Accidents caused by sleep deprivation and fatigue

A growing body of research has shown that nurses and other healthcare professionals working long hours have been found to be at greatly increased risk of injuring their patients or themselves. Recent research has demonstrated that healthcare workers carrying out recurrent lengthy shifts:

  • make over a third more serious medical errors than those whose scheduled work is limited to shorter shifts.
  • make five times as many serious diagnostic errors.
  • have twice as many on-the-job attentional failures at night.
  • suffer more needlestick and other sharp injuries.
  • double their risk of a car accidents when driving home after work
  • suffer decrements in performance similar to those induced by a blood alcohol level of 0.05 to 0.10%.

Nurses and other health care providers regularly work during the biological night, when the endogenous drive for alertness is lowest. Changes in work schedules from days to nights or from days off to nights are often too rapid to allow the system to adapt, having the potential to place workers in a state similar to “jet lag”.

Nurses or carers working nights after they have been awake during the day also suffer deterioration in performance because of long episodes of continuous wakefulness. Acute continuous sleep deprivation has a profound impact on fatigue. After around sixteen hours of wakefulness, alertness and performance decline rapidly.

Workers in the healthcare sector are also frequently exposed to chronic partial sleep deprivation, often for many months at a time, as they repeatedly fail to gain adequate sleep on a daily basis. Healthcare professionals who regularly work nights typically fail to achieve their average daily sleep requirements. Repeated failure to gain sufficient sleep to fully recover from the previous wake episode has a cumulative detrimental effect on waking function that rapidly builds to significantly impair performance.

Individuals working nights and rotating shifts rarely obtain optimal amounts of sleep. It is not uncommon for nurses and other shift workers to acknowledge falling asleep when working nights. In a recent study, almost one-fifth of the nurses working permanent night shifts reported struggling to stay awake while taking care of a patient at least once during the previous month and falling asleep during the night shift occurred at least once a week.

Twelve-hour shifts and frequent overtime are associated with difficulties staying awake on duty, reduced sleep times, and nearly triple the risk of making an error. Fatigue can be exacerbated with increased numbers of shifts worked without a day off, and working more than four consecutive 12-hour shifts is associated with excessive fatigue and longer recovery times.

Insufficient sleep has been associated with cognitive problems, mood alterations, reduced job performance, reduced motivation, increased safety risks, and physiological changes. Depression and irritability increase, and workers feel more stressed when sleep is restricted.

Several studies have also shown that failure to obtain adequate sleep is an important contributor to medical error. Nurses who reported an error or near miss obtained significantly less sleep than nurses who did not report such an adverse event. In addition to jeopardizing patient safety, nurses who fail to obtain adequate amounts of sleep are also risking their own health and safety, with sleep loss being the leading cause of drowsy driving and sleep-related road traffic accidents.

Extended shifts have been associated with increased musculoskeletal injuries, more cardiovascular symptoms, the development of hypertension, and higher risks for injury. Working overtime has also been associated with poorer perceived health, increased neck and musculoskeletal discomfort, increased risk of premature birth, diabetes, and cardiovascular disease, as well as increased morbidity and mortality and higher rates of accidents.

The evidence is overwhelming that nurses and other healthcare workers who work longer than 12 consecutive hours or work when they have not obtained sufficient sleep are putting their patients’ health at risk; risk damaging their own health; and if they drive home when they are drowsy, also put the health of the general public at risk.

For this reason, when determining your roster your employer owes you a duty of care to assign you blocks of work which take account of the now well-established risks that are associated with working for prolonged periods. If you have been forced to work excessively long hours and, as a consequence, either you or someone in your case has suffered an injury, your employer will be liable to you for any physical and psychological damage which you sustain as a result.