The Impact of shiftwork on junior doctors' sleep, alertness, performance and well-being

The implementation of the European Working Time Directive (EWTD), has considerably altered the organisation of junior doctors’ work hours. Total hours have been reduced and full shift schedules have replaced traditional on-call rotas. The negative consequences of shiftwork have been extensively documented; effects are reported to include disrupted sleep, impaired vigilance, cognitive impairment, social isolation, as well as negative effects on mood, job performance, mental health and physical health (Issac 2000, Akerdstedt 2003). However, little is known about the effects that the new shift schedules have upon junior doctors. The current study examined the effects of shift work on junior doctor’s performance, sleep, alertness, health and general well-being, through qualitative one-to-one interviews. Ten junior doctors, from five NHS Trusts across Wales participated in a semistructured interview. Participants included doctors from Foundation Level one and two, Specialist Trainees and Specialist Registrars. Inductive Thematic Analysis indicated a complex relationship between work hours and fatigue influenced by shift sequence, career goals and organisational support systems. Three main themes emerged from the data; ‘Doctor’s schedules’ identified specific shift features which were associated with disrupted sleep and intensified fatigue. The impact of working many consecutive night shifts, together with frequent and poorly distributed on-call duties, were discussed in terms of decreased performance, medical error and concern for patient care. ‘Work-life balance’ depicted an unsatisfactory balance between work and home life, disrupted social and family lives due to anti-social shifts, sleep deprivation and work related fatigue, complicated further by career goals and educational needs. ‘Social and organisational support structures’ identified a critical role for departmental moral and team spirit. Good support structures in the work place acted as a buffer against the demands of difficult work schedules, and negative role stressors. Implications are drawn for schedule design to reduce fatigue alleviate sleep deprivation and improve welfare of junior doctors.1 page(s