Fighting Fatigue

Fatigue is a psycho-physiological phenomenon that occurs naturally after a prolonged or intense period of physical or intellectual activity, resulting in difficulty in continuing the effort or work. It occurs in routine, low-stress situations, rather than in emergency situations, where adrenaline kicks in. It is reversible, through proper rest. It is generally associated with impaired responses, lack of alertness, poor risk assessment, increased risk-taking and poor quality decisions.

In this campaign, we want to cover two aspects of fatigue; short term temporary sleep deprivation, which is more easily reversed by rest, but also the prolonged fatigue from chronic sleep restriction leading to mental problems and even sometimes to burn out and/or deep weariness with the system.

Who is affected by fatigue?

Fatigue affects everyone.

The medical professions are not an exception - they are all likely to be affected by fatigue, including doctors, nurses and care assistants working in or outside a health care institution.

However, it must be stressed that categories of staff who work at night and/or in shifts are more subject to fatigue-related risks.

What are the effects of fatigue

After 12 h awake our empathy starts to wane, logical reasoning is harder, vigilance becomes more variable and cognitive and motor skills become worse to a point where, after 16 to 18 h of wakefulness, our performance is as bad as if we were under the influence of alcohol. Our mood deteriorates, we find it much more difficult to think flexibly and respond to quickly-changing situations, and are more likely to take risks. After the ninth consecutive hour of work the risk of being involved in an accident increases and after a 12 h shift we are twice as likely to crash driving home than after an 8 h shift.

Where does the fatigue come from?

Among the factors that determine the level of fatigue of the healthcare professional, frequency, intensity and duration of the work plays an important role, as well as individual clinical experience, level of supervision and support from the wider team.

The current working conditions shared by a large number of healthcare workers across Europe contribute to the emergence of fatigue: long day & night shifts, reduced teams of staff due to shortages, untenable staff/patient ratios, unrealistic expectations of staff and periodically, abusive patients.

Other elements may also play an important role: work culture and liability for fault.

Which factors are causing prolonged fatigue?

It is known that prolonged fatigue associated with mental health problems or even burn out can be, among other things, caused by:

repeated sleep deprivation
having to continue to function while being tired
not being able to express that you are tired, because it is not recognised or accepted in the culture
feeling that things are not going to change, of being used by others or by ‘the system’
not being recognised as having a difficult job, with responsibilities, which requires constant attention
not feeling respected or valued by the organisation, by government or by wider society
tension between professional and domestic and family demands
not being able to carry out one's job - caring for the person - in the way one thinks one should, in a humane way, by devoting the time necessary for listening and empathy, beyond just performing technical and administrative procedures.

What is fatigue the symptom of?

Fatigue is just a symptom of the extent to which policies of cost rationalisation in healthcare have contributed to progressively shape inhumane working environments in the healthcare sector, both in public and private institutions.

Cost rationalisation is not fundamentally wrong in itself; by pushing for the rationalisation of existing activities, it allows margins to be released and can lead to new human and technical investments that contribute to a higher quality of care.

However, all too often, cost rationalisation is an objective in itself, associated with productivity gains, and the margins generated are not reinvested.

Moreover, increasing productivity often comes at the cost of increased fatigue among health care staff, through the upward revision of patient/practitioner ratios. Another often favoured rationalisation option, the computerisation of administrative tasks, will in some cases lead to an increase in the non-medical tasks to be carried out by healthcare professionals, often because their needs were not taken into account in the development of these tools.

When rationalising costs, policy makers and sometimes even the hospital management seemed to have forgotten that the sector is essential to collective and individual well-being, relying on people who are invested in caring for others.

Quite often, in many places, the limits of what is reasonable to expect from health professionals, as human beings,have been crossed.

The Covid-19 pandemic has only added another layer of inhumanity, when health workers had to work long days and nightshifts, with no rest for weeks on end, while having to make and deliver difficult decisions such as prioritising the sick or preventing relatives from being by their loved one's side as they took their last breath.

It would be a mistake for our campaign to stop at fatigue. The challenges facing health services go far beyond fatigue. It is a question of bringing humanity back to care, of making the working environment liveable again, if we are to avoid the collapse of the health care system on a European scale. However, fatigue is a good place to start; much is known from other safety-critical industries about managing workplace fatigue effectively, which can be used to improve the healthcare environment.