COMMENTARY

Running on Empty: Fatigue and Healthcare Professionals

Claire C. Caruso, PhD, RN

Disclosures

August 02, 2012

Editorial Collaboration

Medscape &

In This Article

Strategies to Promote Adequate Sleep

Employers, managers, and healthcare workers share the responsibility for reducing the costly and sometimes fatal consequences of fatigue. Key strategies include making sleep a priority in the healthcare worker's personal life and designing schedules and organizing the work to reduce fatigue. The following are just a few of the suggestions offered by experts to help healthcare employers and managers reduce fatigue and associated risks.[33,34,35,36,37,38,39,40]

  1. Establish at least 10 consecutive hours per day of protected time off-duty to allow workers to obtain no fewer than 7-8 hours of sleep. A panel of experts authored an Institute of Medicine report that recommended that work hours for nurses be limited to 12 hours a day and 60 hours per week.[41]

  2. Permit frequent brief rest breaks (eg, every 1-2 hours) during demanding work, which are more effective against fatigue than a few longer breaks. Allow longer breaks for meals.

  3. Schedule five 8-hour shifts or four 10-hour shifts per week, which are usually acceptable. Depending on the workload, 12-hour day shifts may be tolerated when interspersed with days off. During the evening and night, shorter shifts (eg, 8 hours) are better tolerated than longer shifts.

  4. Examine work demands with respect to shift length. Twelve-hour shifts are more acceptable for "lighter" tasks (eg, desk work).

  5. Plan 1-2 full days of rest following 5 consecutive 8-hour shifts or 4 consecutive 10-hour shifts. Consider 2 rest days after 3 consecutive 12-hour shifts.

  6. Provide training to inform workers of the challenges linked to shift work and long work hours and what resources are available to them to help with any difficulties they are having with their work schedule.

  7. Examine close calls and incidents to determine the role, if any, of fatigue as a root cause or contributing cause to the incident.

The following are a few of the suggestions experts offer to help healthcare workers[33,34,35,36,37,38,39,40]:

  1. Learn about sleep to adopt better practices and routines to improve sleep. The National Heart, Lung, and Blood Institute's Your Guide to Healthy Sleep provides sleeping tips, information on sleep disorders, and how to seek help from sleep professionals.[41]

  2. Allow enough time for sleep. Most people need 7-9 hours of sleep each day,[42,43] and it is best to get this amount on a daily basis to avoid a build-up of sleep debt and associated risks.

  3. Prepare for sleep by avoiding heavy meals and alcohol before sleep and reducing intake of caffeine and other stimulants several hours before bedtime. These substances can make it difficult to get quality sleep.

  4. Arrange a sleep environment that is very dark, comfortable, quiet, and cool to facilitate falling asleep quickly and staying asleep.

  5. Follow an exercise routine (but not 3 hours before bedtime); daily physical activity improves sleep, helps with stress management, and promotes general health.

  6. Address other sources of sleepiness. For example, some medications cause drowsiness so it is best to find a non-sedating alternative.

  7. Seek assistance from healthcare providers for continuing difficulties with sleep. An estimated 50-70 million Americans have a sleep disorder, which is often undiagnosed and untreated.[2]

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