Nurses and doctors need 20-minute power naps during night shifts and to work no more than three night shifts in a row to keep themselves and patients safe, a study has revealed.
The findings were presented by Consultant Anaesthetist Dr Nancy Redfern of Newcastle Hospitals NHS Foundation Trust, UK at the Euroanaesthesia congress in Italy.
Discussing the potential lethal effects of fatigue on nurses and doctors, and its impact on the quality of their clinical work and judgement when working night shift, Dr Redfern said around half of trainee doctors, consultants and nurses had experienced either an accident or a near miss driving home after a night shift.
Previous research has shown driving after being awake for 20 hours or more and at the body’s circadian low point (in the night or very early morning when it most needs sleep) is as dangerous as driving with blood alcohol levels above the legal limit. And workers who drive home after a 12-hour shift are twice as likely to crash as those working 8-hour shifts.
Dr Redfern said a ‘sleep debt’ begins building after two or more nights of restricted sleep, and it takes at least two nights of good sleep to recover from this. Cognitive function is impaired after 16-18 hours awake leading to a deterioration in the medical worker’s ability to interact effectively with patients and colleagues.
“When fatigue sets in, we in the medical and nursing team are less empathic with patients and colleagues, vigilance becomes more variable, and logical reasoning is affected, making it hard to calculate, for example, the correct doses of drugs a patient needs. We find it hard to think flexibly, or to retain new information which make it difficult to manage quickly changing emergency situations. Our mood gets worse, so our teamwork suffers. Hence, everything that makes us and our patients safe is affected.”
“We hope in the end that regulators will recognise that healthcare workers have the same physiology as employees in every other safety-critical industry and require formal fatigue risk management as part of its overall approach to patient and staff safety.”