"Long Hours for Nurses Affect Patient Mortality" (In the News, April) brings up issues that many nurses are afraid to discuss.

My first nursing job-in a small ED in a Texas border town-left me fatigued, overworked, and stressed. I was more exhausted than I'd ever been while on active duty as a United States Air Force captain working as a tactical air controller in Iraq from 2004 to 2006. I assumed that night shifts lasting 12 or more hours were expected, and that I needed to adapt to fatigue and stress. Although I never did fully get used to these, I did become accustomed to feeling groggy and working on autopilot. I sometimes worked 12-hour night shifts five days in a row. There was no way I was able to give my all to sick patients.

I was surprised to see that staff meetings were routinely scheduled a few hours before the start of the night shift, thereby extending the shift to nearly 15 hours. On their days off, nurses on the night shift were frequently called in for training. None of us questioned these procedures, because we feared seeming weak.

I was relieved when a colleague told me that changes in 2009 to Texas' Nursing Practice Act and Health and Safety Code allowed nurses in hospitals to refuse to work overtime without fear of retribution.

Nurses need to take care of their own physical, mental, and emotional health so that they're able to provide the best possible care for their patients.

Rebecca A. Lowe, RN

Aviano Air Base, Italy