Fatigue in health professionals: does hard work wear you out?

Abstract

Background. A popular view of fatigue suggests that a limited resource is depleted by prolonged demanding activity and as a result one experiences fatigue. In health professionals such fatigue can be associated with errors that put the patients and the health professional at risk. The role of demand and energy expenditure in determining fatigue was examined in real time studies of nurses caring for patients. Method. In study 1, 100 nurses completed electronic diaries assessing fatigue and work demands, approximately every 90 minutes, over two 12 hour work periods. Energy expenditure was assessed continuously using the Actiheart system. In study 2, 254 nurses completed similar diary measures, over 3 work periods of 9.5 hours. Results. In both studies nurses clearly became fatigued over the work period. In study 1 neither demand nor energy expenditure predicted fatigue and within person analyses showed that while some nurses did show greater fatigue when under heavy demand others showed the opposite effect. Work breaks were not associated with a reduction in fatigue. In Study 2 fatigue was reliably associated with reduced demand. Conclusion. These studies do not support a resource depletion model of fatigue. Working hard can be energising rather than fatiguing. It is therefore unlikely that the solution to fatigue at work is to reduce work demand.