Cecily Lalloo, MD of Embrace HR, independent specialist provider to the complex care sector, discusses how to properly support night workers in their roles, to protect their own wellbeing while enabling them to deliver the best possible care to those who need it
Night work is commonplace in all aspects of healthcare, and is essential in delivering the care that is needed to people recovering from life-changing injury or in supporting them with ongoing complex needs.
And while this is an accepted and necessary way of working in care, to provide a 24-hour continuous service, the potential impact on health and safety must not be lost by employers of those workers tasked with delivering care.
Employers have to ensure they comply with legislation in this area, to prevent fatigue, burnout and illness arising from employees who are not properly supported.
Risk assessments must be carried out as employers have a legal duty to assess the risks to the health and safety of employees (and risks to the health and safety of persons not in their employment) to which they are exposed while they are at work.
In the UK the Working Time Regulations 1998 sets out maximum working time which must be – supported by efficient management of employees, to ensure night workers can achieve acceptable levels of sleep and rest, despite the disruption to their circadian rhythms, and protect their health and wellbeing.
Here, we look at some of the main issues employers need to consider
Risks for night workers
For people who work nights, or those who work unsociable or very long shifts, these hours are at odds with the more accepted working patterns of working during the day.
Our circadian rhythm, which expects we will be awake during the day and sleep at night, can be disrupted by night work – and sleep is essential to mental and physical restoration to enable us to work effectively. It allows the body to recover from physical or cognitive activities and helps to protect against fatigue and anxiety.
However, for those working during the night, this is something that is less easy to achieve, and can lead to illness or the exacerbation of existing conditions.
Chronic fatigue resulting from night work is associated with conditions including chronic gastritis, peptic ulcers and cardiovascular illnesses such as hypertension and coronary heart disease. A UCL study found that working more than 11 hours places a person at a 67 per cent higher risk of developing heart disease, compared with those who work a typical seven or eight hour day.
Furthermore, fatigue or poor sleep can lead to a greater risk of errors or accidents, which could be of huge consequence when caring for individuals with acute needs.
Legislation supports night workers in being able to access regular medical checks, and if a night worker becomes ill and there is clear evidence to link their symptoms with night work, the employer must reassign the worker to other duties.
But in helping to reduce the chances of workers becoming ill or their wellbeing being compromised, employers can take pre-emptive steps in protecting workforce and their wellbeing.
Risk assessments are a key part of that, and can ensure the workers tasked with delivering care are able to properly protect those they are supporting.
By properly managing risks and identifying the hazards of night work and helping to mitigate them, workers are better supported to do their jobs and deliver the often life-saving care that is needed.
Employers must commit to addressing risks and protecting the safety, health and wellbeing of workers – which, as well as being best practice, can also help reduce sickness and absence, reduce staff turnover, reduce errors and accidents and increase productivity. Night works should be offered an annual night workers assessment.
A four-stage process should be implemented:
1. Establish a system to manage the risks
2. Assess the risks in your workplace
3. Take action to reduce the risks
4. Review arrangements regularly.
A person must be appointed within the organisation to oversee this, and it is vital that workers are consulted and involved in any decisions about shift work.
Factors including fatigue should be prominent in a risk assessment, as well as other aspects which we know affect healthcare workers such as workload, work activity, duration of shifts, rest breaks within and between shifts, mental and physical demands and welfare.
Risk groups among night workers – such as pregnant workers, younger and older workers, those with existing health conditions and new and temporary workers – should have their particular circumstances taken into account.
Monitor and review
Implementing the four step risk assessment process will reduce the likelihood of potential problems, but cannot always prevent them – which is why workers should be encouraged to report any problems as soon as possible
Supervisors have a role in identifying and reporting problems and if workers are concerned about their personal health, they should be encouraged to visit their GP.
Sometimes it will be necessary for the business to alter the shift schedule or make changes to the work environment. In this case, workers should be consulted in advance on the proposed changes.
While these changes may bring about improvements, they may also create problems, so monitoring any arrangements in place, to ensure they are working for everyone involved, is hugely important.
In any event, arrangements for night or shift workers should be reviewed periodically, to ensure their effectiveness.
Good practice recommendations
While carrying out robust risk assessments and implementing their findings will help the unique features of every business and every care situation, generally there are a number of approaches employers can take to support the wellbeing of their team.
Clearly every situation and business is different, and this may not be appropriate in every one; while it is not legally binding to take such steps, it can be advisable if appropriate to demonstrate the implementation of good practice.
- Plan a workload that is appropriate to the length and timing of the shift
- Schedule a variety of tasks to be completed during the shift to allow workers some choice about the order in which they are done
- Avoid scheduling demanding, dangerous, monotonous and/or safety critical work towards the end of night shifts
- Avoid placing workers on permanent night shifts
- Offer a choice between regular and rotating shift schedules, if possible
- Where possible, arrange shift start/end times to be convenient for public transport or consider providing transport for workers on particular shifts
- Limit shifts to a maximum of 12 hours (including overtime)
- Consider if shifts of a variable length or flexible start/end times could offer a suitable compromise
- Allow workers some discretion over when they take a break where possible, but discourage saving break time to leave work earlier
- Try to limit consecutive working days to a maximum of five to seven days and ensure there is adequate rest time between successive shifts
- Ensure supervisors and team members with responsibility for shift working arrangements are aware of the risks of night work and can recognise problems caused by this
- Provide training and information to workers, management and supervisors on the risks associated with night work and on coping strategies.
To discuss further, or for more information, contact the specialist team at Embrace HR
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