Preventing and managing the increased risk of employee fatigue in healthcare during COVID-19
Increased demand for healthcare and social assistance services during the COVID-19 pandemic may increase the risk of work-related fatigue in some healthcare employees.
Crisis-only guidance
The fatigue risk management guidance on this page applies only during a surge in demand due to COVID-19 and other times of crisis. During times of normal operation, employers in the healthcare and social assistance industry should refer to WorkSafe's existing guidance on fatigue prevention and management.
Read the guidance on this page together with the WorkSafe guidance, Prevention and management of exposure to COVID-19 in the healthcare and social assistance industry.
Health and safety responsibilities
Under the Occupational Health and Safety Act 2004 (OHS Act), employers must, so far as reasonably practicable, provide and maintain for employees a working environment that is safe and without risks to health. This includes preventing risks to safety and health, including psychological health, associated with potential exposure to COVID-19. This guidance can help employers and other duty holders fulfil their OHS Act responsibilities to prevent and manage the potential increased risk of fatigue in healthcare employees due to a surge in demand due to COVID-19.
Identifying risks
Employers must identify risks to employees' health from fatigue due to the COVID-19 crisis. This must be done in consultation with any health and safety representatives (HSRs), employees and independent contractors.
Increased risk of fatigue due to a surge in demand or crisis may arise from a range of factors, including:
- working additional shifts
- working longer shifts
- dealing with more intense workloads
- not getting adequate breaks
- prolonged use of personal protective equipment (PPE) leading to difficulties rehydrating and communicating
- the need to frequently change PPE
The increased demand because of a crisis such as COVID-19 can result in symptoms including, for example:
- mental fatigue from periods of intensive concentration due to increased workload, working remotely or learning a new area of work
- physical fatigue due to working in more difficult physical circumstances, increased patient load, wearing PPE or working with patients with higher acuity and physical needs
- emotional fatigue from working long hours in high-pressure environments
- stress from heavy patient loads and work demands affecting personal life
- anxiety, including anticipation, fear and worry around what could happen
- burnout from supporting others
- Post-Traumatic Stress Disorder (PTSD)
- Shift work
- Implement roster rules to minimise fatigue, which may include:
- a minimum 10 hours between shifts to enable sufficient sleep
- a maximum of 3 consecutive night shifts
- enabling 2 nights' recovery sleep after a set of night shifts for peak times, where reasonably practicable
- at least 1 full day off per week at the peak of the pandemic , comprising 1 night's sleep, followed by a day off and another night's sleep
- Ensure rosters provide adequate coverage for breaks, clinical care and case meetings.
- Use fatigue-based roster rules or fatigue assessments when considering shift swaps extra shifts and overtime.
- Ensure processes are in place to reduce the risk of staff absences affecting the workforce skill mix.
- Implement processes to assess and report employee fatigue and psychological wellbeing. Processes may start if employees have to keep working after more than 10 hours on shift or if employees are rostered to work the day after more than 5 shifts in a row.
- If employees cannot be sent home due to peak demand, consider the following controls:
- 20-minute power naps
- a break
- task variation
- swapping to another less critical area
- Implement roster rules to minimise fatigue, which may include:
- Mental workload
- Provide training and, where possible, a buddy system to ensure clarity and support for those who need to adapt to a new area or system.
- If mental workload is a concern, consider immediate action to manage fatigue such as, for example, a break, task variation or swapping to another less critical area.
- Emotional workload, stress, anxiety, burnout and PTSD
- Ensure an expert group agrees on decision-making principles well in advance. These principles should then be applied by at least 2 people.
- Inform employees in advance about the expected demand on services and likely increase in workload.
- Ensure regular team discussions, especially for more difficult cases, with a focus on what was done well and learning opportunities, and to check whether support is required.
- Implement clear and regular communication processes, including highlighting positive statistics or results.
- If stress or burnout is a concern, consider immediate action to manage fatigue such as, for example, a break, task variation or swapping to another less critical area.
