The impact of shiftwork on junior doctors' sleep, alertness, performance and well-being: a questionnaire survey

Following the implementation of the European Working Time Directive (EWTD), most junior doctors’ work shifts patterns that include blocks of consecutive nightshifts. In some cases, they are required to work as many as 7 night shifts in a row, while for others this is split into blocks of just 3 or 4 consecutive nights. The circadian rhythms of night-workers do not readily adjust to a nocturnal routine over several successive night shifts (Folkard & Tucker, 2003). Consequently, the sleep that is taken during the day between successive nightshifts continues to be disrupted, as it is taken at an inappropriate circadian phase. Thus fatigue continues to build up with each successive night that is worked, with consequent accumulations in performance impairment and risk of error. The current study assesses the impact of junior doctors’ shiftwork arrangements on fatigue and well-being, by means of two questionnaires distributed 6 month apart. The shift features examined include the number of consecutive night shifts before a break; the duration of rest intervals between shifts; the amount of rest breaks and naps taken during night shifts; the frequency of extended shifts; the frequency of weekend shifts; and the frequency of twilight shifts. The main outcome measures are sleep duration; alertness on shift; likelihood of making a minor mistake while on duty; confidence in being able to drive home safely; disruption of work-life balance; job satisfaction; and psychological well-being. The role of a range of moderating factors (e.g. domestic circumstances; job grade; work experience; work load; and circadian type) are also examined. A key focus of the analyses is to examine the accumulation of fatigue across successive shifts and whether the effects of nightworking spill over on to subsequent day shifts (e.g. as a result of circadian disruption). The analyses also considers the impact of napping during the night shift, on circadian disruption and the accumulation of fatigue. Findings are interpreted in the context of the need to optimize the balance between fatigue management and operational requirements (e.g. training, continuity of care), while maintaining compliance with the EWTD.