The current emergency is unprecedented. Health care professionals (HCPs) who have retired are being asked to re-join their registers and return to frontline care.
Demand in ITU/HDU beds is such that staff will be asked to work in areas that will stretch their knowledge and skills in support of the teams already working there. The issues with supply chains, normally an annoyance rather than a calamity, will now have a massive impact on the safety of staff as well as patients.
I'm sure people have seen the images of staff wearing personal protective equipment (PPE) for hours on end. In my own practice we have been pushing the first step of the donning process as being about staff welfare.
Are you fit to wear the kit?
Are you hydrated?
Have you had a wee?
Simple three questions but poignant in the context of the Resuscitation Council UK (2020) guidance released this week on resuscitation and the need to ensure safety of staff over the needs of the patient and don correct PPE prior to resuscitation attempts.(1)
Now put all of that – staff returning to frontline care after many years, the use of PPE for extended periods of time and changes in the way we care to ensure our safety – and ask yourself, how do you do that in a 12 hour shift, maybe the third one in a row, and without being able to get the normal shopping you would on the way home the night before?
We (healthcare in general) have a culture of putting the patient above everything else, including our health and wellbeing. The ‘Nurse bladder’ is legendary and often laughed about, especially when the surgeons get involved and one-upmanship becomes the banter, even though we are actually causing harm to ourselves.
Now add to that people who have had many leisure years or worked outside of clinical care for some time (not everyone re-joining have actually ‘retired’). IN the normal world they would have an induction, period of supernumerary time and supervised practice, and build up to the 12 hour working day. Will we really, in the time it will take to get these people onto the shop floor, be in a place to do this still?
Before we even go into the whole returning to work issues we need to look at ourselves now. Caruso (2) reports that errors in 12 hours shifts are increased by as much as 28% in comparison to an 8 hour shift. This is before you add in the current issues. There has been many more studies showing the danger of the long day working. Indeed, this was part of the evidence that led to the changes in the junior doctor contracts in 2016.
Changing back to the way we worked 25 years ago with a three-shift pattern may be a challenge. It will mean that nurses will need to really know their patients in a shorter time period but will be delivering safer care with less fatigue. It will mean that staff will have three handovers to go through but patients information will be updated at least three times a day instead of the normal two – presuming you are working in a 'work as done' environment and not the 'work as imagined'(3) world where by every patient has every part of their care documented immediately as it happens.
And it will mean that staff won't be able to work three long days for their primary employer and then go and work an additional two (or even more) days on a bank/ agency but they will be healthier and less likely to make mistakes.
(It is worth noting, however, that long day working has enabled people to work as an HCP who wouldn’t otherwise be able to by reducing the amount they pay for childcare.)
With the evidence against long day working, why do we continue to insist we do it even though it puts us and our patients at risk?
Ultimately, changing back to a short shift system in the current climate could reduce the exposure we have to risk, and help support those returning to practice and support those of us currently in practice.
In the immediate future there is still things we can do:
If you have to wear PPE, ensure it is for the minimum amount of time and, after, you sit down, rest, rehydrate and refuel (4).
If you're not OK, share with your team members so they can look out for you.
Plan your working day so that you know when you are going to take breaks and make sure everyone knows that this is your break time and you won't be dealing with any queries or questions during that time.
To aid the above, take your break outside of your immediate working environment. Lots of hospitals are opening welfare areas and there are still some that have staff areas.
And remember, we are no good to anyone if we are run down, broken and not able to function.
1. 3. Resuscitation Council UK (2019). Resuscitation of COVID 19 patients in hospital. Version 1. 2000.
2. Caruso C. Negative effects of shift work and long work hours. Rehabilitation Nursing 2013.
3. Hollnagel E, Braithwaite J, Wears RL. Delivering Resilient Health Care. Routledge. Oxon. 2019
4. Royal College of Nursing (2018) Rest Rehydrate Refuel. Accessed 22nd March 2020.