As the pressure on the NHS continues, it becomes even more important that strategies to support staff delivering care are put in place. Employers will need to consider the impact that fatigue can have on staff, particularly as changing roles and/or work patterns are implemented in order to support staff to stay safe.
Fatigue can lead to additional risks, so organisations should encourage staff to raise any concerns they have with their line managers and consider increased breaks and adjustments to shifts where required. The Health, Safety and Wellbeing Partnership Group’s guidance on shift working provides helpful information.
Dr Michael Farquhar, a consultant in children’s sleep medicine at Evelina London Children's Hospital, offers top tips on relaxation, rest and and how you can support your staff and yourself with fatigue and sleep, especially during this time:
It’s important to remember that how we are feeling, and how our minds and bodies are responding, is a normal response to an extraordinary situation.
- Incorporate strategies and techniques to help you relax and unwind in your daily routine, and use them when you feel particularly stressed, which can help reduce the impact of daytime stress.
- Aim to put boundaries around specific times in the day that are free of media and try not to engage in pandemic-related media before bed, or when waking overnight. We may not be able to stop our minds from churning over information, but at least we will not be adding to the overload.
Dealing with the COVID-19 pandemic is something that will take many months. It's essential therefore to pace ourselves and not exhaust our personal reserves in the first days and weeks of our efforts
- Regular days away from work will be essential to keep us all mentally and physically healthy, and to ensure we continue to give our patients the best of us.
- Within shifts, regular breaks are important to keep us functioning at our best as they allow us to ‘recharge’ ourselves.
A good core sleep routine and habits (sleep hygiene) are the foundation of quality sleep, and the stronger these are, the better able you are likely to be to maintain sleep under stress.
- Relaxation and mindfulness strategies can help you to get back to sleep, especially if you have already made these strategies part of your normal bedtime routine, as your brain will associate the routine of doing this with going to sleep.
- Most important of all, be kind to yourselves and others. Our best support will be, as always, our family, colleagues and friends and, by looking out for each other, we will get through this.
Where staff are working long hours more flexibly, employers should provide an appropriate level of supporting facilities such as rest areas, accommodation, access to food and drink, toiletries etc, to enable the safe and effective provision of services during this period.
It is important that rest breaks are accommodated wherever possible, to ensure staff are able to function effectively and safely. Discussions should take place with local staff-side organisations on these issues to seek agreement on policy at local level.
NHS trusts have been supporting their staff by:
- Homerton University Hospital NHS Foundation Trust catering company is offering vouchers worth £7.00 to all staff to use at the canteen
- York Teaching Hospital NHS Foundation Trust is offering a daily packed lunch meal which is free to all staff working days and nights on sites where catering facilities are available. This applies to all staff whether based in a hospital site or in the community.
- Northampton General Hospital NHS Trust in partnership with the Northamptonshire Health Charity have distributed re-usable water bottles to staff to ensure they stay hydrated and well at work.
The Health and Safety Executive suggests the following tips to reduce the impact of shift working on employees:
Eating small amounts often throughout the night will help keep energy levels up. Foods that are easy to digest such as pasta, rice, bread, salad, fruit, vegetables and milk products are best. Fatty, spicy and/or heavy meals are more difficult to digest, which can make individuals feel drowsy rather than alert. They may also disturb sleep. Sugary foods, such as chocolate, may provide a short-term energy boost, but this will be followed by a dip in energy levels.
Employees should obtain medical advice from their doctor and/or occupational health department if they require regular medication, such as insulin for diabetes, or if they suffer from a chronic condition such as epilepsy. Employees should discuss reasonable adjustments under the Equality Act 2010, such as ensuring adequate breaks, adjusting shift cycles etc.
Have a short sleep before the first night shift.
If coming off night shifts, have a short sleep and go to bed earlier that night.
- Keep to a suitable sleep schedule once identified.
Take regular short breaks during the shift if possible.
Get up and walk around during breaks.
- Plan to do more stimulating work at the times when feeling most drowsy.
- Keep in contact with co-workers as this may help all individuals to stay alert.
NHS staff have been given free access to a number of wellbeing apps from now until the end of December 2020 to support their mental health and wellbeing. One of the offers is access to Sleepio, which is a clinically evidenced sleep improvement programme that is fully automated and highly personalised, using cognitive behavioural techniques to help improve poor sleep.