Struggling to keep your eyes open: ? Could it be Workplace Fatigue

A Nurse with Workplace Fatigue?

“Head Nurse Parker!” I opened my eyes to see the night matron glaring at me in the twilight world of the nurses’ night station. My head was resting on my cupped hands, elbows conveniently propped on a pile of fluid charts. It was 2 am, January 1st 1975. I had fallen asleep on duty sitting upright! Matron stood hands on hips – aghast! Whilst I was terrified.

I tried to remember the name, date of birth, and diagnosis of my 22 patients. The night matron escorted me around the ward testing me. Her anger mounted as my mind emptied itself of anything remotely useful. I’d been “in charge” on nights for nine consecutive shifts. Each shift started at 8:30 pm and finished at 8 am. I’d worked through Christmas, Boxing Day, and tonight, New Year’s Eve, was my last working night.

All the head nurses had been given a large glass of sherry to celebrate the New Year. For those of us already reeling from eight nights under our belts, this did not help. We were battling to sleep through the celebrations in the nurses’ quarters. Today, the landscape is dramatically different.

Employers now have a stringent duty to take all practicable steps to ensure employees are safe at work. Moreover, fatigue is recognised as a workplace hazard to be avoided.

What is Fatigue? More Than Just Feeling Tired

Fatigue is a complex, multifaceted state, far exceeding simple tiredness. It’s a general term encompassing a wide spectrum of feelings: exhaustion, weariness, and overwhelming sleepiness. It can stem from various sources: insufficient sleep, prolonged mental or physical work, or extended stress. Anxiety or even the dulling repetition of boring tasks can also cause it.

Fatigue Types

Acute Fatigue:

This is the most common form, typically a direct result of short-term sleep deprivation or intense activity. Crucially, it’s usually reversible with adequate sleep and relaxation. Think of the tiredness after a long, demanding workday.

Chronic Fatigue:

This is a more insidious and severe state of persistent tiredness not relieved by rest. It can build up over time due to consistently inadequate sleep, prolonged stress, or underlying health conditions.

Circadian Rhythms: The Master Clock of Our Alertness

Our bodies are governed by an intricate “internal” or “biological clock,” a natural cycle of sleep and wakefulness. This cycle, known as circadian rhythms, also includes alertness. While external cues like daylight and darkness play a significant role, the brain ultimately sets this powerful pattern. Most of these cycles are approximately 23-25 hours long, featuring natural dips. During these dips, even well-rested workers experience reduced alertness. These dips typically occur between 2 am and 6 am and again in the early afternoon (1 pm to 3 pm). Therefore, they are danger areas for fatigue. Disrupting these natural rhythms, as is common with shift work and irregular hours, has profound implications. It affects health, safety, and cognitive function heavily.

Health and Safety: The Real Threat of Workplace Fatigue

The negative impacts associated with extended shifts and shift work are well-documented and alarming. They include:

• Increased Accidents and Incidents: A heightened risk of on-the-job accidents, errors, and near-misses.
• Reduced Sleep Quality and Quantity: Chronic disruption of natural sleep patterns, leading to insufficient and poor-quality rest.
• Impaired Performance: Decreased reaction times, poorer decision-making, and reduced cognitive function (Scott, Rogers, Hwang, & Zhang, 2006.)
  Long-Term Health Consequences: Emerging research highlights links between chronic shift work and an increased risk of cardiovascular disease, metabolic disorders (like diabetes), gastrointestinal issues, and even certain cancers, including breast cancer.
• History reminds us of workplace fatigue’s destructive potential. It has been identified as a significant contributory factor to some of the most catastrophic disasters of our time: the Three Mile Island accident in Pennsylvania, the Chernobyl nuclear power plant accident in Russia (Suzuki et al., 2005), and the grounding of the oil tanker Exxon Valdez off the coast of Alaska (Wadsworth et al.). These aren’t just isolated incidents; they are stark warnings of the critical safety issue with far-reaching societal and economic consequences.

Measuring Sleepiness: The Challenge of the Unseen

It’s tough to measure fatigue because everyone experiences it differently. Making it hard to pinpoint exactly how much fatigue contributes to workplace accidents and injuries. However, studies clearly show a link: if workers have slept less than five hours or been awake for over 16 hours, their risk of mistakes due to tiredness increases. Data from places like Alberta Human Resources and Employment consistently reveal this pattern. Most accidents happen during natural “sleepy times” – between midnight and 6 AM, and again from 1 PM to 3 PM.

I noticed this pattern firsthand during my nurse training. This really drove the point home.

Two key tools can assist in assessing sleepiness and fatigue:

1. 1. 1. HSE Fatigue Index (FI): Developed by the UK Health and Safety Executive, the FI is a robust tool designed to measure the effects of rotating shift patterns on health and safety performance. Initially providing guidance for the Railway (Safety Critical Work) Regulations, its use has expanded significantly into other high-risk sectors like policing, nuclear, and chemical industries. The FI evaluates five critical factors influencing fatigue such as, the time of day, shift duration, rest periods, breaks, and cumulative fatigue. The scores added provide a comprehensive overall index for a specific work pattern.
      2. Epworth Sleepiness Scale (ESS): The ESS is a widely recognised and easily completed eight-point questionnaire which quantifies an individual’s general daytime sleepiness. This is done by rating their chances of dozing or falling asleep in different situations. This provides a quick yet snapshot of an individual’s perceived level of sleepiness.

Causes of Fatigue: Beyond Just Lack of Sleep

While insufficient sleep is a primary driver, the causes of fatigue are multifaceted and often interconnected.

Work-Related Factors:

1. 1. • Long work hours especially shifts exceeding 8-10 hours.
      • No breaks or rest periods meaning not enought time to recover between.
      • Poor rest facilities especially during night shifts.
      • Demanding mental or excessive physical exertion.
      • High workload and time pressure.
      • Monotonous or repetitive tasks can cause fatigue.
      • Poor work-life balance meaning the worker cannot disconnect from work.
      • Unpredictable schedules such as last-minute changes to shifts or on-call duties; these disrupt sleep patterns.

Conclusion

In organisations where judgement, quick reactions and safety-critical roles are key, management must always be aware of fatigue. They must also know how to avoid adverse outcomes and errors. Identifying signs and symptoms of both long and short term health issues is crucial. Despite increased opportunities for leisure time on 12-hour and longer shift durations, challenges remain. In addition, the longer workday has the potential to contribute to human error and accidents in the workplace.

After all, if I had had a medical emergency on New Year’s Eve back in 1975, would I have been able to cope? Food for thought…

Further Information

1. • • The HSE suggestions of managing workplace fatigue with a free pdf to download
     • A full description of how and when to use the Epworth Sleepiness Score and its limitations 
     • Although I am not a nurse now, the days on the ward stay with me now. Have a look at the articles on this site for more insights or read my book The Good, The Bad and the Smugly a memoir of more of my misadventures (available on Amazon.)