We all know how it feels when we fail to get a good night's sleep. We move through the day as though in a fog and no amount of coffee can sharpen our mind or erase the sluggishness. But fatigue is different; it's tiredness cranked up a notch, the result of prolonged mental and physical exertion, ongoing stress and anxiety, extended sleeplessness, and exposure to stressful environments, according to researchers. 

It's no wonder, then, that fatigue so often affects healthcare workers, especially in the era of COVID-19 when doctors, nurses, and other caregivers are stretched nearly to the breaking point. In fact, the American Nurses Association recently urged the U.S. Department of Health and Human Services to declare the "current and unsustainable nurse staffing shortage facing our country a national crisis." 

Managing the health and safety of your healthcare workforce directly affects the safety of patients. Although the current pandemic is ongoing, fatigue and burnout are perennial problems that are often signs of broken processes and ineffective management. Read on to learn more about healthcare staff fatigue and how organizations can use workforce management tools to curb fatigue and its negative effects.

Causes and consequences of fatigue in the workplace 

The conditions that can cause fatigue—mentally and physically demanding work, stressful situations, and long work hours and lack of sleep—are constant factors in healthcare operations. Those influences have been heightened during the COVID-19 pandemic. 

Fatigue does more than make people irritable and unfocused, though. Research has shown that it can lead to decreased motivation; reduced reaction times and alertness; poor judgement; impaired concentration; and difficulty with coordination, memory, and information processing, among other problems. For healthcare workers, these signs of fatigue can be costly and deadly. 

While healthcare organizations can't magically cure diseases or prevent stressful situations from happening, they can use workforce management strategies and a Fatigue Risk Management System (FRMS) to curb the effects of those stressors, reduce the risk of fatigue, and help employees cope in healthy ways. 

Implementing a Fatigue Risk Management System (FRMS)

In other industries and government sectors where fatigue poses safety risks—including aviation, disaster work, and the Coast Guard—organizations have successfully implemented workplace fatigue management programs to mitigate its effects on staff. 

And although the healthcare industry has traditionally lagged in implementing a standardized FRMS, that doesn't mean healthcare organizations shouldn't borrow from other industry best practices when implementing their own. In fact, they can do so by using workforce management tools and strategies to provide structure and fuse the best ideas in use across industries. 

How to build an FRMS 

When developing your own system to prevent risks associated with staff fatigue, begin by researching resources inside and outside of the healthcare industry. In addition to using workforce management tools for things like optimal staffing, your FRMS might include guidelines about:

  • Restricting the number of hours workers can be on the job
  • Training and education tools
  • Fatigue assessments, and other resources  

For instance, an American Nurses Association position statement on nurse fatigue says "employers should limit shifts (including mandatory training and meetings) to a maximum of 12 hours in 24 hours." 

However, an FRMS can only work if everyone—from employers, to managers, to employees—are fully invested in its success. For senior management, that means creating a culture of safety where employees feel comfortable reporting that they feel too tired to work and aren't punished for being truthful about their fatigue, the Centers for Disease Control and Prevention (CDC) recommends. 

The CDC also calls on managers to stay alert for signs and symptoms of fatigue, which include everything from yawning to decreased concentration. Employers and managers should keep tools like the Epworth Sleepiness Scale in common areas and encourage employees to use it and take action when needed. 

Employees also have a role to play in preventing fatigue, including following "sleep hygiene" recommendations, like ones outlined by the U.S. Department of Labor's Occupational Safety and Health Administration (OSHA) that include:

  • Getting seven to nine hours of sleep—striving for uninterrupted sleep—every day
  • Making an effort to sleep at the same time every day
  • Sleeping in a place that's cool, comfortable, dark, and quiet 
  • Taking naps that last fewer than 45 minutes
  • Making sure to get sleep within the immediate past eight hours before starting an evening or night shift 

Healthcare workers shouldn't go it alone when it comes to fatigue, either, says the CDC. Employees should use a "buddy system" to check up on each other and watch for signs of fatigue in their coworkers. Employees who find they have trouble falling or staying asleep for long stretches of time should also be encouraged to talk to their doctor about managing possible sleep disorders. 

Address staffing issues in fatigue risk management 

No amount of sleep hygiene practice or well-meaning training can address one of the most important parts of managing fatigue in healthcare workers: appropriate staffing. 

Senior managers who staff their units with safety in mind not only ensure better patient care but also help their employees avoid fatigue and burnout. One important first step to safe staffing is using workforce management tools, including ones that provide visibility into real-time census data and patient acuity, to help managers balance shift work, schedule their workers appropriately, and avoid understaffed units. 

Having the right number and balance of staff for every shift is only the first step for creating a staffing plan that helps prevent fatigue. 

For instance, scheduling employees for back-to-back shifts without enough rest and recovery time between them is a recipe for creating a fatigued workforce. So, too, is scheduling employees for shifts that are too long and don't include breaks. 

Instead, the CDC recommends that employees have at least 11 hours between shifts during each 24-hour period, and one full day of rest per seven days of work. And even though breaks are technically part of every schedule, healthcare workers are notorious for working through them, which is why the CDC says regularly scheduled breaks should be not only encouraged, but formalized. 

Managers should also consider how work responsibilities themselves can lead to fatigue during shifts and take steps to avoid it. For instance, the CDC suggests rotating employees through tasks that are repetitive or particularly strenuous, as well as scheduling tasks that might be difficult or monotonous for the day shift, rather than the night shift. Also, people who are coming onto their shifts could take on tasks that are particularly patient-safety oriented, allowing those who are at the end of a long shift to work on lighter assignments. 

Finally, an overlooked area of fatigue management is the stressful work environment itself. That's why managers should be sure to include things like debriefs and huddles, as well as offer counseling for employees who might need extra support. For instance, research shows that debriefing can help employees reflect, identify errors, and improve future performance. Such tools are even more important in the era of COVID-19. 

When it comes to managing fatigue, everyone in the organization has a role—from the managers who are responsible for scheduling workers to the employees who must practice self-care and recognize when they're too fatigued to safely perform their job duties. Workforce management tools and an FRMS can help healthcare leaders create a supporting, non-punitive environment that will help workers stay healthy, prioritize rest, and keep patients safe.

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