Fatigue is an issue affecting many healthcare workers with the potential to adversely affect work performance (Garrubba & Joseph 2019).
What is Fatigue?
Fatigue can be defined as ‘mental and/or physical exhaustion that reduces your ability to perform your work safely and effectively’ (Safe Work Australia 2017).
Fatigue can have many adverse effects in the workplace, including:
Increased risk of work errors (e.g. medication errors)
Increased risk of accidents and injuries
Reduced reaction times
Reduced communication ability
Reduced ability to identify risks
Reduced ability to convey empathy
Reduced decision-making ability
Reduced ability to control emotions
Reduced attention to detail
Reduced problem-solving ability
(Garrubba & Joseph 2019; Kelton et al. 2014)
Fatigue may also lead to long-term physical health issues such as:
Depression and anxiety.
(Garrubba & Joseph 2019)
Causes of Fatigue in Healthcare
Factors that may contribute to fatigue include:
Poor work scheduling and planning
Working night shifts
Inadequate time between shifts
Being awake for long periods of time
Uncomfortable environmental conditions
Mental and physical work demands
Poor quality of sleep
Travel to and from work
Commitments to family, social activities and other employment.
A 2012 study by Stimpfel, Sloane and Aiken found that patients’ dissatisfaction with their care escalated as the number of nurses working shifts of 13 hours or more increased. Another important finding from Stimpfel et al. (2012) was that:
‘...Nurses working shifts of 10 hours or longer were up to two and a half times more likely than nurses working shorter shifts to experience burnout and job dissatisfaction…’
Stimpfel et al. (2012) describe longer shifts as detrimental to healthcare workers’ wellbeing, care of clients and staff turnover. They also acknowledge the necessity for constructing workplace policies and cultures that support nurses taking leave, leaving their shift on time, and not working overtime without being paid accordingly.
Caruso (2014) found that nurses who are fatigued place other people at risk of harm during their commute to and from their nursing shift, noting that sleep must be made a priority by employers (when rostering) and nurses (in their personal lives).
Scott et al. (2014) found in their study that nurses are more likely to experience decision regret (a ‘negative cognitive emotion that occurs when the actual outcome differs from the desired or expected outcome’) if they are fatigued, lack adequate sleep and are not able to recover well between shifts.
According to Sagherian et al. (2016), there is a higher rate of chronic fatigue among nurses that work on their days off in comparison to nurses who do not work on their days off. Furthermore, there is better recovery between shifts and less fatigue reported by nurses who claim to feel refreshed after sleeping.
Physical performance is lower amongst nurses who experience acute or chronic fatigue, and furthermore, nurses with chronic fatigue consider themselves to be ‘less alert and less able to concentrate when providing patient care’ (Sagherian et al. 2016).
Both acute and chronic fatigue in nurses is also linked to poorer communication (Sagherian et al. 2016).
Fatigue can also present as compassion fatigue, which occurs when a person is fatigued or exhausted to the point where they cannot properly take part in caring relationships (Nolte et al. 2017).
Øyane et al. (2013) found in their Norwegian study that night-shift nurses are more likely to experience insomnia than nurses who do not work night shifts. Chronic fatigue is more prevalent among night-shift nurses, however, anxiety, depression and sleepiness were not found by this study to be linked to night-shift nursing.
Eldevik et al. (2013) found that excessive sleepiness, insomnia and excessive fatigue were connected to ‘quick returns’ (having less than 11 hours between nursing shifts). Smith-Miller et al. (2014) similarly conclude that many nurses experience ‘high rates’ of fatigue, and that working a shift longer than 12 hours increases fatigue and errors.
Strategies for Preventing Fatigue
Get an appropriate amount of uninterrupted sleep before each shift
Avoid alternating between day and night shifts if possible
Take breaks in a quiet place away from the unit
Eat a healthy, well-balanced diet
Reduce caffeine consumption
Reduce stress through strategies such as exercise and meditation
Adjust light sources (bright lights will increase alertness during night shifts, but exposure to sunlight after a night shift will interrupt the sleep-wake cycle)
Try to maintain a healthy work-life balance
Ensure sleep environments are calm and quiet
Remove electronics from sleep environments
Recognise the signs of fatigue and take appropriate actions for the safety of staff and patients.
Nolte, AGW, Downing, C, Temane, A & Hastings-Tolsma, M 2017, ‘Compassion fatigue in nurses: A metasynthesis’, Journal of Clinical Nursing, [Epub ahead of print], viewed November 9 2017, https://www.ncbi.nlm.nih.gov/pubmed/28231623
Sagherian, K, Clinton, ME, Abu-Saad Huijer, H & Geiger-Brown, J 2016, ‘Fatigue, Work Schedules, and Perceived Performance in Bedside Care Nurses’, Workplace Health & Safety, vol. 65, no. 7, pp. 304-12, viewed 9 November 2017, https://www.ncbi.nlm.nih.gov/pubmed/27872407
Scott, LD, Arslanian-Engoren, C & Engoren, MC 2014, ‘Association of sleep and fatigue with decision regret among critical care nurses’, American Journal of Critical Care, vol. 23, no. 1, pp. 13-23, viewed 9 November 2017, http://ajcc.aacnjournals.org/content/23/1/13.short
Stimpfel, AW, Sloane, DM & Aiken, LH 2012, ‘The Longer The Shifts For Hospital Nurses, The Higher The Levels Of Burnout And Patient Dissatisfaction’, Health Affairs (Project Hope), vol. 31, no. 11, pp. 2501–9, viewed 9 November 2017, https://www.ncbi.nlm.nih.gov/pubmed/23129681