Rounded with a sleep:
Thinking about your own health when working shifts and nights
Sleep is fundamental to good health.
Healthcare professionals receive little teaching on the importance of sleep, particularly with respect to their own health when working night shifts.
Knowledge of basic sleep physiology, together with simple strategies to improve core sleep and the ability to cope with working nights, can result in significant improvements both for healthcare professionals, but also for the patients they care for.
An overview of why a better understanding of sleep and shiftworking is essential within the NHS can be found at: Nightshifts (Don’t Forget the Bubbles blog)
Guy’s and St Thomas’ NHS Foundation Trust Induction
At GSTT, we aim to positively support staff who work night shifts. Teaching on this topic is now integrated into mandatory junior doctor induction in Evelina London Children’s Hospital, and for every new Foundation programme doctor starting work in the Trust.
This website is intended to provide information relating to this, and to signpost towards useful resources.
Risks to staff safety
A summary of the current evidence of the health consequences of shift work and insufficient sleep is available in this BMJ review article: https://www.bmj.com/content/355/bmj.i5210
One of the key risks related to nightshift working, and relative sleep deprivation, is of road traffic accidents when driving home. Levels of fatigue and sleep deprivation commonly found at the end of night shifts produce a comparable effect on driving safety as driving at the legal drink/drive limit.
The experience of feeling unsafe due to fatigue when driving home after a night shift is very common among healthcare staff.
Driving tired can have serious, potentially fatal, consequences:
This short BBC Inside Out South report (January 2017) illustrates the risks of driving tired:
GSTT staff who feel too tired to safely drive home after a night shift, and for whom there are no alternative travel options available to them, should contact the duty Site Nurse Practitioner for support.
During a shift, the single most important point is that breaks/rest periods are essential, both for your own safety, and for the safety of the patients you are caring for. They are not a luxury. Fatigue can have a major impact on the care that we deliver, and regular rest helps to reduce that.
More detailed information, including tips and strategies for both healthcare workers and employers to adopt to reduce these risks as much as possible, is available in this paper on Managing the effects of shift work on your health (please click on the image below).
HALT: Take a break
At Guy’s and St Thomas’, the ”HALT: Take A Break” campaign was introduced in March 2017 to emphasise to all staff in the Trust the importance of taking regular breaks, and the key role this play in our ability to deliver care safely, effectively and efficiently: https://www.guysandstthomas.nhs.uk/news-and-events/2017-news/march/20170317-halt-campaign.aspx
Further information is available in the ‘Showing we care about you’ section of GTi (GSTT intranet).
Most people agree that taking breaks is essential to the delivery of safe and effective patient care, however the practicalities around this can be challenging for many reasons – including our attitudes/culture and the way we work.
Local Induction Programmes
If you are interested in including a session on shiftwork, ‘sleep for your own health’, and managing the effects of fatigue in your own induction programmes, a short presentation is available for download here.
This is intended to be delivered in about 5 minutes, as part of standard mandatory induction for all staff.
There is a suggested text to accompany the slides. It is not intended to be a comprehensive set of information on this topic, and is intended primarily to emphasise why this is a topic that NHS workers should think about, and to signpost to further resources which can help with this.
These slides can be modified as required to suit local needs; though we would ask that an Evelina London logo remains on them, as well as contact details for Dr Farquhar.
The new junior doctors contract is now in effect for most training-grade doctors in England. It contains new rules and requirements in relation to rest, breaks and facilities. A summary of these can be found in this London School of Paediatrics article: https://www.londonpaediatrics.co.uk/all-news/night-time-shift-work-and-the-new-junior-doctor-contract/
Dr Mike Farquhar is a consultant in sleep medicine at Evelina London Children’s Hospital with a particular interest in the effects of working at night on NHS staff. He can be contacted via Trust email to discuss any of these issues if needed, or via Twitter @DrMikeFarquhar.
Royal College of Physicians: Working the Night Shift: https://cdn.shopify.com/s/files/1/0924/4392/files/working-the-nightshift-booklet.pdf?1709961806511712341 (2006)
Royal College of Nursing: A Shift in the Right Direction: https://www2.rcn.org.uk/__data/assets/pdf_file/0004/479434/004285.pdf (2012)
Death of Dr Lauren Connelly: https://www.dailyrecord.co.uk/news/scottish-news/worked-to-death—exhausted-young-1084348
Death of Dr Ronak Patel: https://www.bbc.co.uk/news/uk-england-suffolk-36767868
Conviction of nurse for dangerous driving following fatigue-related road traffic accident: https://www.dailyrecord.co.uk/news/local-news/nurse-banned-driving-after-crashing-9550468
Association of Anaesthetists of Great Britain and Ireland Fatigue Resource website: https://www.aagbi.org/professionals/wellbeing/fatigue
BMJ Careers 18th July 2016: NHS needs culture shift regarding sleeping at work
BMJ Careers 2nd March 2017: Is sleeping on nightshifts just a dream? https://careers.bmj.com/careers/advice/Is_sleeping_on_nightshifts_just_a_dream%3F
BMJ Careers 18th April 2017: Is being a doctor bad for your health? https://careers.bmj.com/careers/advice/Is_being_a_doctor_bad_for_your_health%3F
NHS Improvements: Engaging, supporting and valuing doctors in training
“A strong sense of organisational values, embedded throughout the organisation, can provide the foundations for clinical workers engagement; With trusts coming under growing pressure, engaging all healthcare workers in decision-making and innovation will become increasingly important. Even with good clinical practice we can always look at how we can do things better.”
Chief Medical Officer