Fatigue risk management in healthcare

Fatigue is widely accepted as a feature of working life across healthcare. Long hours, shift work and high workload mean that many staff regularly experience some degree of fatigue. Fatigue is associated with increased risk of error and reduced performance and therefore has negative impacts on both patient safety and staff wellbeing. Fatigue is also linked to broader workforce challenges including staff physical and mental health, burnout, absenteeism and retention. Although these risks are well documented, the extent to which they are addressed through structured and systematic approaches within healthcare remains less clear.

We recently reviewed the literature to explore how fatigue is currently managed across healthcare and what strategies are being used in practice. The findings provide an overview of how fatigue is understood and addressed and highlight a gap between the well-established risks associated with fatigue and the ways in which those risks are mitigated in practice.

The gap between evidence and practice

Fatigue is complex and multifaceted, being influenced by several factors including sleep loss, extended working hours, shift patterns, workload intensity, and the cognitive and emotional demands of healthcare work. Fatigue can influence attention, decision-making, communication and overall task performance, all of which are core elements of safe and effective care. Despite this, the review identified a gap between the well-established risks associated with fatigue and the ways in which those risks are managed in practice. Fatigue management across healthcare remains fragmented, with most approaches focused on individual strategies or isolated interventions rather than coordinated programmes.

At an individual level, healthcare staff commonly rely on informal strategies such as caffeine consumption, adjusting sleep routines, physical activity and napping (where possible) to manage their fatigue. These approaches are often developed through experience rather than formal guidance and, while they may help in the short term, they place much of the responsibility for managing fatigue on individuals despite the risk being largely shaped by upstream factors.

Alongside these informal strategies, targeted interventions such as fatigue education programmes, scheduled napping and changes to shift patterns have also been explored. The evidence suggests that although these measures can improve fatigue and performance under certain conditions, implementation was often inconsistent and impacts were limited when introduced in isolation as opposed to being part of a holistic fatigue management programme.

The review also identified growing interest in predictive approaches, including biomathematical modelling to assess fatigue risk within work schedules. While these tools are already established in industries such as aviation and rail, they remain relatively underused in healthcare. One challenge is that planned schedules do not always reflect the realities of clinical work, where shifts frequently overrun and workload can fluctuate significantly.

Cultural and systemic barriers

One of the clearest themes across the literature is the extent to which fatigue has become normalised within healthcare. In many settings, working while fatigued is viewed as an expected part of the job and at times associated with professionalism or dedication. This culture can begin early in training and shapes how fatigue is understood and managed, often positioning it as an individual responsibility rather than something influenced by wider organisational and system factors.

Alongside these cultural expectations, several systemic barriers can limit the implementation of fatigue management strategies in practice. Staffing shortages, workload pressures, long shifts, and inadequate rest environments all affect the feasibility of interventions designed to support rest and recovery. Even where breaks or rest facilities are available, staff may still feel reluctant to use them due to guilt, stigma or workload pressures.

The review also highlights that healthcare has yet to consistently adopt the kind of proactive and non-punitive approach to fatigue reporting seen in other safety-critical industries. In these sectors, fatigue is treated as a reportable and manageable safety risk within wider safety management systems. In healthcare, however, staff may still feel uncomfortable reporting fatigue or raising concerns about unsafe working conditions, which limits opportunities for organisational learning and improvement.

Important enablers to fatigue management were also identified including supportive leadership, better workload distribution, access to appropriate rest facilities and environments that encourage open discussion of fatigue. Together, these findings reinforce that fatigue management depends not only on individual strategies, but also on organisational culture and system design.

Towards a system-wide approach

One of the clearest findings from the review is that there remains a significant gap between understanding fatigue as a risk and managing it in a systematic way. While many strategies already exist, they are often implemented in isolation and rely on individual effort rather than being supported through wider organisational structures.

Looking to other sectors, industries such as aviation and rail have adopted more coordinated approaches. In these settings, fatigue is treated as a predictable and manageable safety risk supported by formal systems that incorporate monitoring, governance, reporting, and continuous evaluation. Although healthcare differs in complexity and unpredictability, these industries demonstrate the value of recognising fatigue as something that can be proactively managed rather than reactively responded to.

Moving towards a more system-wide approach in healthcare does not mean replacing individual strategies but supporting them within a broader organisational framework. This includes recognising fatigue as part of wider safety and workforce considerations, improving awareness and education, and creating working environments that better support rest and recovery. It also requires shared responsibility across individuals, teams, leadership and organisations, rather than relying primarily on individual resilience.

A final thought

The review highlights a clear gap between how fatigue is managed in healthcare compared to the more developed system-based approaches used in other safety-critical industries. Moving forward will require both cultural and organisational change that recognises fatigue as a predictable and manageable safety risk that is shaped by how healthcare systems operate.

While healthcare cannot simply replicate the fatigue management models used in other industries, adapting some of the same underlying principles could help move fatigue management beyond individual resilience and towards a more coordinated, system-level approach that supports both staff wellbeing and patient safety.

You can read the full review here https://doi.org/10.1016/j.ijnurstu.2025.105282