Worked To Death: Fatigue and the health professions, the dirty little secret.

Submitted by Charlton Stanley (aka Otteray Scribe), Guest Blogger

The dirtiest secret of all in the health care professions is not insurance. It is about tired staff.

Nurse Emblem Letha's MarkerOn March 16, 2013, Registered Nurse Elizabeth Jasper had just gotten off work. She was driving her small SUV eastbound on Ohio 50 when it left the road, going airborne, and hitting a tree. The wreckage careened into a parking lot. One does not need to be an accident reconstrucionist to know the crash was not survivable, by just taking one glance at the wreckage.

Beth Jasper, RN, is dead at the age of 38. She leaves her husband and two children. The preliminary investigation so far has revealed Nurse Jasper was supposed to work three 12-hour shifts that week, but had been held over to work extra doing specialized procedures. She is believed to have fallen asleep at the wheel.

Since that time, James Jasper, her widower, has filed a lawsuit against her employer, Jewish Hospital and its parent company, Mercy Health Partners of Southwest Ohio. As details of the lawsuit emerge, it shines a spotlight on a fact of corporate health care in this country which most people never knew.

While the pay for health care providers overall is quite good, the hours are not. I am not going to get into the details of the Jasper v. Jewish Hospital lawsuit. I have posted a link to the lawsuit which outlines the allegations by Beth Jasper’s family and they are there for all to read. Like all such lawsuits, it presents the allegations by the plaintiff, and as of this writing the hospital has not responded.

It is not just nurses, but many health care providers have the problem of unrealistically long hours, unstable work schedules, and being called in on days off. There are hospitals with adequate staffing, and the state of California has laws regulating health provider staffing in hospitals. Other states have not passed similar legislation, but the Nurse’s union, among other groups, has been pushing for such laws.

Think about this. When you or your loved ones are very sick, do you want to have the nurse giving you medications or starting an IV to be the one who has been held over an extra shift after finishing a twelve-hour shift? Recall Beth Jasper, who had completed a twelve hour shift, but was held over at work to perform specialized procedures. One wonders why this one particular nurse is the only one trained and available to operate the equipment, and why could it not have been handed off to a nurse on the next shift?

I have some personal knowledge of how bad it is. My wife was an RN, and Head Nurse (they are now called Nurse Managers) at a large hospital. They had three eight hour shifts. I lost track of how many times she had to fill in when they were short staffed. It was not at all unusual for her to work a double shift—sixteen hours—and then return to her regular shift the next day. And then there were emergencies, when the phone would ring at 3:00 AM. Sometimes she didn’t even have time to put on her uniform, but jump into whatever was handy and race off to the hospital to help deal with the emergency.  I remember a half-dozen bomb threats. There were severe weather and tornado warnings, when all patients had to be moved from their rooms into the central corridor to get them away from the windows. Sometimes a visitor in a patient’s room would light a cigarette and set off the smoke detector, which triggered automatic fire alarms and all hell would break loose. Did it affect her health? You bet. She never ran off the road as did Beth Jasper, but she did hit a huge pothole that almost tore the right front wheel off her car.

It did affect her health. She loved her work, but began developing shortness of breath. She had numerous tests, and the result showed that her heart was failing—a condition called idiopathic cardiomyopathy. At the rate her heart failure was progressing, she did not have long to live. Her cardiologist insisted she retire early and wanted to put her on the heart transplant list, but she refused. She was dedicated and loved her work, so resisted retirement until she could no longer respond to codes or do CPR. After she retired, a strange thing happened that baffled her cardiologists. Her heart function began to return. Damage had been done and it was never fully normal again; but nevertheless, her ejection fraction recovered enough that she could once again function in day to day living. Her job had been killing her.

My son is an emergency room physician and has been Medical Director of more than one Emergency Department. He describes staffing problems at hospitals both large and small.  Sometimes it literally comes to a choice of being short-staffed or shut the ER down altogether. No hospital administrator is willing to shut down the Emergency Department, so they stay open.  Sometimes an ER doctor works as many as eleven or twelve days straight, 12-hour shifts, get one or two days off, rinse and repeat. On top of that, alternating between night shift and day shift. Instead of being the exception in medical care, that is more common than anyone knows. He tells me that despite the fact the job pays well, it is really hard to recruit physicians.  I am not sure if the problem is too many hospitals or not enough doctors. Probably a combination of both.

A number of years ago, shortly after he got out of his residency, he went to sleep at the wheel and ran his SUV off the Interstate, plowing a path through a grove of trees. It is a good thing he was in his Suburban and the trees were fairly small instead of full grown pines.

There was one ER doctor who lived in one state and commuted about three hundred miles to another state. He was filling in to help out at a short-staffed Emergency Department in a small rural hospital. He used his own small twin engine airplane for the trips, which he made two or three times a week, landing at the small town airport near the hospital. One night, he forgot to put the landing gear down, and when he felt the prop strike pavement, he poured on the power. The prop strike had killed the engine on one side, and with full power on the other, it flipped inverted and crashed. Of course, he was killed. Since he was a high-time pilot with a lot of hours, if he had been thinking clearly, he would have chopped all the power, cut off the fuel and let the plane settle onto the runway. The only damage would have been some sheet metal work and new propellers. Fatigue kills.

Here is an email I got from an RN who works in the ICU. Read what she wrote to me when she learned I was working on this story:

People just don’t understand how short staffed we are! And the CEOs just keep adding more!  They wonder why some health care providers end up addicts and there are lawsuits!!!  ……working 16 hr shifts and having 10 patients ….I woke up in a ditch off the Interstate one day.  Luckily I walked away unharmed. Working 80 hr work weeks is common.

