Working Time Society consensus statements: Prescriptive rule sets and risk management-based approaches for the management of fatigue-related risk in working time arrangements

Qualitative Findings for Supporting Newly Graduated Nurse and Teacher Sleep During Their First Year

BACKGROUND

New graduate role transition for nurses and teachers is stressful. Poor adaptation may manifest as insomnia, which has implications for the new professionals, their employers, and the public served. This study examines factors that impact new graduate sleep, with the aim of identifying perceived helps and hindrances to sleep-during-transition.

METHODS

Targeted content analysis of transcripts from a larger longitudinal mixed methods study comparing new graduate sleep during their first year of practice. Study participants (N = 21) answered questions in the final interview regarding the most positive and negative impact(s) on sleep during the transition year. Transcripts were analyzed and compared based on the new graduate sleep typology (i.e., Got Better, Got Worse, Stayed Varied) which emerged from the parent study.

FINDINGS

Most participants, regardless of sleep type, identified a person/group as most positively impacting sleep. They identified work thoughts, stress/anxiety, people, work hours/sleep schedules, and environmental factors as negatively impacting sleep. Work thoughts and stress/anxiety were mentioned together and most frequently by participants in all three sleep types.

CONCLUSION/APPLICATIONS TO PRACTICE

This study provided insight into new graduate nurse and teacher sleep during transition. Support persons and/or groups may be essential regardless of sleep type. Thought management/stress mitigation strategies and good sleep hygiene may also improve the sleep experiences of these new professionals. Occupational health nurses can support sleep-during-transition among new nurses and teachers by acting as sleep advocates. They may also identify a need for medical intervention and/or sleep specialists and should promote fatigue risk mitigating policies.

Guiding principles for determining work shift duration and addressing the effects of work shift duration on performance, safety, and health: guidance from the American Academy of Sleep Medicine and the Sleep Research Society

CITATION

Risks associated with fatigue that accumulates during work shifts have historically been managed through working time arrangements that specify fixed maximum durations of work shifts and minimum durations of time off. By themselves, such arrangements are not sufficient to curb risks to performance, safety, and health caused by misalignment between work schedules and the biological regulation of waking alertness and sleep. Science-based approaches for determining shift duration and mitigating associated risks, while addressing operational needs, require: (1) a recognition of the factors contributing to fatigue and fatigue-related risks; (2) an understanding of evidence-based countermeasures that may reduce fatigue and/or fatigue-related risks; and (3) an informed approach to selecting workplace-specific strategies for managing work hours. We propose a series of guiding principles to assist stakeholders with designing a shift duration decision-making process that effectively balances the need to meet operational demands with the need to manage fatigue-related risks.

Guiding principles for determining work shift duration and addressing the effects of work shift duration on performance, safety, and health: guidance from the American Academy of Sleep Medicine and the Sleep Research Society

Risks associated with fatigue that accumulates during work shifts have historically been managed through working time arrangements that specify fixed maximum durations of work shifts and minimum durations of time off. By themselves, such arrangements are not sufficient to curb risks to performance, safety, and health caused by misalignment between work schedules and the biological regulation of waking alertness and sleep. Science-based approaches for determining shift duration and mitigating associated risks, while addressing operational needs, require: (1) a recognition of the factors contributing to fatigue and fatigue-related risks; (2) an understanding of evidence-based countermeasures that may reduce fatigue and/or fatigue-related risks; and (3) an informed approach to selecting workplace-specific strategies for managing work hours. We propose a series of guiding principles to assist stakeholders with designing a shift duration decision-making process that effectively balances the need to meet operational demands with the need to manage fatigue-related risks.

How much sleep do you need? A comprehensive review of fatigue related impairment and the capacity to work or drive safely

In developed countries, deaths attributable to driving or working while intoxicated have steadily declined over recent decades. In part, this has been due to (a) public education programs about the risks and (b) the deterrence value associated with penalties and prosecutions based on an individual being 'deemed impaired' if they exceed a proscribed level of blood alcohol or drug concentration while driving/working. In contrast, the relative proportion of fatigue-related accidents have remained stubbornly high despite significant public and workplace education. As such, it may be useful to introduce the legal principle of 'deemed impaired' with respect to fatigue and/or sleep loss. A comprehensive review of the impairment and accident literature was performed, including 44 relevant publications. Findings from this review suggests that a driver or worker might reasonably be 'deemed impaired' once the amount of sleep falls below five hours in the prior 24. Building on the legal principles first outlined in recent New Jersey legislation (Maggie's Law), this review argues that an individual can reasonably be 'deemed impaired' based on prior sleep wake behaviour. In Maggie's Law, a driver can be indirectly 'deemed impaired' if they have not slept in the prior 24 h. Based on the extant literature, we argue that, relative to drug and alcohol intoxication, this may be overly conservative. While roadside measurement of fatigue and prior sleep-wake behavior is not yet possible, we suggest that public education programs should provide specific guidance on the amount of sleep required and that post-accident forensic examination of prior sleep wake behaviours may help the community to determine unsafe behaviours and liability more objectively than is currently the case.

