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CQC: Night staff should be allowed rests to ensure safety

  • 18 Comments

NHS trusts should comply with guidelines on allowing nurses and doctors to rest at night, the Care Quality Commission has said.

The comments by Professor Sir Mike Richards, chief inspector of hospitals, come as a coroner heard a junior doctor died in a car accident after probably falling asleep while driving home after a nightshift.

Nursing Times’ sister title Health Service Journal has also seen one email from an NHS trust sent to trainees warning they faced disciplinary action if caught sleeping during night shifts.

Earlier this month a survey of more than 480 junior doctors from 150 NHS trusts revealed many doctors were actively discouraged from taking naps despite evidence based guidelines from the Royal College of Physicians dating back over a decade.

”Where healthcare professionals have concerns about their working conditions we would encourage them to raise these concerns internally with senior colleagues”

Mike Richards

Sir Mike said trusts should consider the guidelines and staff should raise concerns if they are worried about their working conditions.

He said: “We expect providers do to all they can to provide safe, effective, high quality and compassionate care, which includes having regard for best practice guidance.

“Where healthcare professionals have concerns about their working conditions we would encourage them to raise these concerns internally with senior colleagues and the trust’s Freedom to Speak Up guardian.”

An inquest last week into the death of Dr Ronak Patel, who died after his car collided head-on with a lorry in August 2015, heard evidence from police that the “most plausible explanation” for the crash was that he fell asleep at the wheel.

The inquest heard Dr Patel, a trainee anaesthetist, had finished the third of three night shifts at Norfolk and Norwich Hospital and had been singing on a hands-free phone with his wife just before the crash to try and stay awake.

Norfolk and Norwich University Hospitals Foundation Trust said it was deeply saddened by Dr Patel’s death. It said a review of his working pattern showed he was on a normal rota. It also said staff were able to rest in hospital accommodation after a nightshift, and it encouraged doctors to take naps if they wanted to.

“It is absolutely essential [there is] support for hospitals to develop appropriate education and training for their staff in relation to sleep”

Michael Farquhar

A spokesman said: “Taking regular breaks during shifts are crucial and are always encouraged. Rest areas are available for staff to use during their breaks, which during a night shift includes the option to nap if this is possible and is something the doctor wishes to do. The maximum number of night shifts in our medical rotas is three to four, depending on the specialty.”

A junior doctor at another trust told HSJ they were “pulled aside for napping” on a nightshift because they weren’t “discreet enough to avoid detection by a senior manager” after sleeping on a bed in an empty corridor. They said their name was taken and passed to their clinical director.

Another doctor at a different trust said trainees were threatened by email with disciplinary action for sleeping after bed linen was found in a doctors’ mess. They said: “The trust actually had two bunk-beds in the mess. Once the email was sent [the trust] removed all bedding, pillows, etc from the room and subsequently left it with just two bare mattresses. And yet management can’t understand why morale is so shit.”

Consultant sleep specialist Michael Farquhar, from Evelina London Children’s Hospital, who carried out the survey, said: “It is absolutely essential this leads to support for hospitals to develop appropriate education and training for their staff in relation to sleep and night shift working, and that simple, pragmatic measures to reduce both patient safety risks and the risks of harm to staff are put in place.

“It is important that this does not become simply another measure by which trusts can be penalised – this will require recognition of the underlying contributory factors, and targeting resources to make improvements.”

Danny Mortimer, chief executive of NHS Employers, said the health and safety of staff and patients was “paramount”. The new junior doctors’ contract includes paid rest breaks which would be enforced by the new guardians for safe working, he added.

  • 18 Comments

Readers' comments (18)

  • I work permanent nights (3 in a row per week). Where I work (NHS) it is a disciplinary action if caught sleeping anywhere on trust property which even includes your own car in your break. Usually staff are taken off nights and put onto days for punishment. As the only qualified on the ward I am not even able to take my unpaid break as there is no one else to take over. The reason why we do not complain is that we need our shifts for family reasons and complaining would just lead us to be placed on days which for some are unworkable. We are not even paid or given time owing for not being able to take our breaks. Lets hope the report is taken seriously.

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  • The doctors and Nurses are treated like slaves! They chose to be quiet rather than blow the whistle due to fear of losing their jobs. The morale is on its lowest. I'm not surprised a lot of doctors and nurses are still leaving to work abroad. Nurses are forced to work without a proper break. Once they commit mistakes, they get disciplined or worst....get dismissed & referred to NMC. I chose to quit my job as a Nurse and I'm not coming back. Stress-free life is my priority.

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  • I work 3on 3 off permanent nights, with constant obs ,seclusions ,5 min 15 min and 30 minute observation rounds. With an hours journey each way, so I would love to have the chance of just shutting my eyes for 30 mins after an 11hr shift with an hour to drive home, unpaid break. It would cause a nightmare for the recruiting staff and hospital site manager! Who incidentally have a cosy office with no one checking up on them "nodding off"!. Can't see it happening though as most wards often run on bare minimum staff(just one in some cases )

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  • The demands are getting higher, the complaints are getting more. This is all to the CQC's inconsistent assessments. We care for our patients and that unfortunately is taken advantage of. We aren't robots, we are human!!! Someone needs to recognise this now before they kills the health service!

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  • The key here is 'unpaid breaks'. Do management have a right to say what nurses and doctors do in their own time, which is essentially what an unpaid break is. I think not. Provided the break is taken in a private area which has no public or patient access, the healthcare professional should be allowed to rest appropriate to their specific need at that time. These rules are laid down by people who have never worked a night shift in their lives; it is well known internal rotation and shift work shortens life expectancy, is detrimental to health and increases the risk of cancer. Let's not include accidents related to exhaustion to that shameful statistic.

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  • Look after and respect staff and they will stay - abuse and exploit staff and they will leave - simples!
    I worked for years in many different NHS establishments all with varying views on 'breaks'.
    Life is to be lived - I only realised that once I had left the NHS.
    What a loss to the NHS - I really enjoyed caring for patients.
    I will never return.

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  • Is there a nurses union you could progress this matter through. Breaks are taken 'in your own time' which is your choice. Who can stop you nodding off in a chair in the staff room with your feet up? If you are not getting breaks, and not being paid for them, you are bring exploited. There is a plethora of evidence on the net regarding the benefits of a power nap on ND staff performance levels. These practices are shockingly old fashioned and lack any shred of modern health practices but also reflects on the lemming mentality of the night staff who blindly 'obey' rules that are all too often set down by people who've never worked a month or two of night shifts.m

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  • Anonymous- unfortunately not, no. This is one of the main reasons nursing is such a mess, the unions are worse than awful.

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  • Management can't stop anyone doing what they want to do in their own time, ie unpaid break. I had this brought up once in a trust where I work. Unison took the matter up and nipped it in the bud immediately. Don't just obey. You have rights.

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  • In relation to nights our hospital has been visited by CQC who cited observations on nights as unsafe due to certain wards carrying out bad practice. This caused panic in the hierarchy and resulted in the spanish inquisition a total knee jerk reaction castigating staff throughout the Hopital. Not at anytime were staff who run nights asked for feedback or consulted as outlined in Trust policy, instead threats of discipliary action, bullying. Being told what to do does not constitute good management. The root cause of the problems lies in poor staffing levels, staff being unable to take a break, and stress. In addition Management are randomly monitoring staff on CCTV in order to check for any practice that would require disciplinary action. The rights of staff are being undermined resulting in high sickness rates and high turnover.

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