The impact of work-related fatigue for nurses and other staff is not being adequately recognised as a serious risk to patient safety, according to a report by the Health Services Safety Investigations Body (HSSIB).
The report looked at the impact of staff fatigue on patient safety in acute hospital trusts.
It found that fatigue was linked to preventable patient harm and staff safety incidents, both directly and indirectly, including road accidents where NHS colleagues had lost their lives.
It also described barriers to recognising the size and scale of the issue, saying that there was ‘little evidence available’ to understand the scale of impact, and that the healthcare sector ‘lacks robust systems’ to monitor and manage the issue.
The report found there were various ‘cultural norms’ widespread in the NHS, such as pride, heroism around long working hours, which discouraged open conversations about fatigue, and that there was limited organisational accountability for this.
The report, which used interviews, site visits, national data and expert insight, focused on acute NHS hospital trusts and in some cases included those providing community services. However, it said the learning would be relevant to providers and staff across other health and care settings.
Near-miss incidents
The investigation heard how the death of a colleague while commuting had prompted staff to take action to reduce the risk of staff fatigue, such as establishing the Fight Fatigue Campaign.
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Run in partnership with the Association of Anaesthetists, the Royal College of Anaesthetists and the Faculty of Intensive Care Medicine, the campaign aims to fight the negative effects of shift working and fatigue on the NHS workforce.
The report pointed to a 2021 study that revealed almost half (49%) of surveyed nurses and midwives said they had ‘nodded off’ while working, with 44% also experiencing a ‘near miss car accident’ while travelling.
One ward nurse recalled the stress of taking on complex clinical tasks when exhausted, saying: ‘… [there are a] lot of drug calculations … that are quite high-risk decisions we’re making with administering certain drugs. That takes quite a lot of mental effort … as well as the physical.’
Working unsafe hours
Staff described feeling the pressure of working long hours as a ‘badge of pride’, especially for senior staff.
They told the investigation that working beyond contracted hours was at times ‘actively encouraged’ by employers.
For example, the investigation heard of a nurse in one NHS hospital being thanked by the comment: ‘Thank you for staying after your shift, to continue caring for those critically unwell patients. I think those patients were lucky to have had you as their nurse.’
Staff recalled feeling that they would be letting their colleagues and patients down if they did not continue working or if they called in sick because they were very tired.
The report cited a 2024 study that described how many UK nurses ‘regard working while tired as simply ‘part of the job’ – something healthcare professionals must accept’.
Nurses who were working twelve hours or more were more likely to describe ‘lower quality of care, poorer patient safety, increasing rates of care left undone’ than those regularly working eight hours or less, it found.
On top of this, nurses working shifts of 12 hours or more also more often recalled ‘job dissatisfaction…intention to leave their current job and to experience burnout’.
What does the report recommend?
The report from HSSIB suggests that NHS England and the Department of Health and Social Care (DHSC) should identify and review current processes that capture staff fatigue related data to enhance the understanding of fatigue risk. This would help inform future strategy and action to address the issue.
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A second recommendation also called for the development of a consensus statement defining fatigue for healthcare staff.
‘This will help to support a consistent understanding of fatigue among healthcare providers and improve the understanding of factors that may impact on staff fatigue and patient safety,’ it said.
Saskia Fursland, senior safety investigator at HSSIB, said: ‘Fatigue is more than just being tired – it can significantly impair decision-making, motor skills, and alertness. We must move away from viewing fatigue as an individual issue and putting the onus on personal responsibility and instead treat it as a system-level risk that deserves urgent attention.
A DHSC spokesperson said the government had inherited a ‘demoralised workforce’ within a ‘broken’ and ‘overworked’ NHS.
‘We hugely value the vital work NHS staff carry out every day, which is why, alongside ending the resident doctor strikes, one of this government’s first actions was giving NHS staff an above inflation pay rise.
‘We have also recently announced a support package to improve their working lives, including by making it easier to take up flexible working and developing new guidance on working patterns,’ they added.
An NHS England spokesperson commented that NHS staff are working ‘incredibly hard’ to meet rising demands but acknowledged that this could ‘take a toll on their wellbeing’.
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‘Staff should always feel confident to report patient safety concerns, including those that are linked to fatigue, and we will work with local NHS systems to address any issues – while there is more we could and should do, the NHS is offering more flexible working options than ever before, and there is a range of mental health support available for staff, including access to wellbeing resources,’ they explained.
In December, an exclusive Nursing in Practice survey found that more than a quarter (28%) of general practice nursing staff are considering leaving their role in the next year.
In July, the annual data report from the Nursing and Midwifery Council (NMC) found that 5,500 early-career nursing and midwifery staff has quit the profession in the last year.
