• Hundreds of junior doctors respond to survey revealing they are actively discouraged from sleeping at night
  • Evidence-based guidelines produced in 2006 recommended doctors be allowed to nap to safeguard patients
  • Guy’s and St Thomas’ FT sleep specialist says the issue affects all staff working at night and “must not be ignored.”

Hospitals are putting patient safety at risk by forcing junior doctors to work throughout the night without rest despite evidence-based guidelines dating back over a decade, HSJ has been told. 

Junior doctors have reported a “culture of fear” on hospital wards at night with some saying they face disciplinary action if being caught taking short naps. This is at odds with evidence that a nap of between 20 and 30 minutes reduces incidents of harm to patients.

One trainee told a survey, carried out by consultant sleep specialist Dr Michael Farquhar from the Evelina London Children’s Hospital, that senior nurses had been instructed to tour wards at night to find sleeping doctors while another said site managers actively woke sleeping medics (see box below).

More than 480 junior doctors responded to Dr Farquhar’s study from more than 150 hospital trusts and all levels of training across the country.

Doctors reported more than a third of departments did not support napping during nightshifts with 45 per cent not knowing what their department’s position was. Only 5 per cent of doctors said their trust had a formal policy, with 40 trainees saying their trusts actively didn’t support naps while more than 200 said they did not know.

More than three quarters of the doctors said they did not have suitable sleeping facilities.

The Department of Health today called for NHS trusts to ensure doctors were given their required breaks.

In 2006 the Royal College of Physicians issued evidence-based guidelines which said a short nap of between 20 and 45minutes during the night was essential to tackle fatigue. It warned that working at night increased the risk of poor decisions and mistakes.

This was backed up by the Royal College of Nursing in 2012 which issued its own support for nurses working nightshifts and recommended employers support “power napping.”

Dr Farquhar, who lectures trainee paediatricians in London on how to effectively manage their sleep is being supported by his trust, Guy’s and St Thomas’ NHS Foundation Trust, to launch a hospital wide policy to encourage all staff to take short naps at night. Work is also underway to spread this more widely across the capital.

He told HSJ the way NHS staff were being made to work at night had to change: “We are asking people to perform and carry out complex tasks, with crucial decisions needing to be made rapidly in a high-intensity environment, at a time when their brains think they should be asleep. Their responses are not going to be what they should be. You are slower and make less good decisions; this means the care delivered can suffer.

“This is a patient safety issue. It must not be ignored.”

He added: “Our survey results revealed there are some hospitals and departments actively discouraging rest at night. The evidence is clear that if you have a short nap of less than 30 minutes you will likely improve your functioning and level of performance. The evidence is not controversial but the message has not got through to how we staff hospitals at night. This is not just about doctors but nurses too and everybody working at night.”

”What does worry me is that what started to come through from the survey was doctors saying they don’t even get breaks. These breaks are not there just for the benefit of the people taking them - they are an essential part of delivering effective care to the patients they are looking after.”

In 2004 the National Patient Safety Agency highlighted the risk of a lack of sleep for patient safety saying it was contributory factor to serious incidents. The Health and Safety Executive has also warned employers that they must have policies in place to manage the risks of shift working.

The Royal College of Physicians backed Dr Farquhar’s call for action warning the way hospitals were making doctors work could lead to patient harm.

RCP registrar Andrew Goddard said: “All the evidence points to naps being crucial to maintain performance, so if junior doctor doctors are being prevented from napping, this raises major patient safety concerns.”

The RCP said it would be including new guidance on the issue as part of a report on improving working conditions for trainee doctors in coming months.

A Department of Health spokesman said: “Safer care is more likely to be provided by doctors who have sufficient rest during and between shifts. It’s imperative that NHS employers ensure all staff get the right breaks on any shift.”

Comments from junior doctors working at night:

“There is a culture of fear amongst staff who do sleep with rumours of matron coming round to wake you up and take your registration number. After a busy night shift once, I was so exhausted I nearly crashed my car.”

“Sleeping is actively discouraged. There is nowhere to rest let alone sleep. At one trust they had posters saying ‘you are paid to work not sleep, anyone found sleeping during night shifts will be reported to their manager’.”

“The worst mistake I’ve made yet as a junior doctor was after an unbroken 15 hour night shift.”

“At the last trust I worked there were patrols made at night to specifically look for people napping on breaks, with threats of disciplinary action.”

“I have worked in trusts before who threatened to refer you to the GMC if you were found to be taking a nap. This was terrible for both productivity and moral.”