Frequently Asked Questions about fatigue

 

Q1. What is fatigue?
Fatigue goes beyond common ‘tiredness’. Fatigue is the state where tiredness becomes overwhelming and isn’t relieved by rest or sleep. You can find the facts about fatigue here.

Q2. What causes fatigue?
Fatigue can be triggered, or exacerbated, by a variety of factors including stress, poor diet and nutrition, lack of sleep and other lifestyle factors. Within the NHS, high-pressure working environments, long working hours, sporadic shift patterns, night-working and a lack of appropriate rest can all contribute to a fatigued NHS workforce.

Q3. I work for the NHS, what can I do to fight fatigue?
First, don’t try to ‘power through it’. Fatigue puts you, your colleagues and your patients at risk. The #FightFatigue campaign has published a range of practical resources that will help organisations and individuals to help manage, and reduce, fatigue.

Q4. I find it very hard to sleep before / in between night shifts, how can I manage this?
This is a common problem affecting night shift workers. We have published helpful tips about working well at night. You should also read the BMJ’s article on optimising sleep for night shifts, and look at its interesting infographic.

Q5. What advice do you have about how to take a power nap?

 

Some general points about power napping:

  • You need a quiet, dark room which is not too hot or cold
  • Ideally somewhere you can lie down flat
  • Ideal length is 20 minutes (10-30 minutes) - you don’t want to fall into a deep sleep and have to wake up from that.  Set your alarm, giving yourself a bit of time to relax first
  • Consider a small dose of caffeine before your nap, it will then be kicking in as you wake.  Avoid (or reduce dose) if you need to sleep again when you get home.
  • Don’t worry about falling asleep, instead think about relaxing.  There are various breathing techniques and audio tools that you can try.  Keep your eyes closed even if you can’t sleep.

 

Q6.Surely this is a problem for all shift workers?  Why the focus on medical staff and anaesthetists?

The #FightFatigue campaign was launched by bodies who represent and ensure the welfare of anaesthetists and intensivists. We agree that fatigue affects everyone, but we must strive to achieve a safe standard for all, and not wait until the last professional group/organisation recognises the impact of fatigue on safety for patients and staff. Many other industries – such as aviation – who have responsibility for the welfare of large numbers of people, already have ‘safety critical’ classifications in place which mean rest breaks and rest facilities are rigorously in force; with no such protections currently offered within the NHS, we felt a collective duty to raise our voice.

Q7.What can I do to support my NHS colleagues if I think they’re struggling with fatigue?
It’s great that you want to support your colleagues – respecting the importance of fatigue self-assessment and protected rest breaks is crucial to changing the culture around fatigue. Let your colleague know that they have your support and signpost them to the #FightFatigue campaign hub for more information and advice.

Q8. What should I do if I think my colleague is too tired to drive?
This can sometimes feel like an uncomfortable conversation to have, but it’s vital that we get better at talking about fatigue. Introduce our simple fatigue tool into your team’s practice – it offers easy to remember mnemonics that provide a structure for supporting colleagues who may be on the brink of driving when fatigued.

Q9. I am concerned that my department cannot meet the standards for rest facilities, what should I do?
The standards have been carefully designed, considered and debated.  It was felt that all hospitals should be able to achieve the minimum “amber” standard, even if physical constraints prevent dedicated on call rooms being available. We are aware of hospitals who have managed to make changes, converting an office to an on call room for example or even just preventing re-allocation of on call rooms to offices.

Q10. I am discouraged by my department from napping on night shifts, what should I do?
One of the first things to do is to share the #FightFatigue resources; these simple guides contain evidence of why we need to improve attitudes to rest and practical ways for departments to support better rest breaks.

 

  • It might be helpful to look at examples of hospitals and Trusts where a change in culture is supported – for example the HALT – Take a break campaign at Guys and St Thomas’ NHS Foundation Trust.
  • Identify a small team of like-minded people who can help you make change in this area.  You could approach your Linkman and College Tutor who should both have heard the talk by Dr Mike Farquhar, Consultant in Sleep Medicine at the Evelina London at Guys St Thomas, at the about fatigue. You can also watch his ARIES Talk at the RCoA here.


Q11. We don’t have anyone who can deliver education on fatigue and shift working locally, who can I ask?
We’ve published lots of information and links to training talks and videos on our website to help with training. 

Q12. Our rota and workforce constraints do not allow for rest after a period of on call, we feel we have no option other than to carry on, what can we do?
The short answer is, if you feel unsafe to work, you have a duty to declare this and must not work. Just because you have always worked this way, doesn’t mean you should continue too.  We appreciate that workforce constraints make this difficult. It might be useful to see what your Occupational Physician thinks.  More and more is being written about the impact of fatigue on safety, and an Occupational Physician may know about this from work in other industries.  In fact most other safety-critical industries have a formal fatigue risk management strategy, for example the petrochemical industry, the nuclear industry, some road haulage firms, the electrical industry as well as aviation.  Another approach would be to start there, and draw up a Departmental fatigue risk management strategy.  We are currently planning a survey into consultant fatigue and working patterns and we hope to share examples of good practice here, to help others to improve.  

Q13. We have seen the data regarding trainee fatigue, is there a plan to look at other grades of doctors?
Yes, we are investigating the possibility of a survey of both consultants and staff and associate specialist grade doctors.  We are working with colleagues in other membership organisations regarding this.  We recognise that “survey fatigue” can also occur and want to ensure that any survey is appropriately timed.

Q14. Have the negative consequences of this work been considered?  For example, will talking more about this issue make people more anxious about being fatigued?
Yes, we realise that this can be a difficult subject, but we believe it is important to address it.  After all, we all have a circadian rhythm, it’s part of being human.  What we want to do is raise awareness about the impact of fatigue on everyone's practice and help individuals and the wider NHS to identify ways of mitigating this.  Becoming aware of an issue and developing a sense of urgency are the first steps needed before people seek remedies.

Q15. What can my organisation do to help to #FightFatigue?
We need to affect change across the NHS if the issue of fatigue is to be put to bed, and a number of organisations have already backed the campaign. There are four simple ways to get involved:

 

  1. Download the fatigue awareness educational resources and ensure they are used as part of the induction programmes for staff working in all departments.
  2. Adopt the minimum standards for rest facilities, and follow the guidelines published by the AAGBI.
  3. Promote positive attitudes towards rest across the workforce and help reduce the stigma attached to talking about fatigue by joining the #FightFatigue Twibbon campaign.
  4. Make a commitment to become a signatory to the #FightFatigue campaign joint statement, and offer feedback on how to enhance this initiative, email fatigue@aagbi.org