Fatigue

  • It sneaks up on you.
  • We tend to deny how we function and not recognize our own fatigue.
  • Recognizing and addressing fatigue must be done in supportive and non-punitive environments.
  • You can’t wish it away or wash it away with coffee.

Young woman fatigued at work

Common Causes of Fatigue

  1. Inadequate sleep
  2. Fragmented sleep, <6 hours per night
  3. Desynchronized circadian rhythms
  4. llness
  5. Depression/anxiety/stress
  6. Sleep Disorders

Professionalism

Fatigue Word ArtProfessionalism is demonstrated through a personal role in the following:

  • Assurance of one’s fitness for duty.
  • Time management before, during and after clinical assignments.
  • Assurance of safety and welfare of patients.
  • Acting on impairment in oneself and others.

Healthcare professionals must be aware of the negative effects of sleep deprivation and fatigue on their ability to provide safe and effective patient care.

You might be fatigued if you experience any of the following:

Mental Symptoms:

  • Narrow attention span & forgetfulness
  • Reduced performance standards
  • Feelings of depression
  • Impaired judgment
  • Impaired judgment/decision making

Physical Symptoms:

  • Frequent unexplained headaches
  • Muscular aches and pains
  • Blurred/double vision
  • Loss of appetite

You might see the following in someone who is fatigued:

Mental Symptoms:

  • Irritability/intolerance
  • Reduced short-term memory
  • Lack of interest and drive
  • Confused and fearfulness
  • Decreased startle response
  • Anxiety
  • Social withdrawal

Physical Symptoms:

  • Degraded motor skills
  • Tenseness and tremors
  • Slower reaction time
  • Falling asleep at inappropriate times

Fatigue Mitigation Tips

  • Know your own alertness/sleep pattern.
  • Eat nutritionally and avoid heavy meals.
  • Get regular exercise.
  • Ensure a healthy sleep environment (cooler temperature, dark, quiet).
  • Try to keep the same schedule on work days and off days to maximize alertness.
  • AVOID starting call with a sleep deficit.
    • Get 7-9 hours of sleep.
  • AVOID heavy meals within 3 hours of sleep.
  • AVOID stimulants to keep you up.
  • AVOID alcohol to help you sleep.
  • AVOID heavy exercise 3 hours before sleep.
  • When engaged in clinical responsibilities
    • Immediately contact a colleague (i.e. upper level resident/fellow, attending, program director) if you are too fatigued to work.
    • Strategically nap. 20-30 minutes improves alertness and performance (Do not nap longer as you risk extreme grogginess.)
    • If up all night, be aware that your least alert time is 6am-11am.
    • Utilize your program’s call room/nap room or available transportation.
    • Take action to relieve a fatigued colleague from patient care duties after ensuring a smooth transition of care.

Two Types of Fatigue Errors

Healthcare professionals must recognize that sometimes the best interests of the patient may be served by transitioning care to another qualified and rested provider. Know your program’s fatigue mitigation process

  1. Errors of Commission – doing something incorrectly
  2. Errors of Omission – not doing something that should be done

Fatigued Driving and Class A Misdemeanor

In 2013, Senate Bill 874 amended Arkansas Code § 5-10-105, by classifying “fatigued driving” in a fatal accident as an offense under negligent homicide, punishable by a class A misdemeanor. According to the law, fatigue driving means the driver has been without sleep for 24 consecutive hours or in the state of being asleep after being without sleep for 24 consecutive hours.

Sleep deprivation is the second leading cause of automobile accidents.

Call/Nap Rooms

UAMS provides call rooms and nap rooms for residents. Please contact your Program Coordinator for location, room numbers, and codes for entry.

Rip it Snippet – Fatigue Video

Clinical Experience and Education

ACGME Common Program Requirements Section VI