Working Hours and Fatigue: Meeting the Needs of American Workers and Employers

In November 2022, the American Journal of Industrial Medicine (AJIM) published a special issue focusing on work-related fatigue. The issue explores factors that may increase work-related fatigue and actions to reduce work-related injuries and illnesses. [1]

This issue is a result of discussions and collaborations from the 2019 NIOSH Working Hours, Sleep and Fatigue Forum and also pulls from reports by the National Institute for Occupational Safety and Health (NIOSH) on long work hours and shift work. The issue’s articles give insight into the challenges of managing fatigue across industries and job tasks.

The articles identify knowledge gaps and needs as well as future directions for fatigue research. Similarities were identified across industries to share lessons learned and successful practices to lessen workplace fatigue. Six articles look at approaches in specific sectors including Agriculture, Forestry and Fishing; Healthcare and Social Assistance; Mining; Oil and Gas Extraction; Public Safety; and Transportation and Utilities. The articles identify factors for fatigue risk and effective responses. Two more articles address topics that cut across all industries, focusing on workers with greater risks for workplace injuries and illness and on evaluating the economics of nonstandard work schedules.

What Is Fatigue and Why Should We Worry About It?

Fatigue has no standard definition, but some have described it as feeling weary or tired. [2, 3]). Workers might feel that they lack the energy to do their job safely or effectively. They might have trouble paying attention or take longer to react to what happens around them (4). Fatigued workers might take more risks that lead to injury or errors. [2, 4, 5, 6]) For example, in healthcare, fatigued emergency room doctors are known to be at higher risk of medical errors (7).  Work-related fatigue costs U.S. employers an estimated $218 billion or more every year because of reduced productivity or workers’ absences due to health issues. [8] Researchers estimate that close to 1 in 8 workplace injuries may relate to fatigue and that more than 1 in 5 of all fatal vehicle crashes may involve a drowsy driver. [9, 10] The effects of work-related fatigue can also spill over into personal lives and can impact public safety, for example when fatigued workers drive on public roads.

Fatigue Comes From Many Sources

Unlike most other workplace hazards, work-related fatigue is complex and can stem from many sources. [11] A person’s age, health, lifestyle choices, and nonwork responsibilities all contribute to fatigue. [11] Work-related factors that can contribute to fatigue include scheduling practices, such as night shifts or extended hours, that can interfere with sleep. [11] Physically or mentally demanding tasks, repetitive routines, working in extreme temperatures, or feeling stress can also increase fatigue. [12] Because fatigue comes from so many possible factors, it can be difficult to manage. No single solution fits all situations, organizations, or people.

Finding Ways to Reduce Fatigue

The special issue articles address challenges to managing fatigue in a wide range of industries, and they suggest actions proven to lower risks. Limiting work hours is a traditional way to manage fatigue, but this and other successful strategies apply to jobs with predictable schedules. Training workers how to get better sleep has also been a common way to lower fatigue. [13] Most sleep programs do not consider the many sources of fatigue or individual differences for rest and recovery. This is because of the nature of some jobs that are at high risk for fatigue. For example, workers in some industries do their jobs in remote areas with shared temporary living areas (such as mining). Other workers must work for long periods doing physically demanding labor (such as utility work during storm events). In these cases, restricting work hours or promoting sleep in quiet, dark environments may not always be possible.

Studies of work-related fatigue are most common among sectors such as Transportation and Utilities, Healthcare and Social Assistance, and Public Safety. Most jobs in these sectors require nonstandard schedules such as overnight shifts, extended work hours and irregular shifts. [14, 15, 16] Better work schedules and educational resources are common priorities, but more actions to manage fatigue are needed in these industries.