Shorter sleep duration is associated with potential risks for overwork-related death among Japanese truck drivers: use of the Karoshi prodromes from worker's compensation cases

Purpose

We aimed to cross-sectionally investigate how work and sleep conditions could be associated with excessive fatigue symptoms as an early sign of Karoshi (overwork-related cerebrovascular and cardiovascular diseases; CCVDs).

Methods

We distributed a questionnaire regarding work, sleep, and excessive fatigue symptoms to 5410 truck drivers, as the riskiest occupation for overwork-related CCVDs, and collected 1992 total samples (response rate: 36.8%). The research team collected 1564 investigation reports required for compensation for Karoshi. Of them, 190 reports listed the prodromes of Karoshi, which were used to develop the new excessive fatigue symptoms inventory.

Results

One-way analyses of variance showed that the excessive fatigue symptoms differed significantly by monthly overtime hours (p < 0.001), daily working time (p < 0.001), work schedule (p = 0.025), waiting time on-site (p = 0.049), number of night shifts (p = 0.011), and sleep duration on workdays (p < 0.001). Multivariate mixed-model regression analyses revealed shorter sleep duration as the most effective parameter for predicting excessive fatigue symptoms. Multiple logistic regression analysis confirmed that the occurrences of CCVDs were significantly higher in the middle [adjusted ORs = 3.56 (1.28–9.94)] and high-score groups [3.55 (1.24–10.21)] than in the low-score group.

Conclusion

The findings suggested that shorter sleep duration was associated more closely with a marked increase in fatigue, as compared with the other work and sleep factors. Hence, ensuring sleep opportunities could be targeted for reducing the potential risks of Karoshi among truck drivers.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-021-01655-5.

Evaluation of Fatigue and Workload among Workers Conducting Complex Manual Assembly in Manufacturing

OCCUPATIONAL APPLICATIONSWe conducted a study to evaluate fatigue and workload among workers performing complex assembly tasks. We investigate several predictors of fatigue, including subjective workload estimates, sleep duration, the shift being worked, and production levels. High levels of fatigue were reported in one-third of the shifts evaluated. The main predictors of high fatigue were workload estimates, working evening shifts, and baseline fatigue. Among the six dimensions of workload, only mental demand and frustration were predictors of high fatigue. Mental demand was also rated highest. Participants reported less than seven hours of sleep in 60% of the nights evaluated. These results suggest that managers and supervisors should consider cognitive workload as a key contributing factor to fatigue in complex manual assembly. Similarly, work schedule planning should consider shift duration, start times, and end times, because of the negative influence on fatigue and the potential disruptions on sleep among workers.

Fatigue and recovery among Malaysian doctors: the role of work-related activities during non-work time

OBJECTIVES

This paper aims to estimate the level of acute fatigue, chronic fatigue and intershift recovery among doctors working at public hospitals in Malaysia and determine their inter-relationship and their association with work-related activities during non-work time.

DESIGN

Cross-sectional.

SETTING

Seven core clinical disciplines from seven tertiary public hospitals in Malaysia.

PARTICIPANTS

Study was conducted among 330 randomly-sampled doctors. Response rate was 80.61% (n=266).

RESULTS

The mean score of acute fatigue, chronic fatigue and intershift recovery were 68.51 (SD=16.549), 54.60 (SD=21.259) and 37.29 (SD=19.540), respectively. All these scores were out of 100 points each. Acute and chronic fatigue were correlated (r=0.663), and both were negatively correlated with intershift recovery (r=-0.704 and r=-0.670, respectively). Among the work-related activities done during non-work time, work-related ruminations dominated both the more frequent activities and the association with poorer fatigue and recovery outcomes. Rumination on being scolded/violated was found to be positively associated with both acute fatigue (adjusted regression coefficient (Adj.b)=2.190, 95% CI=1.139 to 3.240) and chronic fatigue (Adj.b=5.089, 95% CI=3.876 to 6.303), and negatively associated with recovery (Adj.b=-3.316, 95% CI=-4.516 to -2.117). Doing work task at workplace or attending extra work-related activities such as locum and attending training were found to have negative associations with fatigue and positive associations with recovery. Nevertheless, doing work-related activities at home was positively associated with acute fatigue. In terms of communication, it was found that face-to-face conversation with partner did associate with higher recovery but virtual conversation with partner associated with higher acute fatigue and lower recovery.

