Have you thought about the impact of shift work and fatigue on your practice as a doctor?
Most doctors are passionate about improving the health and wellbeing of their patients. The irony, of course, is that our own work conditions may make it challenging to stay healthy at times. Long hours, rushed meals, not enough sleep and shift work are all an integral part of our work. These factors put us at risk of fatigue and clinical error.
Long hours and shift work are a combination of many factors:
- the need for training exposure and skill acquisition
- a belief that “this is how we have always done it”
- cost pressures on our health system
- the need for services to be available 24/7, over weekends and on public holidays.
It may take time for safer rosters and better shift work patterns to make their way into our RMO rosters. In the meantime there are a couple of things you need to know:
- Shift work and excessive work hours >10 hours cause fatigue
- Fatigue is serious and is a danger to yourself and your patients
- The Health and Safety in Employment Act 2003 Amendment clearly identifies that fatigue in workplaces is a hazard and that shift work is a cause of fatigue
- Managing fatigue is a shared responsibility between employer and employee
- We cannot adapt to shift work but we can learn to manage it safely
- Sleep debt from over working and ‘burning the candle at both ends’ accumulates… the more it accumulates the worse our performance and the higher our risk of medical error
- The longer we are awake, the poorer our performance.
- Serious health risks are associated with chronic sleep debt.
Strategies for managing fatigue and shift work
- Get involved politically to make our workplaces safer by joining your union (the RDA) and NZMA so we can advocate on your behalf
- Record your actual hours and keep an eye on them—don’t make a habit of staying late or working overtime unless you absolutely have to
- Ensure you take all your annual leave entitlements and if leave is an ongoing problem at your DHB then contact your union for support
- On your days off ensure you recover from sleep debt and rest at least some of the time
- Develop a fatigue checklist to keep a tab on your sleep
- When working long days, nights or weekends remember the basics – stay hydrated, take meal breaks, take toilet breaks and take breaks to take stock and breathe!
- Figure out safe ways of travelling to and from work on days you work excessive hours or nights
- Eat a healthy balanced diet and always take snacks on long days!
- Incorporate exercise and fitness into your life on a regular basis
- Avoid over indulging in alcohol and relying on drugs, including prescription drugs, to manage your fatigue and sleep
- Don’t self prescribe sleeping pills or aids to help you relax – this should be overseen by a GP
- Ensure you stay in touch with family and friends and let them know when you need to rest and just don’t feel up to socialising
- Ensure your partner/spouse understands your sleep/rest needs and can support you in this
As a final note, all 21 DHBs and the RDA recently agreed to provide a free online training on fatigue and shift work. Although it may feel like a chore to do this, especially if you are already feeling fatigued, there is real benefit in learning about fatigue and how to manage shift work and our rosters better. Email your RMO office if you want to do the free course.