• The Transportation and Utilities sector is encouraged to consider stress and time pressures. [14]
• The Healthcare and Social Assistance sector is encouraged to promote improvements in workplace culture and reduced fatigued driving. [15]
• Workers in Public Services, such as firefighting, emergency medical services, corrections, and law enforcement, often wait a long time between emergency responses. Workers must jump into action quickly when they receive an alarm, which can happen while they sleep. During emergencies, they can face intense and physically demanding work and have psychological distress. Current efforts to reduce fatigue do not adequately address these working conditions. [16]

In industries such as Oil and Gas Extraction; Mining; and Agriculture, Forestry and Fishing, few studies identify fatigue risks or actions to lessen fatigue. [17, 18, 19] Similar job tasks (such as driving), or work environments (such as extreme temperatures), are common in other industries with more experience in managing fatigue. For this reason, industries in different sectors can benefit by sharing their actions and experiences.

Special considerations in Oil and Gas Extraction include technologies to detect fatigue and fatigue risk management systems. [17] Mining sector workers also have fatigue risks such as, dim lighting in underground environments and long commutes to remote areas. [18] Agriculture, Forestry and Fishing workers may need to labor for long hours stretching over several days or weeks during harvest season. Contributions to fatigue from these extreme work schedules need more research. [19]

Information and Economic Evaluation

All workplaces will benefit if workers receive better access to easy-to-understand health and safety resources and information about fatigue mitigation strategies. Some worker groups that will especially benefit from these resources include young or new employees, small business workers, women, minorities, and people with low levels of education or social and economic status. [20] Based on this diversity, researchers and safety and health professionals should consider different languages and methods to reach workers to ensure that resources are culturally appropriate. For example, some workers may be more comfortable using social media, while others may prefer paper-based sources.

Economic evaluation is an important tool that organizations and policymakers can use for deciding how to reduce fatigue. [21] Scientific studies should look at the costs of fatigue at work, and the benefits to reducing the risk. More studies should combine expertise from different disciplines, including economics and epidemiology (the study of the frequency, distribution, and control of safety and health risks). This will give a more balanced approach that considers impacts to workers, employers, and society.

Focus on the Future

The goal is that all the articles from this special issue will help workers and employers find solutions to reduce fatigue in their workplaces and give researchers direction for future studies.  Please share with us in the comment section below how your workplace manages fatigue.

Grace Vixama, MPH, is a health communications specialist in the NIOSH Division of Science Integration, Science Applications Branch.

Imelda Wong, PhD, coordinates the NIOSH Center for Work and Fatigue Research and is a board member of the Working Time Society of the International Commission on Occupational Health.  

Naomi Swanson, PhD, is a senior science advisor in the NIOSH Division of Science Integration and is co-manager of the Healthy Work Design and Well-Being Cross Sector Program.

For more information on fatigue visit the fatigue blog category.

