Fatigue in the workplace is an emerging health and safety issue that requires increased understanding of its impact and prevention. With its mandate to improve safety in the Ontario workplace, the Public Services Health and Safety Association (#PSHSA) is taking major steps to improve how fatigue will be prevented and handled in the workplace.

A link between fatigue and impacts on work performance has been shown and increasingly health care professionals are also taking steps to prevent and address fatigue as part of creating healthy work environments. Research has shown that more than 20 per  cent of all serious incidents and negative patient outcomes are fatigue-related. Numerous factors may cause fatigue to develop including heavy patient load, shift work and a field that is always changing and evolving for nursing professionals. In addition stress from reduced budgets, staff scheduling and a slowing economy all go towards adding to an already stressful workplace.  The organization itself suffers when its staff are subjected to fatigue which may result in increased absenteeism, turnover, and increasing Workers’ Compensation costs. This could also result in conflict between management and workers which only adds to the overall dysfunction and challenges. The recent classification of shift work as ‘probably carcinogenic to humans’ by the International Agency for Research on Cancer (IARC) and the 2013 research in Occupational & Environmental Medicine indicating that breast cancer risks are doubled for female long term night shift workers makes this a critical health issue to address.

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In nursing when workers experience fatigue, it can cause lack of concentration which can lead to reduced situational awareness (SA)—the constant state of knowing what’s going on in your immediate environment, why it is happening and what is likely to happen next. Fatigue can also contribute to stress which may lead to poor decision-making and unintentional medical errors. In some situations fatigue can be addressed by getting sufficient sleep or leaving a stressful work environment; however, continuing a poor sleeping routine or not coping with the workplace environment will continue to contribute to ongoing chronic fatigue.

The results of a joint CNA/RNAO national research study (2010) of more than 7000 RNs representing all sectors of health care indicated that:

• Nurses working 12.5 hours or longer are found to be 3 times more likely to make an error.
• Of the 7,000 nurses polled, 80% feel tired after work.
• Of the 7,000 polled, 55% feel they are “almost always” tired at work.
• On average, nurses work more than 40 hours a week.
• During a 28-day study, every nurse involved worked at least one overtime shift.
• Two out of 3 nurses work 10 or more overtime shifts in 28 days. (RNAO, Managing and Mitigating Fatigue: Tips and Tools for Nurses)

Implementing fatigue management strategies has had a positive impact in other sectors. Developing effective interventions relevant for the healthcare and community service sector is crucial. The Public Services Health and Safety Association is delving into the causes and consequences of fatigue across various sectors. We are looking to develop strategies to build awareness, address and mitigate fatigue which is emerging more as a workplace issue.

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As pointed out in the RNAO Best Practice Guideline “Preventing and Mitigating Nurse Fatigue in Health Care” a multi-pronged approach is needed with strategies from External/ System partners (like PSHSA), workplaces and individuals.

Last month PSHSA announced it is providing leading work-related injuries researcher, Lora Cavuoto with Fatigue Science Readibands, a wearable wrist-worn technology that monitors sleep, activity and fatigue. The goal is to gather data-driven research to understand the impact of fatigue and implement innovative solutions to prevent it as a workplace hazard.

Studies have shown that fatigue is about four times more likely to contribute to workplace impairment than drugs or alcohol, and a fatigued worker is at 70 per cent greater risk of accident than a non-fatigued worker.

“We know that fatigue in the workplace is a major health and safety issue,” said Glenn Cullen, VP Corporate Programs and Product Development, PSHSA. “We need to learn how to prevent fatigue in the workplace and new technology like Fatigue Science Readibands will help us develop effective Fatigue Risk Management Programs. We are aiming to develop ways to intervene before fatigue becomes a risk to the health and safety of workers and control the hazard once it has been identified.”

PSHSA is supplying researcher Cavuoto with Fatigue Science Readibands that provide 24/7 measurement of sleep patterns and mental fatigue. Wearing the Readibands, study participants will be asked to perform a set of tasks, with participants’ natural variation in sleep-related fatigue and work-load factored in to the experiment. With this data, Cavuoto will be able to estimate fatigue based on work schedule, sleep and work conditions, and test these findings in a real-life scenario.

The research will evaluate the interaction of sleep-based fatigue and workload in targeted industries that utilize shifts such as healthcare and emergency services. This research will also evaluate fatigue mitigating interventions for the purpose of improving program effectiveness in the workplace.

“Today, we have little understanding of when and how fatigue intervention should be implemented,” says lead researcher Lora Cavuoto. “This research partnership with PSHSA will allow us to build first-of-its-kind fatigue interventions and customize them for particular industries, like healthcare, fire departments, police and mining to name a few.”

Managing fatigue is key for maintaining a culture of quality and patient safety within our healthcare system. To reduce the damaging effects of that fatigue presents, workers must address the core issues and develop coping mechanisms. One should be aware of the root causes, symptoms and effects on body, mind and performance.

The PSHSA fatigue study is scheduled to begin in early 2016. As a result of the study and learnings, PSHSA is looking forward to providing products and services to assist the workforce in Ontario with addressing this pervasive issue.

Public Services Health & Safety Association (PSHSA) works with Ontario’s public sector workers and employers, providing occupational health and safety training, resources and consulting to reduce workplace risks and prevent workplace injuries and illnesses.