“Burnout is at a crisis level, made worse by COVID-19,” says sleep medicine specialist Indira Gurubhagavatula, MD, MPH, quoted by MedPageToday.
Approximately 50% of healthcare professionals were already experiencing some form of burnout syndrome before the pandemic, which only worsened their professional and personal wellbeing. Per the Surgeon General Advisory issued on May 23, 2022, there is an urgent need to address the healthcare worker burnout crisis sweeping across the country. This is not only to support those currently struggling but also to prepare for the projected shortage of 3 million low-wage healthcare workers in the next five years.
As awareness of the escalating prevalence of burnout grows, so do efforts to mitigate it. Thus far, the predominant solution has been integrating wellness programs promoting mindfulness techniques, conscious movement, and stress management. Because these strategies do not address the root causes of burnout syndrome and merely attempt to treat symptoms, they have proven insufficient as the burnout crisis continues to worsen.
Sleep as a Root Cause?
More recently, fatigue is emerging as a mediator of occupational stress sparking interest in the potential role of sleep loss, insomnia, and chronic fatigue in occupational burnout.
Insomnia symptoms and sleep deprivation pose a significant public health concern and economic burden. In 2010, data estimates concluded that insomnia costs U.S. workers an annual total of 252.7 days of lost productivity and $63.2 billion. With an ongoing pandemic, record burnout levels, supply chain issues, and dramatic labor shortages in the current health care environment, how much is insomnia costing medical professionals?
There is a growing interest in and research efforts on the role of sleep and fatigue in occupational burnout, specifically in healthcare practitioners. A recent study found that insufficient and disordered sleep was strongly associated with occupational burnout and could be the underlying cause of the health care system’s burnout crisis.
Impact of Sleep Deprivation on Providers
Alongside fatigue, poor wellbeing, and ultimately, occupational burnout, chronic sleep deprivation has a widespread effect on providers’ physical and mental health.
Studies have shown that even one night of missed sleep can affect cognitive performance. Adults who sleep less than 5 hours per night score lower on standardized tests in language and numeric skills, information retention, short-term memory, and concentration.
Furthermore, chronic sleep loss has been linked to a heightened risk of musculoskeletal injury, obesity, diabetes, and cardiovascular disease. Increased risk of cancer is a concern as well. Nurses who worked rotating night shifts for over 15 years were 1.79 times and 1.35 times at risk of developing breast and colorectal cancer, respectively.
Risk to Patients
In healthcare practitioners, insufficient sleep duration, poor sleep quality, and untreated insomnia can increase medical errors and decrease performance speed. A 2020 study found that severe sleep-related impairment resulted in 97% greater odds of self-reported clinically significant medical errors among clinicians. Sleep loss has also been associated with decreased patient safety and care quality ratings among nurse practitioners.
Sleep deprivation can also affect mood and decrease communication effectiveness, with a single night of insufficient sleep reducing cognitive performance by as much as 25%. And the effects of prolonged sleep loss on clinical performance have been compared to alcohol-related impairment; 19 hours of being awake has been equaled to a blood alcohol concentration of 0.05% and 24 hours to 0.10% – enough to be considered driving under the influence.
Addressing the Fatigue-Driven Burnout Crisis
During a national shortage of healthcare workers, it is even more difficult for physicians to carve out extra time for rest and recovery. Moreover, there are currently no guidelines limiting the volume of procedures performed by an individual healthcare practitioner or the length of time they may be on call.
That is why there is a pressing need for institutional policies – similar to those installed in the aviation industry. Such fatigue risk management programs are designed to minimize the tolerance of failure due to reduced mental or physical performance from sleep loss. They include thoughtful schedule design, non-punitive reporting of fatigue or burnout, and standardized procedures to protect against fatigue-related errors.
As a system, health care needs to begin prioritizing effective, efficient, and empathetic long-term functioning, highlighting important factors such as worker productivity, retention, patient safety, and a stronger brand over short-term care models.
To mitigate medical worker fatigue and burnout, educational and awareness programs must train all system members to recognize potentially dangerous symptoms. In addition, infrastructure to aid fatigue countermeasure implementation, such as improved on-call rooms, is currently lacking.
Searching for Balance
Finding a balance between the need for continuous care with the healthcare providers’ need for rest is not a simple task, yet it is critical for the health and wellbeing of the nation.
Regardless of age and career stage, all medical professionals need to be conscious of their professional and personal demands, balancing them with sufficient rest to avoid excessive fatigue, occupational burnout, and the potentially fatal consequences of both.