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NHS needs culture shift regarding sleeping at work

BMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i3982 (Published 18 July 2016) Cite this as: BMJ 2016;354:i3982
  1. Abi Rimmer
  1. BMJ Careers

The NHS needs a sizeable culture shift in its attitude to doctors sleeping during night shifts, Michael Farquhar, a paediatric consultant sleep specialist, has told BMJ Careers.

Farquhar said, “There is still this idea that if you are being paid you must not sleep, and that is fundamentally wrong. Your brain is not meant to be awake at night.”

He continued, “Planning sleep and using sleep in a careful and controlled way to improve the level of care that you are delivering is really important. But there is this blanket cultural idea that we don’t pay people to sleep and it’s wrong. It needs a huge cultural shift.”

Farquhar has held a short session on sleep physiology for trainee paediatricians, which has been included in the London School of Paediatrics’ annual induction for new paediatricians. One of his recommendations has been that during statutory breaks night shift workers should be encouraged to have short naps of less than 30 minutes.

However, after carrying out an online survey of trainee paediatricians in London, Farquhar found that not all junior doctors were able to achieve such naps. He received 104 replies to the survey from trainees of all grades from every major London hospital. Only 16% of respondents said that naps during night shift breaks were supported, and 31% said that they were actively discouraged.

Farquhar said that only 10% of respondents were aware of a formal local policy relating to naps on night shift and none were aware of a formal policy on the issue at their hospital. Almost 80% of respondents said that they had received no teaching regarding sleep during night shift working.

Farquhar said that all trainees should be taught about the importance of taking a break during night shifts because it would improve patient safety. “We can’t stop people working night shifts,” he said. “We clearly need to work night shifts to be able to deliver care. But there are lots of simple things that we can do to try to lessen the impact [on trainees]. Some of that relates to what people do before they come on to night shift. It also relates to what they do during the night shift and what they do after the night shift to recover.”

He said that there was evidence, supported by the Royal College of Physicians and Royal College of Nursing, about the importance of resting during night shifts.1 2 “We have to be able to take in that information, assimilate it, understand it and react very quickly,” he said. “If you’re doing that with a brain that fundamentally should be asleep, you’re not going to do it as well as you should do, and that has an impact.”

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