Cath Lab Digest

“Tonight will make 9 straight days on call. I’m exhausted. We’ve been in the hospital 5 nights, and a couple times on 2,” she said.
 “Why so many?”
 “Not enough people to cover. One on vacation, one on sick leave, and two rotated to radiology. Even our nurse manager had to take call.”
“That sounds awful. What about registry nurse help?”
“They’d rather take 12-hour shifts rather than lower paying call. Who wouldn’t?”
“How about traveling nurses?”
“Administration is not hiring. I’m not sure how long we can go on like this.”

I heard this story recently (and have heard it before) from a couple of experienced and dedicated nurses. ‘Call’ was becoming overwhelming and it was evident that soon fatigue and its associated consequences would set in. While probably an atypical situation, it likely occurs at times in every lab, every workplace and for everyone with demanding after-hour duties.

It is no surprise that fatigue is a major issue in almost all areas of the workforce, including medical service care delivery such as the cath lab. From a quick review of the subject (thank you, Google), fatigue is increasing among U.S. workers. Of 820 human resource leaders, over 80% believe that fatigue among workers is worse than in previous years.¹

Of importance to our discussion relating to work in the cath lab, it appears that (like many businesses), the main reason for workplace fatigue is too few employees for the work to be done. Additional, potential factors contributing to workplace fatigue also include the blurring boundaries between work and home life, desire to advance (or to please), and overwork due to fear of losing one’s job.

Fatigue diminishes our cognitive functions, i.e., alertness, perception, and reasoning. It was interesting to learn that severe fatigue, as occurs when someone has been awake for 14 to 17 hours followed by only 6 hours of sleep, can be similar to being under the influence of alcohol.²

Alertness in the workplace pays dividends through increased productivity, safety and quality. Fatigue can be minimized by addressing it on several levels: (1) education, (2) work hours (including start times, shift length, type of shifts (fixed vs. rotating shifts), (3) consecutive work days, and (4) overtime. In certain industries, the risk of fatigue-related work problems has prompted the government to pass legislation to control factors producing fatigue. This legislation is easily seen in the rules related to workers in air traffic control, trucking and other public transportation, and nuclear power plants. Fortunately, for those of us working in the cath lab, fatigue may not have the same “life or death” consequences, but all of us should still be concerned about how it affects cath lab safety and performance.

Sleep deprivation is one of the most common correctable causes of workplace fatigue. Because it is at times a conscious behavior (i.e., staying awake), we should remind ourselves that this decision should be good one. Since people sleep more on their days off than they do on workdays, the people on the longer workdays will end up averaging more sleep than those on the 8-hour workdays. Managers should consider longer but fewer shifts to reduce fatigue. The number of consecutive days of work is also related directly to the degree of fatigue. The more days in a row one works, the more one’s sleep deficit accumulates, often in an undetectable fashion. Most people will not realize a small drop in cognitive function as each day passes. With each passing work night, fatigue through sleep deprivation reduces safety and productivity. Reducing the number of consecutive days worked will provide a respite to catch up on sleep. Although the recovery time is uncertain, most researchers believe that at least two days off in a row will have the most beneficial recuperative impact.

Fatigue factors: Rotating vs. fixed shifts and overtime

From an alertness point of view, fixed shifts are superior to rotating shifts. There is a significant amount of research indicating higher health risks and lower overall alertness on rotating shifts.

Overtime (and on-call time) disrupts people’s lives. Many personal plans must be cancelled, resulting in a degree of stress and job dissatisfaction. Forfeited sleep hours are often traded for overtime hours. How much overtime is too much is a difficult question to answer. Most companies feel that an annual average between 5% and 15% is about right.³ However, the overtime related to cath lab work is highly variable and, as most know, totally unpredictable. The consequences of fatigue, such as diminished alertness, will translate into decreased productivity, safety and quality. Eliminating fatigue and improving alertness can be facilitated by: (1) creating a work structure that promotes awareness and (2) giving the staff the education, training, and support needed to make good decisions.³