Fatigue survey headlines and call to action - RCN Critical Care and Flight Nurse forum

Kerryn McGowran 28 Apr 2021

The Royal College of Nursing Critical Care and Flight forum has collaborated with The Association of Anaesthetists of Great Britain and Ireland (AAGBI), Royal College of Anaesthetists (RCoA), Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI), the Paediatric Intensive Care Society (PICS) to jointly work on fatigue management for healthcare professionals.
This initially involved a survey of fatigue within anaesthetists in training. As the Royal College of Nursing Critical Care and Flight forum we were keen to understand how fatigue is affecting nurses too. This is so that we can better represent the members and provide guidance to nurses working in critical care and flight.

The 28th April is World Day for Safety and Health at work, so we would like to share the headlines of our forum survey on Fatigue and issue a call to action to our members:

What is fatigue?

The Faculty of Intensive Care Medicine (2017) describes fatigue as ‘extreme tiredness resulting from mental or physical exertion or illnesses. Susceptibility to fatigue depends on many factors, including those directly related to the individual such as their workload, colleagues, and the area of nursing they work within. Further factors such as age, changes in family life, and physical and mental health often fluctuate the effect of, and susceptibility to, fatigue.

There are two types of fatigue, Acute and Chronic (The honourable company of air pilots, 2017):

  1. Acute fatigue is short term and can be experienced during a sequence of duties that may be within prescriptive limits. It is rectified by allowing a suitable period of rest for the individual member concerned.
  2. Chronic fatigue has long-term medical consequences and can be brought on by irregular sleep patterns, circadian rhythm changes, eating at odd times, and a whole host of domestic and personal factors. As this disorganised time progresses, the normal pattern of life begins to break up and minor irrelevant things become very important to the affected person. Conversely, very important things become minor, so compliance with safety procedures, normal balanced speech and temper can change. Some of the behaviours and symptoms of an affected person can include aggression, ignoring warnings, feeling very depressed, crying and laughing inappropriately, and repeatedly falling asleep.

There is a myriad of symptoms frequently misunderstood and misdiagnosed by those with limited knowledge. If left unchecked and undiagnosed, it can take many months, even years, to correct. Acute and chronic fatigue can affect our actions, causing deleterious effects on patient outcomes. To Err is Human stated that 98,000 patients die annually from preventable medical errors (Kohn et al, 2000). Does fatigue play a part in this, or even exaggerate the risk? Fatigue can be insidious and develop over months to years. It is very important that we look after both ourselves, and our colleagues’ welfare. It’s easy to forget in the rush to get home, that it may be safer to have some food and drink, and have a rest before travelling and putting yourself, and others at increased risk. Sleep-related vehicle accidents account for up to 20% of all road traffic accidents and drowsy driving is as important a factor in accidents as drink driving.

RCN Critical care and flight nurse forum Fatigue survey outcomes

25 questions were asked of our membership and we received a participation of 392 nurses using 2 platforms:

  • 320 Facebook responses
  • 72 Survey monkey responses

Headlines

Commuting:

  • 75% of all nurses drive themselves to and from work
  • 26% of overall nurses use the motorway as part of their commute
  • 74% feel unsafe to drive post night/long shift
  • 30% of all nurses have had an accident/near miss after a night shift
  • common theme is respondents don’t feel they have any other choice than commute.

Rest facilities & night shifts:

  • 5% of nurses report having post shift rest facilities
  • 26% of all nurses report that they have access to adequate rest facilities
  • 45% of all nurses never get at least 30minutes uninterrupted sleep during a nightshift or following an overnight flight
  • 55% of all nurses sometimes/regularly get at least 30 minutes uninterrupted sleep during a nightshift or following an overnight flight
  • 39% of all nurses never feel well rested during a set of nights
  • several nurses use some sort of substance (mainly caffeine) to stay awake around the time of night shifts
  • 23% of nurses report that their organization has a policy on rest during a night shift.

Impacts of work-related fatigue:

  • 92% of nurses report that work-related fatigue has negatively impacted their personal lives
  • 42% of all nurses report that is has negatively impacted patient safety
  • 43% of all nurses report it has negatively impacted medication safety
  • 91% report it has impacted their personal health and wellbeing
  • 73% of all nurses feel it has moderately or significantly impacted their physical health
  • 63% of all nurses feel it has moderately or significantly impacted their mental health
  • 69% of all nurses feel it has moderately or significantly impacted their emotional wellbeing (you could argue mental health and emotional wellbeing are the same)
  • 82% of all nurses feel it has moderately or significantly impacted their social and family life
  • 59% of all nurses feel it has moderately or significantly impacted their ability to manage work-related projects, CPD for example
  • 75% of all nurses feel it has moderately or significantly impacted their ability to enjoy hobbies, sport, travel etc.
  • 24% of all nurses are always able to achieve the European Working Time directive – whereas 24% only achieve this less than 50% of the time

This survey was conducted before the COVID-19 pandemic and the authors believe that COVID-19 fatigue will enhance the results, and demonstrate more awareness but detrimental affects about fatigue within nursing. This is not just felt by those working clinical shifts in critical care but also repatriation company nurses working virtually and often isolated from peer support.

Call to action

The Critical Care and Flight forum will publish resources on awareness and mechanisms to manage and mitigate fatigue for nurses. This will also include guidance for repatriation companies and hospitals.

We now have a call to action for volunteers who have an interest and passion in joining a working group to further drive this initiative.

Further resources

AirMed&Rescue. Fatigue management in the UK: Is this being ignored by the retrieval and repatriation industry, or are there good examples in practice?

Kerryn McGowran

Kerryn McGowran

Chair - Critical Care and Flight Nursing Forum

Director of Nursing EMEA - International SOS

Kerryn McGowran is the Director of Nursing – Assistance- Europe, Middle East and Africa at International SOS in London. Since joining International SOS 14 years ago, Kerryn has held progressively more senior roles in medical assistance with experience working on and managing both corporate and Government contracts, including the US Military contract TRICARE. She has extensive practical experience as a flight nurse transferring patients on commercial airlines for the company, and developing and implementing the medical transportation process regionally. In her current role she is responsible for the professional leadership of a large team of nursing staff across Europe, Middle East and Africa.

Authors

  • Nadia Marashi – Healthcare Programme Manager, International SOS and RCN CCFN Wellness Ambassador
  • Kerryn McGowran – Chair Royal College of Nursing, Critical Care and Flight Forum and Director of Nursing EMEA International SOS
  • Stuart Cox - Advanced Critical Care Practitioner, University Hospitals Southampton NHS & Dorset and Somerset Air Ambulance
  • Association of Anaesthetics Fatigue group members

Page last updated - 26/09/2021