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 the ability to work safely and effectively’ (Safe Work Australia, 2021).

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 motivation
• 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
• Impaired memory
• Poor teamwork.

(Garrubba & Joseph, 2019; Kelton et al., 2014)

Fatigue may also lead to long-term physical health issues such as:

• Heart disease
• Diabetes
• Hypertension
• Gastrointestinal issues
• Depression and anxiety (Garrubba & Joseph, 2019)

(Garrubba & Joseph 2019)

Causes of Fatigue in Healthcare

Factors that may contribute to fatigue include:

• Long shifts
• Roster patterns
• 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
• Inadequate breaks
• Poor quality of sleep
• Sleep loss
• Travel to and from work
• Commitments to family, social activities, and other employment (ANMF, 2019)

(ANMF 2019)

Overworked Nurses

A 2012 study by Stimpfel et al. 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 shifts 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 who 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 are 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).

Night Shifts

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 concluded 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
• Exercise regularly
• 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 (Kelton et al., 2014; Hobbs & Wightman, 2018)

(Kelton et al. 2014; Hobbs & Wightman 2018)