"So, What to do?" Further Explored!

So. We've promised you more.


The points in more detail:



• develop clinical frameworks for (fatigue) safety by employing best practice in clinical processes


A clinical framework has as its bones a network of enmeshed clinical processes that produce the final result. As someone famous once said:


"Any system is perfectly engineered to produce the results it gets."


Which means that if something you don't want to happen happens, it is because the system is engineered to allow that happenstance to happen.


From a fatigue happenstance, if you want to see where the systemic leverage points lie,

try playing 'Surgery Stat!'.


If you play it honestly, and try to overlay the ACORN Standards (yes, all 55 of them!), then you may find some interesting things happen.


Inevitably, 'System' is what happens.


The default thinking mode is to revert to 'What we've always done for the reasons we've always done them'.


Stop right now, and start thinking from different perspectives, including 'outside the box' ones.


And don't forget the hard decks for fatigue.


Not because you want to be nice to your staff. It's because safety is paramount to OUTCOMES and RESULTS!



• empower perioperative nurses to engage in (fatigue) safety measures


How can you achieve your outcomes if you don't get buy-in from your staff?


Like everyone, your staff have minds of their own, and they aren't afraid to use them.


"Fatigue? It's just people becoming SOFT! We never worried about fatigue in MY DAY!"


Just human nature, I'm afraid.


It's their job to be professional, and your job to convince them that respecting fatigue boundaries is being professional!



• optimise as much as possible workload, workload distribution and work intensity to enhance (fatigue) safety


Workload distribution is the intensity of workload over the course of a shift.


If it is skewed to the end of the shift with no wind down period, fatigue is exacerbated because the cognitive and physical effort demanded of staff occurs when fatigue is most apparent in it's effect.


If the peak workload occurs within the day, and staff have time to clean up and wind down at the end, then fatigue is minimised.


You just have to think for yourself: "What were my best days?"


I'm guessing they were the ones where you achieved your productivity, then got to finish up at a (for nurses) leisurely pace, thank everybody for a good day, and walk out the door.


I'm guessing they were NOT the days when your workload got faster and faster as you tried to rush through the busy list, never getting any closer to the end, and then, because the last case finished five minutes from the end of your shift or five minutes after, you had to rush through the clean up because there was no-one to help you, restock because you had no chance at any other time during the day, and then drag your tired arse out the door and limp home.


Don't think this is just my idea. It's been researched.



• utilise performance management processes to ensure clinicians work within (fatigue) safety boundaries


Performance management time. The worst and most unproductive five minutes of my year, right?


Try Manager Tools 'One on One Basics'.


Then you will realise what you are missing out on.


It's not about criticism or praise.


It's about investing in relationships, and once a year is not enough!



• ensure adequate education, competency and orientation of new and existing staff with respect to maximising the (fatigue) safety culture


New staff? Big opportunity to invest some time to setting the tone for your department.


"I don't know what you did where you came from,


We take fatigue seriously here."



• develop fair and equitable fatigue-mitigating rosters (including lower fatigue-risk in on-call structures)


Rosters: The Grandest 'Grand Diabolical' Sudoko ever.


Probably the most difficult shift in cultural thinking needs to occur here if we are to comply with Fatigue Prevention!


It's the old joke:


"How do we get to XYZ?"

"Well, if I wanted to get to XYZ, I wouldn't start from here!"


Use the definitive fatigue parameters.


Remember you have an obligation, not just to work life, but to home life as well.


The Charter of Human Rights and Equal Opportunities demands that you not discriminate against someone because of their carer's responsibilities.


It's not a request. It's the LAW.


Supreme complexity!


If you find a great answer, let us know your solution, and we will publish it, because everyone's stuck for answers right now!


Some places in America have elected to employ on-call staff on contract with a promise of, say, 30 hours per week of just on-call, whether they come in or not.


It leaves the daytime allocations fresh and secure, so that you know you won't be playing 3 staff down for all the next day.


Worth it? Because fatigue is toxic and cumulative, I would think so. But I'm not the one paying the bills.


Then again, it may finish up being the most cost-neutral strategy there is!



• employ rest strategies which facilitate well-being and work effectiveness




For me, it means 20 hours work in a timespan of 29 hours, all on 5 1/2 hours sleep.

And hitting the wall at 2 PM.


The evidence would tell you that the most productive thing you can do is nap.


20-40 minutes.


It resets your fatigue without reducing the quality of your night-time sleep.


It may actually improve things all round. Better fatigue control, better, safer productivity at work, better engagement at home when you walk in the door at bewitching hour to start your domestic routine of getting the family fed, watered, bathed, homework and off to bed.


And STILL be able to sleep yourself because you are not over-tired.


Win-win. If only our guilt-chips let us do it!


Otherwise, Make sure you pro-actively ensure your staff get their allocated, undisturbed breaks as a minimum.


Not because you're nice, but because that is the most effective fatigue reduction strategy you can employ.


And because 'people not getting their breaks is definitive evidence that the workload is exceeding the capacity of the resources available to deal with it'. (Pete Smith, 2014)



• Be vigilant for opportunities to further improve team behaviours (which may flag or exacerbate fatigue).


Ah. If it weren't for human nature, my job would be easy.


Conflict is a given.


Again: Manager Tools Basics: 'Dealing with conflict'.


Further, team behaviours are a missing part in the big picture puzzle.


The airline industry has been working on Crew Resource Management for thirty years.


'Below Ten Thousand' is just the start of us engaging in that for our own clinical environment.


Do what you can to improve the performance of team behaviours.


And remember: Conflict as a sign of fatigue is not beyond the realm of possibility.


At least, treat it as a possible flag.




So. There you have it. A little treatise to try to place some sketchy lines on the drawing board.


Sooner or later, those sketchy lines may start to look like a picture.

But it will take your colouring in to make it a better one.

This sketch (so far) is ours.

Send us yours