Is Sleep Deprivation Driving the Burnout Crisis in Healthcare Workers?

CHARLOTTE (N.C.) — Despite all the mindfulness techniques and yoga classes, healthcare workers have not seen an improvement in their burnout. Researchers are trying to stop this occupational syndrome from spreading.

“Burnout is at a crisis level, made worse by COVID-19,” lamented Indira Gurubhagavatula, MD, MPH, a sleep medicine specialist at the University of Pennsylvania and Corporal Michael J. Crescenz VA Medical Center in Philadelphia, during a session of the annual SLEEP meeting hosted jointly by the American Academy of Sleep Medicine and the Sleep Research Society.

She pointed out that half of doctors had been burned out before the pandemic, and this likely contributed to an increase during the pandemic ,, especially among women and ethnic minorities.

It’s evident that stress management and wellness programs don’t work to reduce employee burnout . It’s like treating symptoms rather than treating the problem. Hans Van Dongen, PhD, a sleep deprivation scientist at Washington State University in Spokane, said that they are potentially helpful but not sufficient.

After multiple failed interventions, there is a growing interest in the possibility that when doctors complain about how after-hours charting and meaningless clicks in EHRs contribute to burnout, they are really talking about issues mediated in part by diminished sleep and fatigue. This would suggest that sleep interventions may be the solution to burnout.

Recently, one group found that insufficient and disordered sleep are correlated with occupational burnout. Gurubhagavatula warned that it is not clear which causes the other and that these findings are subject to unmeasured confounders.

These data are an important step forward in a field that has been neglected by the highest rungs of healthcare and public health.

A Surgeon General Advisory from May sounded the alarm on clinician burnout and resignation, projecting a shortage of 3 million low-wage healthcare workers in the next 5 years. Gurubhagavatula said that while the advisory made mention of the importance of adequate sleep for workers and patients, it did not address the science of sleep or its role in burnout.

She also said that the new draft workforce health-care plan of the National Academy of Medicine doesn’t mention sleep.

Yet burnout is an unrelenting, decades-long issue: A poll of 1,000 health workers in September 2021 found that one in five had quit since the start of the pandemic. Nearly a third said they were considering quitting.

If sleep is the real problem, then institutional solutions are possible. Healthcare can learn from the aviation industry and implement fatigue risk management (FRMPs) for their patients.

An FRMP in aviation is a plan that provides fatigue education, incident reporting processes and monitoring, evaluation, and a mechanism for evaluating and changing flight schedules under the supervision of the Federal Aviation Administration.

Aviation is very mature when it comes to fatigue management,” stated Erin Flynn Evans, PhD, MPH, director NASA’s fatigue countermeasures laboratory. She described the industry’s low tolerance for failure, which can lead to plane crashes and other disasters. She also explained how NASA takes great care to ensure that pilots and other workers don’t suffer from reduced mental or physical performance due to sleep loss. She outlined institutional policies that promote sleep health. These policies may be applicable to the healthcare sector. She also described thoughtful schedule design, which relies on bio-mathematical modelling based on performance metrics throughout a day, and non-punitive reporting on fatigue or burnout.

Infrastructure can also be used to support fatigue countermeasure implementation. Flynn Evans suggested that hospitals might consider investing in more on-call rooms. Flynn-Evans said that it may be beneficial for nurses to take a break in the call room before driving home. “

The panelists at SLEEP encouraged the audience to support these investments and interventions at their own institutions. In light of the current shortage of healthcare workers, arguing for less work time would likely be ignored. It may be helpful to speak the language business when appealing to upper managers, said Van Dongen. He suggested highlighting worker productivity (vs. presenteism), better worker retention, greater patient safety (vs. litigation), and a stronger brand, vs. short-term profits.

” What if a hospital said, “We’re #1 in well-rested doctors that will treat you?” He joked half-jokingly. “That could be attractive to leadership. “