More than 3.5 million people are employed as shift workers in the UK. They work in a wide variety of industries including the emergency services, healthcare, the utilities, transport, manufacturing (including oil, gas & chemical industries), entertainment and retail. Poorly designed shift-working arrangements and long working hours that do not balance the demands of work with time for rest and recovery can result in fatigue, accidents, injuries and ill health.
Fatigue refers to the issues that arise from excessive working time or poorly designed shift patterns. It is generally considered to be a decline in mental and/or physical performance that results from prolonged exertion, sleep loss and/or disruption of the internal clock. It is also related to workload; in that workers are more easily fatigued if their work is machine-paced, complex or monotonous.
Fatigue results in slower reactions, reduced ability to process information, memory lapses, absent-mindedness, decreased awareness, lack of attention, underestimation of risk, reduced coordination etc. Fatigue can lead to errors and accidents, ill-health and injury, and reduced productivity. It is often a root cause of major accidents e.g. Clapham Junction rail disaster, Chernobyl, the Texas City oil refinery explosion, the Exxon Valdez oil spill and the loss of the Challenger space shuttle.
Fatigue has also been implicated in 20% of accidents on major roads and is said to cost the UK £115 - £240 million per year in terms of work accidents alone.
Key principles in fatigue
- Fatigue needs to be managed, like any other hazard.
- It is important not to underestimate the risks of fatigue. For example, the incidence of accidents and injuries has been found to be higher on night shifts, after a succession of shifts, when shifts are long and when there are inadequate breaks.
- The legal duty is on employers to manage risks from fatigue, irrespective of any individual's willingness to work extra hours or preference for certain shift patterns for social reasons. Compliance with the Working Time Regulations alone is insufficient to manage the risks of fatigue.
- Changes to working hours need to be risk assessed. The key considerations should be the principles contained in HSE's guidance. Risk assessment may include the use of tools such as HSE's 'fatigue risk index'.
- Employees should be consulted on working hours and shift patterns. However, note that employees may prefer certain shift patterns that are unhealthy and likely to cause fatigue.
- Develop a policy that specifically addresses and sets limits on working hours, overtime and shift-swapping, and which guards against fatigue.
- Implement the policy and make arrangements to monitor and enforce it. This may include developing a robust system of recording working hours, overtime, shift-swapping and on-call working.
- Problems with overtime and shift-swapping may indicate inadequate resource allocation and staffing levels.
- There are many different shift work-schedules and each schedule has different features. This sheer diversity of work and workplaces means that there is no single optimal shift system that suits everyone. However, a planned and systematic approach to assessing and managing the risks of shift work can improve the health and safety of workers.
- There are a number of key risk factors in shift schedule design, which must be considered when assessing and managing the risks of shift work. These are the workload, the work activity, shift timing and duration, direction of rotation and the number and length of breaks during and between shifts. Other features of the workplace environment such as the physical environment, management issues and employee welfare can also contribute to the risks associated with shift work.
- Sleep disturbances can lead to a 'sleep debt' and fatigue. Night workers are particularly at risk of fatigue because their day sleep is often lighter, shorter and more easily disturbed because of daytime noise and a natural reluctance to sleep during daylight.
Some good practice guidance on shift roster design
- Restrict number of night shifts (to 4 maximum if possible).
- Allow at least 2 days off following night shift.
- Avoid keeping workers on permanent night shifts.
- Move early shift starts before 6am forward (e.g. 7am not 6am start).
- Limit the number of successive early starts i.e. before 7am (to 4 maximum if possible)
- Shifts involving an early start should be shorter in length to counter the impact of fatigue later in the shift.
- If 12-hour shifts worked then no overtime worked in addition.
- Avoid long working hours (more than 50 hours per week).
- If 8/10 hour shifts then no more than 4/2 hours additional overtime to be worked.
- Restrict 'back to backs' with 8 hour shifts and avoid entirely with 12 hour shifts.
- Allow minimum of 12 hours between shifts and avoid 'quick return' of 8 hours if possible. (Rest period between shifts should permit sufficient time for commuting, meals and sleep.)
- Plan some weekends off, advisably at least every 3 weeks.
- Rotate shifts quickly (e.g. every 2-3 days). Avoid rotating shifts every 1-2 weeks.
- Use forward rotation (morning/afternoon/night) for preference.
- Arrange start/finish times of the shift to be convenient for public transport, social and domestic activities.
- Consider travelling time of workforce.
- Allow some individual choice where possible to accommodate larks/owls and family commitments.
- Keep the timing of shifts regular and predicable but also allow employees to have some flexibility to choose their own work schedule.
Hints and tips for shift-workers
People vary in how they cope with shift work depending on their health, fitness, age, lifestyle, and domestic responsibilities- some adapt well, others do not. Whilst we cannot change our inbuilt characteristics, it is possible to alter our behaviour or make lifestyle changes that may make shift work more tolerable. The hints and tips below draw on commonly available advice and best practice from a range of sources and may improve sleep quality, increase alertness and reduce health risks for shift workers.
Driving to and from work
Driving to and from work can be risky, particularly after a long shift, a night shift or before an early start. The following strategies may make driving safer:
- consider using public transport or taxis rather than driving
- exercise briefly before your journey
- share driving if possible
- drive carefully and defensively
- try not to hurry
- stop if you feel sleepy and take a short nap if it is safe to do so
- make occasional use of caffeine or 'energy' drinks
Identify a suitable sleep schedule
Most adults need 7-8 hours' sleep a day although this may decrease with age. If you cannot do this, try to rest, as this is still beneficial. Recording sleep patterns and problems using a diary may help to explain fatigue and tiredness. It can also be used to help find the most suitable strategies and conditions for a better quality of sleep.