- Inform employees in advance about the availability of Employee Assistance Programs, psychologists or general practitioners and encourage employees to use these services.
- Use the hierarchy of control
The hierarchy of control is a system for controlling risks in the workplace and can help employers eliminate or control risks to their employees and others.
Quarantining and screening for COVID-19
Information about Pandemic Orders issued by the Victorian Minister for Health is available on the DH website.
If not subject to Pandemic Orders issued by the Victorian Minister for Health, employers should implement a screening process to minimise the introduction of COVID-19 to a workplace.
Employers should ask employees before they enter the workplace if they are currently subject to any Pandemic Order requirements (such as needing to isolate or quarantine), and instruct employees who have been in contact with confirmed or probable cases of COVID-19 to follow Department of Health (DH) procedures.
To ensure person-to-person contact is minimised, screening may be in the form of a self-assessment that employees can complete prior to attending the workplace for each shift.
The staff COVID-19 health questionnaire on the COVID-19 Victoria website is a useful screening tool for employers.
Ensure employees know what to do
An employer's duty to eliminate or reduce risks associated with exposure to COVID-19 so far as is reasonably practicable includes ensuring that:
- confirmed COVID-19 cases do not attend the workplace
- employees know what to do or who to notify if they feel unwell or suspect they've been infected, according to the information provided by DH
- employees who have been in contact with confirmed or probable cases of COVID-19 are instructed to follow DH procedures
- any unwell employee does not attend the workplace, including those who have been tested for COVID-19 and are awaiting their test result
The symptoms of COVID-19 are: fever, chills or sweats, cough, sore throat, shortness of breath, runny nose and loss or change in sense of smell or taste.
Some people may also experience headache, muscle soreness, stuffy nose, nausea, vomiting and diarrhoea.
If an employee develops any COVID-19 symptoms, however mild, they should:
- self-isolate immediately, get tested and if needed, seek advice from their doctor or the Victorian Coronavirus Hotline on 1800 675 398.
- tell their employer as soon as possible, follow the procedures their workplace has in place to deal with symptomatic people, and update their employer if their situation changes, for example: if they receive a positive COVID-19 diagnosis
In the event of a suspected or confirmed COVID-19 case or cases at the workplace, Pandemic Orders issued by the Victorian Minister for Health may also require employers to take specific response actions.
Legal duties
Employers have duties under the OHS Act, which include that they must, so far as reasonably practicable:
- provide and maintain a working environment that is safe and without risks to the health of employees and independent contractors
- provide adequate facilities for the welfare of employees and independent contractors
- provide such information, instruction, training or supervision to employees and independent contractors as is necessary to enable those persons to perform their work in a way that is safe and without risks to health
- monitor the health of employees at any workplace
- monitor conditions at any workplace under the employer's management and control
- provide information concerning health and safety to employees, including, where appropriate, in languages other than English
- ensure that persons other than employees are not exposed to risks to their health or safety arising from the conduct of the undertaking of the employer
- consult with employees and any HSRs on matters related to health or safety that directly affect, or are likely to directly affect them
A person with management or control of a workplace must ensure, so far as reasonably practicable, that the workplace and the means of entering and leaving it are safe and without risks to health.
Employees also have duties under the OHS Act, which includes that they must:
- take reasonable care for their own health and safety
- take reasonable care for the health and safety of persons who may be affected by the employee's acts or omissions at a workplace
- co-operate with their employer with respect to any action taken by the employer to comply with a requirement imposed by or under the OHS Act
The OHS Act gives HSRs a role in raising and resolving any OHS issues with their employer, and powers to take issues further if necessary. WorkSafe has guidance on powers for HSRs and a card linking to the guidance appears in Further information.
WorkSafe Advisory Service
WorkSafe's advisory service is available between 7:30am and 6:30pm Monday to Friday. If you need more support, you can also contact WorkSafe using the Translating and Interpreting Service (TIS National) or the National Relay Service.
