The safety fallout of worker fatigue in health care

For as long as Consultant Emergency Physician Dr Stephen Parnis can remember, he has begun each shift on his various emergency wards wondering how many workers will be present. Absenteeism — due to COVID-19 infections and isolation orders — has been so rife through parts of the pandemic that some teams have regularly had to operate at half capacity.

The fallout of understaffing has been huge, Parnis says, with workers across the sector collectively burnt out. Forced to take on longer hours and stretch themselves thinner during shifts, it is little wonder that 56% are “exhausted” and 86% under stress.

With mental fatigue at an all-time high, so too, Parnis believes, are clinical errors.

Cognitive impairment

“Worker fatigue is something that all health systems need to be very mindful of at present,” Dr Parnis told Hospital + Healthcare. “In emergency medicine, it is fair to say that whether you are a doctor, nurse, allied health professional, administrative worker, or support person, you are rarely — if ever — coming to work feeling rested in these pandemic times. When you’re tired to this degree, you are at real risk of making critical mistakes — whether that’s an error of clinical judgement, an oversight, or a physical slip-up involving a fine instrument.”

Indeed, a federal investigation in 2019 revealed that working while tired is no less dangerous than working under the influence of alcohol. Academia agrees, with prolonged periods of demanding cognitive activity linked to reduced alertness and a decline in mental functioning. As a result, tired employees are 70% more likely to be involved in a workplace accident.

Within health care, this reduction in cognitive ability can manifest itself in a variety of dangerous ways, Parnis warned.

“In terms of the cognitive side of practice, tired workers could miss important details on a chest X-ray or a CT scan. They might not be thorough enough in their history-taking, or as sharp in their decision-making, leading to an incorrect diagnosis or poor management plan.

“In terms of procedures, a fatigued person might take longer, or be less likely to get optimal outcomes. They could miss an injury that they might otherwise have picked up.”

Tired workers may also struggle to manage situations with varying urgency, where quick decision-making is vital. “Often in health care, workers have to make the call on things that can wait for hours versus things that need to happen instantly. Getting this wrong could be a life or death scenario,” Parnis said.

Communication and listening skills could also take a hit from mental fatigue, with further consequences for patient safety. “There are enormous levels of noise in healthcare settings at the best of times. Add to that mental fatigue — and mandates for wearing masks or shields — and clarity on what is said is not always easy. This could present itself as a significant safety hazard,” Parnis said.

Stretching roles

The understaffing has also seen some workers being delegated duties that pertain to their former experience, but sit outside of their current responsibilities.

“I needed to re-learn how to perform ECGs recently, something I haven’t done for several decades. At this stage in my career, my ability to master new or long-disused skills isn’t what it used to be. I was acutely aware of the need to avoid making errors at every step,” Parnis said.

Compassion fatigue

The mental fatigue epidemic is taking its toll on workers, with 42% of 600 frontline healthcare staff surveyed “less willing” to work than before the pandemic. A consequence of this is ‘compassion fatigue’, Parnis warned — where a person’s ability to feel empathy declines.

“Personally, I know I am showing early signs of burnout when I lose my ability to care properly about a patient’s circumstances. Compassion in healthcare is very important — especially in times where workers are required to ‘go the extra mile’ during shifts. It’s what motivates us to do our jobs well and perform tasks to the highest degree. No doubt, rafts of (rightfully) unwilling workers will have safety consequences for the sector.”

Training

The impact of worker burnout could even interfere with medical training and present longer-term safety issues for healthcare.

“There are medical students in the system now that have never known clinical medicine outside of pandemic times. This has interfered with their access to patients, and I’m wondering how this will play out in their careers. It may also impact their decisions about working in medicine long-term, adding fuel to the chronic understaffing problem that already exists within health care,” Parnis said.

The solution?

While Dr Parnis appreciates the gesture from hospital administrators, he would like to see fewer emails referring psychological support, and more encouraging annual leave. “There is no substitute for time away, doing different things, or doing nothing at all.”

Image credit: ©stock.adobe.com/au/Yingyaipumi