Plus-Hex CLINICAL
ABSTRACT Lack of sleep can affect concentration and reaction times . This study investigates the effects of working on-call emergency shifts on the cognitive function and motor skills of veterinary professionals , using a cross-sectional experimental design .
A pilot testing battery – based on the Bruininks Motor Ability Test and the CANTAB Cognitive Safety Phase 1 Battery – was used on participating veterinary surgeons and veterinary nurses after every night shift in a 4-week period using a cross-sectional experimental design .
Significant differences were demonstrated in multiple cognitive functions , motor skills and reaction times between those who lost little sleep and those who lost lots of sleep . The study was conducted in a single practice , with a small sample size and within a short time frame , which limits the conclusions that can be drawn ; however , it still demonstrates proof of concept and forms a basis on which further studies can be created to confirm the reliability of the results .
The study demonstrates that veterinary professionals suffer the same detrimental effects of out-of-hours shifts as their counterparts in human medicine , and suggests that steps need to be taken to prevent this affecting staff wellbeing and patient outcomes .
The study also allows for discussions around the further use and adaptation of battery testing to help support these findings . Practice managers , veterinary surgeons and veterinary nurses in leadership roles could use these findings to focus on staff scheduling and allowing for proper rest periods , and they could potentially help to improve the wellbeing and retention of staff .
The pilot study has helped raise awareness of the similarities between veterinary and medical professionals and the need for further exploration of this topic .
Keywords out-of-hours , night shift , workplace , health , safety , veterinary , staff , wellbeing
Introduction
Sleep patterns and levels of fatigue in healthcare professionals can be affected by factors such as variations in shift patterns , challenging work , emotional input and gross working hours [ 1 – 3 ] . However , medical professionals and their governing bodies do not seem to recognise or try to prevent the dangers of fatigue in clinical practice , potentially putting patients at risk of harm [ 2 , 4 – 6 ] .
When looking at moral typecasting in society , and its impact on medical professionals , it has been found that people believe that , relative to the average working professional , clinicians are better able to ignore physical and mental health issues , and physicians ' job performance is less impacted by bodily and emotional needs [ 7 ] , which may suggest why this issue has been overlooked for so long , despite evidence of the need to address it [ 7 – 10 ] .
Following a report from Medscape in 2019 [ 11 ] , the Student American Veterinary Medical Association ( SAVMA ) implemented guidelines stating that individuals should have 1 rest day in 7 , should not exceed 6 hours of work without a 30-minute break , and if working for 24 hours must have a minimum of a 9-hour rest period before the next shift , which must not include any on-call element [ 12 ] . Similarly , the USA and New Zealand are implementing strategies to combat the effects of tiredness and stress in veterinary surgeons ( VSs ) [ 11 , 12 ] . In the UK , however , Working Time Regulations are often waived for veterinary professionals , due to the irregular hours worked when providing out-of-hours ( OOH ) care for patients . The increasing pressure to provide ever higher levels of overnight care may encourage the waiving of rights and feelings of guilt if refused [ 13 – 15 ] . OOH care can be achieved in many ways , but usually involves veterinary nurses ( VNs ) and VSs working nights , either exclusively or as part of a rotation of days and nights [ 13 , 14 , 16 , 17 ] . It will also often involve ‘ sleeping night shifts ’, with sleep expected in part during the night , but with the risk of being woken for calls or patient care . These periods of sleep can vary in length and in some cases sleep is not guaranteed at all [ 18 , 19 ] .
Being roused while in slow-wave sleep or REM affects different aspects of an individual ' s ability to pay attention , and the impacts of sleep deprivation on executive function can vary depending on the task being carried out [ 20 ] . Therefore , it is important to understand how veterinary professionals are being affected by what are often routine parts of their work pattern . Symptoms of sleep deprivation include memory problems , shortened attention span and poor visuospatial skills . They can also include indicators of poor motor function , such as difficulty with two-handed tasks , inadequate grasp , poor balance , poor hand-to-eye coordination and difficulty manipulating tools [ 21 – 23 ] . The cognitive effects of circadian misalignment are normally task dependent , and the effects of fatigue are often more pronounced after night shifts than day shifts [ 4 , 22 – 25 ] .
Working 17 – 19 hours without sleep can impair cognitive function and motor skills equivalent to , or worse than , having a blood alcohol level of 0.005 %. As waking hours without sleep increase , the effects increase to the equivalent of 0.1 % blood alcohol [ 24 , 25 ] . Driving or performing surgery would be illegal if the impairments derived from being awake for an extended period were chemically induced , and this should be considered when allocating schedules [ 26 , 27 ] .
There are many reasons why veterinary professionals may be sleep deprived , including workload , staff shortages and associated burnout [ 28 ] , but this pilot study focused on sleep deprivation derived from working on-call shifts .
Volume 39 ( 1 ) • February 2024
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