Intensive care unit, patient safety


Background: The frequency of alarms from monitors and other electro-medical devices is of great utility but can increase the professional’s workload and expose nurses in the intensive care unit to Alarm Fatigue. A recent study suggested that students in training can also experience the problem during their first clinical experiences in intensive care. Unfortunately, no data are available about the Italian panorama. To explore Alarm Fatigue among Bachelor of Science in Nursing students at the end of their internship experience in intensive care settings. Methods: Multicenter cross-sectional design. A convenience sample of nurses from 3 Italian university hospitals was recruited. The students completed the revised version of the “Alarm Fatigue questionnaire-ita” at the end of the clinical internship in intensive care settings. Results: 130 nursing students were enrolled (response rate 59.36%). The overall level of Alarm Fatigue was Me= 24.5 IQR [17.5, 30.5]. In addition, 9.23% of the sample reported errors or near misses related to Alarm Fatigue during the internship experience. The alarm fatigue level was higher in students who committed “errors/almost errors” (p=0.038) and in “student workers” (p=0.005). Discussion: The extent of alarm fatigue experienced by nursing students requires developing a preventive strategy.

Abstract 422 | PDF Downloads 366


1. Sowan AK, Staggers N, Reed CC, Austin T, Chen Q, Xu S, et al. State of Science in Alarm System Safety: Implications for Researchers, Vendors, and Clinical Leaders. Biomed Instrum Technol. 2022;56(1):19–28. doi:10.2345/0899-8205-56.1.19

2. Lewandowska K, Weisbrot M, Cieloszyk A, Mędrzycka-Dąbrowska W, Krupa S, Ozga D. Impact of Alarm Fatigue on the Work of Nurses in an Intensive Care Environment-A Systematic Review. Int J Environ Res Public Health. 2020;17(22):E8409. doi:10.3390/ijerph17228409

3. Carelli L, Terzoni S, Destrebecq A, Formenti P, Soumahoro F, Esposito A, et al. Alarm fatigue in nurses working in intensive care units: A multicenter study. Work. 2022;72(2):651–656. doi:10.3233/WOR-210552

4. Dee SA, Tucciarone J, Plotkin G, Mallilo C. Determining the Impact of an Alarm Management Program on Alarm Fatigue among ICU and Telemetry RNs: An Evidence Based Research Project. SAGE Open Nurs. 2022;8:23779608221098710. doi:10.1177/23779608221098713

5. Simpson KR, Lyndon A. False Alarms and Overmonitoring: Major Factors in Alarm Fatigue Among Labor Nurses. J Nurs Care Qual. 2019;34(1):66–72. doi:10.1097/NCQ.0000000000000335

6. Despins LA. Factors influencing when intensive care unit nurses go to the bedside to investigate patient related alarms: A descriptive qualitative study. Intensive Crit Care Nurs. 2017;43:101–107. doi:10.1016/j.iccn.2017.04.003

7. Weeks K, Timalonis J, Donovan L. Does alarm fatigue start in nursing school? Nursing (Lond). 2021;51(5):59–63. doi:10.1097/01.NURSE.0000743284.73649.7a

8. Sendelbach S, Funk M. Alarm fatigue: a patient safety concern. AACN Adv Crit Care. 2013;24(4):378-388. doi:10.1097/NCI.0b013e3182a903f9

9. Hall KK, Shoemaker-Hunt S, Hoffman L, et al. Making Healthcare Safer III: A Critical Analysis of Existing and Emerging Patient Safety Practices. Rockville (MD): Agency for Healthcare Research and Quality (US); March 2020

10. Alsaad AA, Alman CR, Thompson KM, Park SH, Monteau RE, Maniaci MJ. A multidisciplinary approach to reducing alarm fatigue and cost through appropriate use of cardiac telemetry. Postgrad Med J. 2017;93(1101):430. doi:10.1136/postgradmedj-2016-134764

11. The Joint Commission. National Patient Safety Goals Effective January 1, 2014. (Last accessed Feb. 2, 2022).

12. Oliveira AEC de, Machado AB, Santos EDD, Almeida ÉB de. Alarm fatigue and the implications for patient safety. Rev Bras Enferm. 2018;71(6):3035–3040. doi:10.1590/0034-7167-2017-0481

13. Wilken M, Hüske-Kraus D, Röhrig R. Alarm Fatigue: Using Alarm Data from a Patient Data Monitoring System on an Intensive Care Unit to Improve the Alarm Management. Stud Health Technol Inform. 2019;267:273-281. doi:10.3233/SHTI190838
14. Fujita LY, Choi SY. Customizing Physiologic Alarms in the Emergency Department: A Regression Discontinuity, Quality Improvement Study. J Emerg Nurs. 2020;46(2):188-198.e2. doi:10.1016/j.jen.2019.10.017
15. Torabizadeh C, Yousefinya A, Zand F, Rakhshan M, Fararooei M. A nurses’ alarm fatigue questionnaire: development and psychometric properties. J Clin Monit Comput. 2017;31(6):1305–1312. doi:10.1007/s10877-016-9958-x
16. Moore A, Nguyen A, Rivas S, Bany-Mohammed A, Majeika J, Martinez L. A qualitative examination of the impacts of financial stress on college students' well-being: Insights from a large, private institution. SAGE Open Med. 2021;9:20503121211018122. Published 2021 May 22. doi:10.1177/20503121211018122
17. Castello M, Ferrara P, Destrebecq A, Terzoni S. The perception of clinical risk among students of different health professions: a multicentre study. Br J Nurs. 2019;28(3):193-197. doi:10.12968/bjon.2019.28.3.193
18. Carnevale FA. Moral distress in the ICU: it's time to do something about it!. Minerva Anestesiol. 2020;86(4):455-460. doi:10.23736/S0375-9393.19.14021-7
19. Ramírez-Elvira S, Romero-Béjar JL, Suleiman-Martos N, et al. Prevalence, Risk Factors and Burnout Levels in Intensive Care Unit Nurses: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2021;18(21):11432. doi:10.3390/ijerph182111432