Alarm Fatigue in Hemodialysis Nurses Linked to Shifts, Income and Resilience

Machine alarm fatigue among hemodialysis nurses is shaped by a web of individual, organizational and device-related factors, according to a convergent parallel mixed-methods study published in BMC Nursing. The research, conducted from March to June 2026 across three campuses of a tertiary hospital in Hubei Province, China, combined a survey of 75 hemodialysis nurses with in-depth interviews of 13 nurses to map both the measurable drivers of alarm fatigue and the lived experience behind them. The authors describe alarm fatigue as not merely a professional concern for nurses but a direct threat to the safety of patients undergoing hemodialysis, noting that systematic analyses of its influencing factors and well-established management strategies have been lacking.

In the quantitative phase, the team used a general information questionnaire, the Machine Alarm Fatigue Scale and the Resilience Scale, analyzing the data with descriptive statistics, univariate tests including t-tests, one-way ANOVA, the Kruskal-Wallis H test and Spearman correlation, and multiple linear regression. The multivariate model identified several independent associations. Monthly income was positively associated with alarm fatigue scores (β = 0.185, p = 0.003), as were night shift duty (β = 0.247, p = 0.002) and rotating shifts on continuous renal replacement therapy machines (β = 0.216, p = 0.002).

Psychological resilience showed the strongest association in the opposite direction: higher total scores on the Resilience Scale were linked to lower alarm fatigue (β = −0.452, p < 0.001). Experience also mattered. With nurses of one to five years in hemodialysis as the reference category, those with six to ten years (β = −0.131, p = 0.040) and more than ten years (β = −0.155, p = 0.043) of experience reported significantly lower alarm fatigue scores.

The qualitative component, analyzed through conventional content analysis, added texture to these statistical signals. Interviews revealed four major themes concerning the influencing factors of alarm fatigue and suggestions for improvement. The first was the dynamic association between alarm rhythm and the phases of dialysis treatment, suggesting that the pattern of alarms is not uniform across a session but tied to where a patient is in the treatment cycle.

The second theme captured behavioral differentiation from passive response to active anticipation, describing how nurses move from simply reacting to alarms toward predicting when they will sound and why. The third concerned the attribution of non-actionable alarms to multiple responsible agents, pointing to the distributed causes behind alarms that do not require intervention. The fourth theme described latent occupational fatigue under seemingly quiet operations, the idea that fatigue accumulates even when the ward appears calm.

These four themes were further elaborated into twelve sub-themes. Because the design was convergent parallel, quantitative and qualitative data were collected simultaneously with equal priority and integrated during the results and discussion phases. This structure allowed the statistical associations and the interview themes to illuminate one another: the regression coefficients quantified which factors carry weight, while the themes explained how those factors operate in daily dialysis practice.

The authors emphasize that these are associations observed in a single-center sample rather than demonstrated causal effects, and the study's findings are specific to the surveyed population of hemodialysis nurses. Based on the combined evidence, the study's conclusion points toward multi-level strategies for managers. These include structured knowledge transfer, so that less experienced nurses can benefit from the accumulated expertise that the data associate with lower fatigue; optimization of staffing allocation, addressing the shift-type associations with night and rotating CRRT duty; monitoring of psychological resilience, given its strong inverse association with alarm fatigue scores; and improvement of device functions, responding to the device-related dimension that emerged in both the regression model and the interview themes.

The authors suggest that such strategies could systematically reduce alarm fatigue and help ensure a safe hemodialysis nursing environment. The interview themes offer a window into how the statistical associations play out at the bedside. The theme linking alarm rhythm to treatment phases implies that the alarm burden is patterned rather than random, varying with where a patient sits in the dialysis cycle.

The theme of latent occupational fatigue under seemingly quiet operations suggests that the absence of constant alarm noise does not necessarily indicate the absence of fatigue, a point the authors connect to the occupational dimension of the problem. The study also carries practical implications for how hospitals allocate personnel. The independent associations of night shift and rotating CRRT shifts with higher alarm fatigue scores suggest that duty schedules are among the modifiable organizational factors worth attention, while the income association indicates that economic factors may relate to how nurses experience the alarm environment.

The resilience finding, the largest coefficient in the model, aligns with the study's recommendation that managers monitor psychological resilience as part of a broader approach rather than treating alarm fatigue as a device problem alone. As an open-access study shared early to provide faster access to peer-reviewed, accepted research, the article is citable and carries a permanent DOI, with a final Version of Record to follow. For clinicians and hospital managers, the study offers a reference framework: alarm fatigue in hemodialysis nursing is associated with years of working experience, shift type, income and psychological resilience, and it spans individual, organizational and device-related dimensions.

The authors position their four themes and twelve sub-themes as a basis for clinical practice improvements, from knowledge transfer structures to device function upgrades, aimed at reducing the fatigue that accumulates whenever machines speak and nurses must decide whether to listen.

Subject of Research: Machine alarm fatigue and coping strategies among hemodialysis nurses

Article Title: Coping strategies and influencing factors for machine alarm fatigue in hemodialysis nurses: a convergent parallel mixed-methods study

Article References: Wang, Y., Wang, Q., Xu, Y., Tian, Y., Wu, J., Lü, X., Tian, Y., & Wei, Y. (2026). Coping strategies and influencing factors for machine alarm fatigue in hemodialysis nurses: a convergent parallel mixed-methods study. BMC Nursing. https://doi.org/10.1186/s12912-026-05576-x

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05576-x

Keywords: alarm fatigue, hemodialysis, nursing, mixed-methods, psychological resilience, night shift, CRRT, patient safety, occupational fatigue, dialysis machines, content analysis, BMC Nursing