Worker Fatigue and Its Adverse Effects: Why Do We Continue To Ignore The Evidence?
How many people or friends do you know who work 12+ hour shifts or work long shifts several days in a row with little sleep? How many professions do you whose work requires the same? I can name at least 12 friends that I know who long hours. I also know the toll those hours take on them professionally and personally. As for professions, probably the first ones that come to mind are doctors, nurses, police, firefighters and military personnel. There are other workers who have similar work demands, although they may occur when production demands (i.e. large orders come in) exceed the norm. Then overtime and extra shifts can occur. The result of fatigue on humans has been documented over and over. We know that fatigue results in decreased physical and mental function. The overall performance declines and errors and mistakes are more likely to occur. The question that I have is why do we continue to allow and/or expect certain professions to work those types of hours and yet have regulations that prevent other professions (airline pilots, truck drivers) from working those same extended hours? Why…when we know that extended work hours leads to worker fatigue and poor performance?
Last December, 2011, The Joint Commission (1) came out with a sentinel alert regarding healthcare worker fatigue and patient safety. Let me point out a few statements from the alert:
“Shift length and work schedules have a significant effect on health care providers’ quantity and quality of sleep and, consequently, on their job performance, as well as on the safety of their patients and their individual safety.”
“…in a series of studies of nurse fatigue and patient safety – showed that nurses who work shifts of 12.5 hours or longer are three times more likely to make an error in patient care.”
“Additional studies show that longer shift length increased the risk of errors and close calls and were associated with decreased vigilance, and that nurses suffer higher rates of occupational injury when working shifts in excess of 12 hours.”
“An overwhelming number of studies keep saying the same thing – once you pass a certain point, the risk of mistakes increases significantly,” says Ann Rogers, Ph.D., R.N., FAAN, a nationally renowned sleep medicine expert with Emory University’s Nell Hodgson Woodruff School of Nursing. “We have been slow to accept that we have physical limits and biologically we are not built to do the things we are trying to do.” (emphasis mine)
The alert cites studies about doctors who worked 24 hour shifts and surgeons who got less than 6 hours of sleep before surgery. Some interesting, if not frightening statistics from those studies were:
- Make 36 percent more serious preventable adverse events than individuals who work no more than 16 consecutive hours
- Make five times as many serious diagnostic errors
- Experience a 1.5 to 2 standard deviation deterioration in performance relative to baseline rested performance on both clinical and non-clinical tasks
- Report making 300 percent more fatigue related preventable adverse events that led to a patient’s death
The alert makes it perfectly clear that extended work hours are a known hazard. However, it doesn’t recommend eliminating the practice of extended shifts. It only recommends ways in which to “mitigate” the adverse effects of extended shifts. In my opinion this is a perfect example of willful blindness and cognitive dissonance. Everyone knows that humans are not made to work extended hours. Study after study shows that adverse effects are much more likely to occur as a result of fatigue. But yet we continue to find and create more reasons to continue with the current practice and culture rather than acknowledge the threat that is staring us in the face. I invite you to read the feature article in this month’s (January 2012) Ergo Edge newsletter, “Everything Is Fine… No Problems Here.” Are You Sure About That?, in which I explain the reasons and causes behind this phenomena.
The effects of working extended hours should be note by operations and production leaders in all industries. Policies and practices of allowing, encouraging extended work hours should be halted. The business may have filled their staffing needs with bodies, but those bodies are not of sound mind and body. The negative results will eventually come to fruition and then what is the response given? Is it, “we took steps to mitigate the effects of fatigue but accidents still happen” or is it “we knew better but didn’t bother to change anything just because…that’s the way we’ve always done it”? The former is most likely; the latter is the honest answer.
So, the question remains, why do we continue to ignore the evidence of extended hours and fatigue?
1 http://www.pwrnewmedia.com/2011/joint_commission/fatigue/downloads/printfriendly.pdf