Running on Empty: Fatigue and Healthcare Professionals

Claire C. Caruso, PhD, RN


August 02, 2012

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In This Article

The Consequences of Inadequate Sleep

Considerable evidence suggests that shift work and long hours lead to shorter time asleep and poorer sleep quality.[5,6] Sleep deprivation can impair job performance and increase risk for worker errors and injuries. Errors made by fatigued healthcare workers also can endanger patients.[7,8] Moreover, sleep deprivation endangers both workers and others on the road during commutes to and from work. An estimated 20% of vehicle crashes are attributed to drowsy driving.[9,10]

Laboratory studies have compared performance in healthy participants after being kept awake for long hours or after consuming alcohol.[11,12,13] In terms of performance, being awake for 17 hours was similar to having a blood alcohol level of 0.05%, and being awake for 24 hours was similar to a blood alcohol level of 0.10%. The blood alcohol level that defines drunk driving in the United States is 0.08%, but several other countries use a cut-off of 0.05% because of the decrements in performance seen at that level.[14]

Shift type and length also influence performance. Compared with the day shift, incidents increased by 15% on the evening shift and 28% on the night shift. Compared with 8-hour shifts, incidents increased by 13% for 10-hour shifts and 28% for 12-hours shifts.[15]

Shift work and long work hours are associated with a growing number of health risks: obesity; smoking; metabolic disturbances; cardiovascular, gastrointestinal, and musculoskeletal disorders; mental disturbances, and adverse reproductive outcomes.[16,17,18,19,20,21,22,23,24] In 2007, the International Agency for Research on Cancer of the World Health Organization identified shift work with circadian disruption as a probable carcinogen.[25] The night shift is associated with a 40% increased risk for breast cancer, the most frequently studied cancer.[26,27]

Shift work also can exacerbate symptoms and progression of chronic diseases, such as sleep disorders, gastrointestinal disorders, heart disease, hypertension, epilepsy, psychiatric conditions, alcohol and other drug abuse, insulin-dependent diabetes, asthma, and health conditions that require medications with circadian changes in effectiveness.[28] Shift work and long work hours also strain personal relationships, including marriage and family life.[29]

Shift work, long work hours, and fatigue cost employers an estimated $116 billion or $2000 per employee per year owing to a variety of factors: reduced productivity; increased errors; absenteeism; increased healthcare and worker compensation costs; and worker attrition due to disability, death, and moving to jobs with less demanding work schedules.[30,31] Nurses said demanding work hours were a leading factor that drove them out of their jobs.[32]


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