Question 8

You have agreed to develop and implement a strategy to mitigate fatigue in the medical workforce in your ICU.

Outline the principles of staff fatigue management. Include in your answer how you would implement a fatigue management strategy.

[Click here to toggle visibility of the answers]

College answer

Not available.


"Why did you agree to this" would be the first normal response, but further, it is surely ironic that this question is posed to senior ICU trainees who had just experienced two of the most gruelling years of their career, during which many reported nobody paying any attention whatsoever to their burnout and fatigue, and during which some were in fact prohibited from taking leave.


  • Fatigue is "a state of mental and/or physical exhaustion which reduces a person’s ability to perform work safely and effectively" (

Influencing factors

  • Consecutive hours worked
  • Hours of sleep
  • Pattern of work (eg. erratic shift work)
  • Workload and work stress (physical, mental emotional stressors)
  • Individual factors (eg. existing mental and physical health impairments)

Institutional strategies to prevent fatigue

  • Protective rostering (no more than 40 hrs per week, sensible shift duration)
  • Scheduled downtime (need at least 10 hours between shifts)
  • Scheduled breaks (eg. naps)
  • Dedicated rest areas for staff
  • Automation of monotonous tasks
  • Workload management (eg. regulation of elective admissions)

Institutional strategies to ameliorate fatigue

  • Resiliency and coping skills training;
  • Support for workers (clinical supervision, mentoring)
  • Relaxation and lifestyle courses, such as mindfulness, meditation, yoga and exercise. 

Personal strategies to reduce fatigue

  • Sleep hygiene and fatigue management education
  • Culture change to accept the need for self-care
  • Individualised fatigue risk management strategies

Implementation of these strategies

  • Governance (authority over the program, leadership position)
  • Resources for implementation (including support for the program from the highest levels of hospital governance)
  • Integration with quality assurance and patient safety services to share resources
  • Local representatives or "champions" can be supported to establish a culture that promotes self-care and self-assessment of fatigue risk
  • Auditable criteria such as the mandatory maximum working hours, break times, staffing numbers, availability of leave or hours between shifts can be imposed and regularly tested
    Monitoring of these criteria, as well as monitoring of fatigue-related accidents
    Regular staff interviews or forums to gauge the subjective effect of these changes would need to be integrated into the process of auditing the overall strategy


Bywood, Petra, et al. "Fatigue and burnout in healthcare." (2020).

Frone, Michael R., and Marie-Cecile O. Tidwell. "The meaning and measurement of work fatigue: Development and evaluation of the Three-Dimensional Work Fatigue Inventory (3D-WFI)." Journal of occupational health psychology 20.3 (2015): 273.

Barger, Laura K., et al. "Effect of fatigue training on safety, fatigue, and sleep in emergency medical services personnel and other shift workers: a systematic review and meta-analysis." Prehospital emergency care 22.sup1 (2018): 58-68.