References

1. Wong I, Swanson N [2022]. Approaches to managing work-related fatigue to meet the needs of American workers and employers. Am J Ind Med 65(11): 823–939, https://doi.org/10.1002/ajim.23402.
2. Lock A [2018]. Psychological and physiological health effects of fatigue. Occup Med 68(8): 502–511, https://doi.org/10.1093/occmed/kqy109.
3. van Dijk F [2003]. Fatigue at work. J Occup Environ Med 60:i1–i2, http://dx.doi.org/10.1136/oem.60.suppl_1.i1.
4. Lerman SE, Eskin E, Flower DJ, George EC, Gerson B, Hartenbaum N, et al. [2012]. Fatigue risk management in the workplace. J Occup Environ Med 54(2):231–258, https://doi.org/10.1097/JOM.0b013e318247a3b0.
5. Patterson PD, Weaver MD, Frank RC, et  al. [2012]. Association between poor sleep, fatigue, and safety outcomes in emergency medical services providers. Prehosp Emerg Care 16:86–97, https://doi.org/10.3109/10903127.2011.616261.
6. Ricci J, Chee E, Lorandeau A, Berger J [2007]. Fatigue in the U.S. workforce: prevalence and implications for lost productive work time. J Occup Environ Med, 49(1):1–10, https://doi.org/10.1097/01.jom.0000249782.60321.2a.
7. Uehli K, Mehta AJ, Miedinger D, Hug K, Schindler C, Holsboer-Trachsler E, Leuppi JD, Künzli N [2014]. Sleep problems and work injuries: a systematic review and meta-analysis. Sleep Med Rev 18(1):61–73, https://doi.org/10.1016/j.smrv.2013.01.004.
8. Tefft BC [2012]. Prevalence of motor vehicle crashes involving drowsy drivers, United States, 1999–2008. Accid Anal Prev 45:180–186, https://doi.org/10.1016/j.aap.2011.05.028.
9. Di Milia L, Smolensky M, Giovanni C, Howarth H, Ohayone M, Philip P [2011]. Demographic factors, fatigue, and driving accidents: an examination of the published literature. Accid Anal Prev 43(2):516–532, https://doi.org/10.1016/j.aap.2009.12.018.
10. Techera U, Hallowell M, Stambaugh N, Littlejohn R [2016]. Causes and consequences of occupational fatigue: meta-analysis and systems model. J Occup Environ Med 58(10):961–973, https://doi.org/10.1097/JOM.0000000000000837.
11. Dawson D, McCulloch K [2005]. Managing fatigue: it’s about sleep. Sleep Med Rev 9:365–380, https://doi.org/10.1016/j.smrv.2005.03.002.
12. Sieber W, Chen G, Krueger G, Lincoln J, Menéndez C, O’Connor M [2022]. Research gaps and needs for preventing worker fatigue in the transportation and utilities industries. Am J Ind Med 65(11):857–866, https://doi.org/10.1002/ajim.23346.
13. Caruso C, Arbour M, Berger A, Hittle B, Tucker S, Patrician P, et al. [2022]. Research priorities to reduce risks from work hours and fatigue in the healthcare and social assistance sector. Am J Ind Med 65(11):867-877, https://doi.org/10.1002/ajim.23363.
14. Allison P, Tiesman H, Wong I, Bernzweig D, James L, James S, et al. [2022]. Working hours, sleep, and fatigue in the public safety sector: a scoping review of the research. Am J Ind Med 65(11):878–897, https://doi.org/10.1002/ajim.23407.
15. Hagan‐Haynes K, Pratt S, Lerman S, Wong I, Baker A, Flower D, et al. [2022]. U.S. research needs related to fatigue, sleep, and working hours among oil and gas extraction workers. Am J Ind Med 65(11):840–856, https://doi.org/10.1002/ajim.23310.
16. Bauerle TJ, Sammarco J, Dugdale ZJ, Dawson D [2022]. The human factors of mineworker fatigue: an overview on prevalence, mitigation, and what’s next. Am J Ind Med 65(11):832–839, https://doi.org/10.1002/ajim.23301.
17. Elliott K, Lincoln J, Flynn M, Levin J, Smidt M, Dzugan J, et al. [2022]. Working hours, sleep, and fatigue in the agriculture, forestry, and fishing sector: a scoping review. Am J Ind Med 65(11):898–912, https://doi.org/10.1002/ajim.23418.
18. Cunningham TR, Guerin RJ, Ferguson J, Cavallari J [2022]. Work-related fatigue: a hazard for workers experiencing disproportionate occupational risks. Am J Ind Med 65(11): 913–925, https://doi.org/10.1002/ajim.23325.
19. Wong IS, Quay B, Irvin E, Belzer MH[2022]. Describing economic benefits and costs of nonstandard work hours: a scoping review. Am J Ind Med 65(11): 926–939, https://doi.org/10.1002/ajim.23302.
20. Cunningham TR, Guerin RJ, Ferguson J, Cavallari J [2022]. Work-related fatigue: a hazard for workers experiencing disproportionate occupational risks. Am J Ind Med 65(11): 913–925, https://doi.org/10.1002/ajim.23325.
21. Wong IS, Quay B, Irvin E, Belzer MH[2022]. Describing economic benefits and costs of nonstandard work hours: a scoping review. Am J Ind Med 65(11): 926–939, https://doi.org/10.1002/ajim.23302.