CONCLUSIONS

Work-related ruminations during non-work time were common and associated with poor fatigue and recovery outcomes while overt work activities done at workplace during non-work time were associated with better fatigue and recovery levels. There is a need for future studies with design that allow causal inference to address these relationships.

Seasonal variation in fatigue indicators in Brazilian civil aviation crew rosters

Background

Analyzing, understanding and managing fatigue risk in aviation is relevant for flight safety and to reduce human error.

Objective

To analyze probable levels of fatigue among a convenience sample of Brazilian civil aviation pilots and flight attendants and to develop appropriate methods and indicators to quantify potential fatigue risk in critical phases of flight (landings and takeoffs).

Methods

Data were obtained from flight rosters voluntarily and anonymously fed to a digital platform. Rosters were analyzed with software SAFTE-FAST, which considers homeostatic process and circadian cycles related to attention and wakefulness and sleep inertia.

Results

The rosters for January (n=248), May (n=259) and July (n=261) 2018 were associated with incidence of 77, 54 and 77% respectively of least one event of minimal effectiveness (<77%) during critical phases of flight. The distribution of minimal effectiveness and hazard area during critical phases of flight exhibited significant seasonal oscillation upon comparing the results for January and July relative to May 2018 (p<0.001).

Conclusion

Relative likelihood of fatigue was high in the crew rosters, with significant seasonal oscillation of minimal effectiveness and hazard area in critical phases of flight. These results point to the need for improved roster management since prescriptive rules were insufficient to mitigate risk.

Behavior: How a Global Social Lockdown Unlocks Time for Sleep

Two new studies show that the social lockdown imposed as a result of the SARS-CoV-2 pandemic has helped unlock more time for sleep. Although daily stress during the lockdown increased, and sleep quality decreased, sleep behaviour was generally healthier.

Fatigue and short-term unplanned absences among police officers

PURPOSE –

The purpose of this paper is to assess whether shift work, sleep loss and fatigue are related to short-term unplanned absences in policing.

DESIGN/METHODOLOGY/APPROACH –

N = 367 police officers from the Buffalo Police Department were studied. Day-by-day work and sick leave data were obtained from the payroll. Absenteeism was defined as taking a single sick day on a regularly scheduled workday. Biomathematical models of fatigue (BMMF) predicted officers' sleep-wake behaviors and on-duty fatigue and sleepiness. Prior sleep, fatigue and sleepiness were tested as predictors of absenteeism during the next shift.

FINDINGS –

A total of 513,666 shifts and 4,868 cases of absenteeism were studied. The odds of absenteeism increased as on-duty fatigue and sleepiness increased and prior sleep decreased. This was particularly evident for swing shift officers and night shift officers who were predicted by BMMF to obtain less sleep and have greater fatigue and sleepiness than day shift officers. The odds of absenteeism were higher for female officers than male officers; this finding was not due to a differential response to sleep loss, fatigue or sleepiness.

PRACTICAL IMPLICATIONS –

Absenteeism may represent a self-management strategy for fatigue or compensatory behavior to reduced sleep opportunity. Long and irregular work hours that reduce sleep opportunity may be administratively controllable culprits of absenteeism.

ORIGINALITY/VALUE –

Police fatigue has consequences for police officers, departments and communities. BMMF provide a potential tool for predicting and mitigating police fatigue. BMMF were used to investigate the effects of sleep and fatigue on absenteeism.

The Economic Burden of Sleepy Driving

Driving while sleepy on a regular basis may be due to sleep restriction associated with work schedules or with poor sleep hygiene. It also may be associated with sleep disorders or with sedative drugs. This review assesses the potential consequences of driving sleepy on a regular basis from a societal point of view. Driving while sleepy on a regular basis increases the risk of motor vehicle accidents (MVAs), impairs the ability to work, has an impact on productivity, and probably also has an impact on the risk of non-MVA occupational accidents and on public disasters.