Where does the fatigue come from?
Among the factors that determine the level of fatigue of the healthcare professional, frequency, intensity and duration of work plays an important role, as well as individual clinical experience, level of supervision and support from the wider team.
The current working conditions shared by a large number of healthcare workers across Europe contribute to the emergence of fatigue: long day & night shifts, reduced teams of staff due to shortages, untenable staff/patient ratios, unrealistic expectations of staff and periodically, abusive patients.
Other elements may also play an important role: work culture and liability for fault.
What makes fatigue so specific in healthcare?
In addition to working conditions, two factors that generate fatigue should be highlighted: the work culture and the high level of responsibility.
The medical world shares a work culture in which fatigue is an integral part of the job; it is a form of co-product or occupational hazard, a collateral effect that cannot be avoided. In this context, complaining or raising concerns about it, or trying to avoid it is not always an option, unlike in other sectors where identifying and managing potential fatigue is seen as normal and even desiredbehaviours that generate safety.
In the medical world, complaining about long hours and subsequent fatigue can be seen as an admission of weakness, and can hinder career advancement, especially for young practitioners who have to go through a kind of initiation rite, an excessive workload, and therefore fatigue, before being able to move on to a quieter life.
Another aspect of the work is the high level of responsibility that rests on the shoulders of healthcare workers, since they have human lives in their hands and the smallest mistake, even carelessness, can lead to real human tragedy.
This responsibility is both moral and legal. Moral because, even in the absence of fault, the health professional will often come to question the sequence of events and the role he or she played in them. Legal, because it is less and less rare for victims or their families to bring before the courts what they consider to be medical errors, for which they wish to be compensated.
Find out more about the culture of fatigue in the healthcare.
Which factors are causing prolonged fatigue?
Prolonged fatigue associated with mental health problems or even burnout can be, among other things, caused by:
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Repeated sleep deprivation;
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Having to continue to function while being tired;
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Not being able to express that you are tired, because it is not recognised or accepted in the culture;
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Feeling that things are not going to change, of being used by others or by ‘the system’;
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Not being recognised as having a difficult job, with responsibilities, which requires constant attention;
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Not feeling respected or valued by the organisation, by government or by wider society;
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Tension between professional and domestic and family demands;
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Not being able to carry out one's job - caring for the person - in the way one thinks one should, in a humane way, by devoting the time necessary for listening and empathy, beyond just performing technical and administrative procedures.
Ultimately, what is fatigue the symptom of?
Fatigue highlights difficult work conditions and could ultimately seen as a symptom of the extent to which policies of cost rationalisation in healthcare have contributed to progressively shape inhumane working environments in the healthcare sector, both in public and private institutions.
Cost rationalisation is not fundamentally wrong in itself; pushing for the rationalisation of existing activities allows margins to be released and can lead to new human and technical investments that contribute to a higher quality of care.
However, all too often, cost rationalisation is an objective in itself, associated with productivity gains, and the margins generated are not reinvested.
Moreover, increasing productivity often comes at the cost of increased fatigue among healthcare staff, through the upward revision of patient/practitioner ratios. Another often favoured rationalisation option, the computerisation of administrative tasks, will in some cases lead to an increase in the non-medical tasks to be carried out by healthcare professionals, often because their needs were not taken into account in the development of these tools.
When rationalising costs, policy makers and sometimes even the hospital management seemed to have forgotten that the sector is essential to collective and individual well-being, relying on people who are invested in caring for others.
We are fighting AGAINST fatigue but what are we fighting FOR?
Quite often, in many places, the limits of what is reasonable to expect from health professionals, as human beings,have been crossed.
The Covid-19 pandemic has only added another layer of inhumanity, when health workers had to work long days and nightshifts, with no rest for weeks on end, having to make and deliver difficult decisions such as prioritising the sick or preventing relatives from being by their loved one's side as they took their last breath.
Fatigue is a good starting point for our campaign, but it It would be a mistake for our campaign to stop at fatigue. The challenges facing health services go far beyond fatigue. It is a question of bringing humanity back to care, of making the working environment liveable again, if we are to avoid the collapse of the health care system on a European scale.
However, fatigue is where we decided to start; inexpensive improvements can be made. Much is known from other safety-critical industries about managing workplace fatigue effectively, which can be used to improve the healthcare environment.