- if you work regular shifts, try going to bed at different times e.g. soon after you arrive back from work or stay up and sleep before the next shift;
- have a short sleep before your first night shift;
- if coming off night shifts, have a short sleep and go to bed earlier that night;
- once you have identified a suitable sleep schedule try to keep to it.
Make the environment favourable for sleeping
Sleep loss and fatigue are some of the most significant problems for shift workers. It is important to try and maintain your normal level of sleep and rest. Daytime sleep is usually lighter, shorter and of poorer quality than night time sleep. It is more frequently disturbed because of warmer temperatures and daytime noise. To help make the environment favourable for sleeping:
- sleep in your bedroom and avoid using it for other activities such as watching television, eating and working
- use heavy curtains, blackout blinds or eye shades to darken the bedroom
- disconnect the phone or use an answer machine and turn the ringer down
- ask your family not to disturb you and to keep the noise down when you are sleeping
- discuss your work pattern with close neighbours and ask them to try and avoid noisy activities during your sleep time
- if it is too noisy to sleep consider using earplugs, white noise or background music to mask external noises
- Adjust the bedroom temperature to a comfortable level, cool conditions improve sleep.
Techniques to promote sleep
To promote sleeping, try to follow a similar routine to the one you follow before a normal night's sleep. The following tips may help you relax after a shift and promote sleep:
- go for a short walk, relax with a book, listen to music and/or take a hot bath before going to bed
- avoid vigorous exercise before sleep as it is stimulating and raises the body temperature
- avoid caffeine, 'energy' drinks and other stimulants a few hours before bedtime as they can stop you going to sleep
- don't go to bed feeling hungry: have a light meal or snack before sleeping but avoid fatty, spicy and/or heavy meals, as these are more difficult to digest and can disturb sleep
- Avoid alcohol as it lowers the quality of sleep.
It is very important to consider the timing and quality of your meals. Digestive problems are common in shift workers due to disruption of the body clock and poor diet. Plan your meals to help you stay alert at work and to relax/sleep when you need to rest.
- regular light meals/snacks are less likely to affect alertness or cause drowsiness than a single heavy meal
- choose foods that are easy to digest such as pasta, rice, bread, salad, fruit, vegetables and milk products
- Avoid fatty, spicy and/or heavy meals as these are more difficult to digest. They can make you feel drowsy when you need to be alert. They may also disturb sleep when you need to rest
- avoid sugary foods, such as chocolate - they provide a short-term energy boost followed by a dip in energy levels
- fruit and vegetables are good snacks as their sugar is converted into energy relatively slowly and they also provide vitamins, minerals and fiber
- Drink plenty of fluid as dehydration can reduce both mental and physical performance but avoid drinking too much fluid before sleeping as this may overload the bladder.
Stimulants and sedatives
Shift workers often turn to stimulants such as coffee or cigarettes to keep them awake and sedatives such as alcohol or sleeping pills to help them sleep. Avoid such aids as they only have short-term effects on alertness as tolerance to their effects develops. Persistent use may also increase the risk of dependence.
Caffeine is a mild stimulant present in coffee, tea and cola as well as in tablet form and in special 'energy' drinks. It can improve reaction time and feelings of alertness for short periods. Only use caffeine occasionally and don't rely on it to keep you awake. If you do decide to take caffeine or other stimulants, you should consider what might happen when its effects wear off e.g. when you are operating machinery or driving.
Avoid the use of alcohol to help you fall asleep. Although alcohol can promote the onset of sleep it is also associated with earlier awakenings, disrupted sleep and poorer sleep quality. Regularly drinking too much increases the risk of long-term damage to your physical and mental health, your work, social and personal relationships.
Regular use of sleeping pills and other sedatives to aid sleep are not recommended because they can lead to dependency and addiction.
New drugs have recently been developed that can alter our state of alertness. Although their use may be widespread abroad, the ways in which they work and their long-term effects are not yet fully understood and consequently their use is not advised unless under medical supervision.
Physical fitness and a healthier lifestyle
An unhealthy lifestyle combined with shift work may increase the likelihood of sleep disorders and sleep loss or exacerbate existing sleep problems. A good diet, regular meals and exercise can improve sleep quality, health and well-being.
- you can improve your fitness by spending 30 minutes a day on a physical activity including housework and walking. Consider joining a gym or taking part in a regular exercise class
- eat healthy meals on a regular basis
- cut down or give up smoking
- reduce your alcohol intake
- seek advice from your doctor if you require regular medication such as insulin for diabetes or suffer from a chronic condition such as epilepsy.
Family and friends
Working shifts that differ from the routines of friends and family can leave you feeling isolated and it is important to make the effort not to lose contact with them:
- talk to friends and family about shiftwork. If they understand the problems you are facing it will be easier for them to be supportive and considerate;
- make your family and friends aware of your shift schedule so they can include you when planning social activities;
- make the most of your time off and plan mealtimes, weekends and evenings together;
- plan your domestic duties around your shift schedule and try to ensure that you do not complete them at the cost of rest/sleep. You may need to change the times/days when some jobs are done;
- invite others who work similar shifts to join you in social activities when others are at work and there are fewer crowds.
Ways to improve your alertness at work
On some shifts, such as nights and very early mornings you may find it difficult to remain alert and this can affect your performance. It may also increase the risk of errors, injury and accidents. You may find it helpful to:
- take moderate exercise before starting work which may increase your alertness during the shift
- keep the light bright
- 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 you feel most drowsy
- Keep in contact co-workers as this may help both you and them stay alert.
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