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Young doctors are tired of being tired

By Mindo - 19th Jun 2019

HSE and hospital management should recognise the detrimental effects night shifts can have on healthcare workers and allow staff working outside 9-to-5 to get adequate rest, according to Dr Neasa Conneally 

As doctors in training, conversation among my friends and I always inevitably turns towards the long hours we’re working and the particular pains of shift work and nights. Every doctor does it throughout their career and, of course, it’s not unique to us alone. The hospital is also ticking away with nurses, porters, healthcare assistants, radiographers and administration staff when we’re on during the wee hours. Things are a lot better than they were; older doctors often take great pleasure in telling us that we don’t know how good we have it.  Sure, back in the day, weren’t they on call for 72 hours straight and then went straight into a full week’s work and weren’t they perfectly grand?

Rose-tinted glasses aside, there is a great deal of evidence that working long hours outside of the 9-to-5 isn’t ‘perfectly grand’ and can in fact have a great impact on workers’ mental and physical health. Dr Michael Farquhar, a paediatric sleep specialist in the NHS with a particular interest in the impact of shift work on healthcare workers, wrote in the BMJ in 2016 that moderate sleep deprivation, the equivalent to being awake for 16-to-18 hours, can have the same effect on reaction time as being at the legal blood alcohol limit for safe driving. Up to 20 per cent of road traffic accidents are thought to be fatigue-related and are significantly more likely to lead to serious harm or death. Night-shift workers have been shown to sleep less well and for shorter times in the day, are less alert and perform less well than day-shift workers and are more likely to make simple mistakes and avoidable errors, leading to increased risks to patient safety. They also have impaired alertness and reaction times and are more likely to make decisions that involve higher degrees of risk.

Significant sleep disruption also has longer-term health effects. It has been shown to increase the risks of cardiovascular disease, diabetes and obesity, reduce the effectiveness of the immune system and impact cognitive function and emotional regulation. In 2007, the World Health Organisation classified night-shift work as a probable carcinogen due to circadian disruption.

Following the success of the IMO’s ‘24 No More’ campaign in 2013, shifts longer than 24 hours are now a thing of the past for most specialities in most hospitals, which one would argue can only be a good thing.

However, in the past year I have had the pleasure of being on both a 24-hour call rota and nights and controversial as it may sound, I actually preferred the 24-hour shifts.  They are a short, sharp kind of pain, which is quickly over and you can then carry on with the rest of your week, rather like being punched in the face. They come with the promise of a sparse but clean on-call room, usually with an extremely rickety bed and thin HSE sheets, however any few hours of snatched sleep between the bleeps leave you feeling positively refreshed.

In comparison, I always enter a period of nights with a sense of dread and trepidation, knowing that the cumulative fatigue will only get worse throughout the week and by the time that your body has switched to your new time zone, it’s time to go back to days, leaving you with a horrible, disorientated hangover and sense that you’ve done real damage to your body.

Despite all this, hospitals are always going to run 24/7, shift work — it is inevitable and unavoidable. There’s plenty of advice out there on how to survive it, such as keeping hydrated, avoiding junk food and resisting the siren call of Red Bull from the 24-hour shop across the road that just leaves you jittery and exhausted. There should be particular awareness of the 4am dip, when both staff and patients are at their lowest physiological ebb. Mistakes are most likely during this time. Prescribing and other critical decisions should be checked carefully. Use public transport to get home instead of driving if at all possible and when you’re home, make sure that you’ve a dark, quiet room, avoid scrolling through your phone and get out for some fresh air in the evening before work.

However, I feel that the hospitals themselves also have a real part to play in how well their staff get through the night. Relatively simple things, such as providing good staff rest areas, with a decent sofa and a microwave and kettle, are inexpensive and make a big difference.

To date, Irish hospitals don’t seem to be moving in the direction that hospitals in the UK are, anecdotally removing doctors’ res rooms and banning people from sleeping during the quiet times at night, which seems damaging to morale at best and dangerous at worst. Ensuring that hospital staff are as well-rested at night as possible is to the benefit of the staff but most importantly, our patients.

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