When she refers to “ten patients” keep in mind she is an ICU critical care nurse. The sickest of the sick. Like most other nurses and medical staff, she is concerned about the risk of medication errors by tired staff. It happens.

My wife had to call doctors frequently when taking orders off patient’s charts. Finding orders for wrong medications or wrong doses was almost a daily occurrence. I recall one night when she was working the graveyard shift. She called me in the wee hours of the morning, clearly shaken. One of the doctors had written an order for patient medication that would have been fatal had she not caught the mistake at the last moment before administering the medication. It was a math error in calculating dosage. When the doctor wrote that order, he had been at the hospital for more than 24 hours straight because there was no one to relieve him.

I recall a surgeon who seemed to never go home. No matter what time of day or night I went to the hospital, I would run into him. Wearing scrubs, going or coming from the surgical suite, or in his white lab coat, sitting at the nurse’s station writing in patient charts. He stayed fit and trim, and looked in perfect health. He died. Still a relatively young man. Heart failure.

One of the problems is nurses being called in for extra duty when they are already bone tired. One of my friends, a now-retired RN, wrote about that, and how she taught her nurses to deal with it:

I always worked 7 PM to 7 AM and often fell asleep in the car when I got home. Nurses like working “twelves”, as we call it, because of the extra days off. The obvious downside is that hospitals have a larger pool of nurses to call in for extra shifts. I worked with lots of Filipino and Indian nurses who didn’t know how to say “No” when they were asked to come in extra, so I held a class for them one night. “When you answer the phone and get the request, say ‘I’d love to help but I’ve been drinking.’” Teetotalers all, they got the giggles and said they couldn’t say such a thing. “Sure you can! Repeat after me: I’D LOVE TO HELP BUT I’VE BEEN DRINKING. Hospitals cannot ask you to come in once you utter those words.” I had them practice the words all night long, and many of them then managed to avoid extra unwanted shifts.

I notice in the comment sections of news articles about the lawsuit, some commenters suggested just leaving at the end of the shift. They don’t understand that a good nurse or doctor is not going to leave the hospital with patients unattended. Not going to happen, and hospital administrators know that. Not only know it, but count on it. Additionally, if a nurse, respiratory therapist, X-ray tech or anyone else is called at home and refuses to come in for extra shifts, they can—and likely will be–fired. That is why my nurse friend taught her nurses to say they had been drinking. That is about the only excuse that will fly with staffing managers. Claim you are sick, and they want proof.

I hope that Nurse Beth Jasper did not die in vain. Just maybe, her death will serve to shine a bright light on a serious problem in our health care delivery system. The World Health Organization studied numerous critical factors when they ranked every member country’s health care delivery system. We do not have the best health care system in the world. That distinction goes to France. The US ranked 38th, right behind Costa Rica. However, the US did rank #1 in one area. Cost per patient. France, with their world class health care delivery system, ranked #4 in cost per patient.

Before anyone who doesn’t like the UN starts complaining, I don’t think anyone would accuse Bloomberg of being biased against the US. Bloomberg’s organization conducted their own study of health care delivery systems in the 48 countries with more or less advanced economic systems. In other words, they eliminated so-called third world economies from the study. According to Bloomberg, Hong Kong, Singapore and Japan occupied the top three slots. The US ranked 46 on the list of 48 countries. Serbia and Brazil were 47 and 48, respectively.

SLEEP DEPRIVATION CAN KILL:

What this story is really about, is sleep deprivation and fatigue. Some commenters in the news stories have taken a “blame the victim” attitude. There are comments to the effect that people ought to know better than to drive when there is danger of falling asleep, and that Beth Jasper was responsible for her own death. Aside from being cruel to the point of sociopathy, most of those types of comments ignore what we know about the science of sleep, as well as the manner in which people make decisions.

First of all, sleep deprivation is cumulative. Miss one or two hours of sleep a few days in a row, and you cannot make it up by one really good night of sleep. In fact, studies have shown it may take longer to recover from several days of sleep deprivation than the total amount of sleep lost in the first place.

For those who expect people to have insight into when they are driving sleepy, I have news. There is a phenomenon called microsleep. It means dozing off for a few seconds at a time, without even being aware of the sleep. Several news programs have done stories on microsleep. Reporters who were filmed dozing off for a few seconds at a time, some while driving, were both startled and frightened at how quickly and easily micorosleep happens. Most of all, how frequently. The video below is a story done by an ABC reporter for Nightline.

We already live in a society where most people do not get adequate sleep. Most people who read these words will have experienced at least one episode of microsleep in the past few days without being aware of it. Of all the physical and psychological effects of sleep deprivation, one of the most curious is the fact it causes lack of insight as to how sleepy one is. Sleep loss impairs judgment. People who don’t sleep much and describe themselves as “doing just fine,” are wrong. Sometimes dead wrong. When working at tasks where good judgment, sound decision making and attention to detail are required are far more likely to make mistakes.

The people most at risk for microsleep episodes while driving or trying to multitask are those who work rotating or swing shifts, who work long hours with little rest, and whose work schedule prevents them from getting enough sleep or even time to relax.

According to sleep researchers, there are numerous health risks associated with sleep deprivation. Some of the most serious are various types of heart disease, such as that which affected my wife. In one famous study, British sleep scientists studied the sleep patterns of more than 10,000 British civil servants over two decades. The results, published in 2007 as the “Whitehall II Study,” showed that civil service employees who reduced their sleep from seven to five hours or less per night nearly doubled their risk of death from all causes. In particular, lack of sleep doubled the risk of death from cardiovascular disease.

This list is just several of the commonly known adverse health effects of sleep deprivation:

  • Heart disease
  • Heart attack
  • Heart failure
  • Irregular heartbeat
  • High blood pressure
  • Stroke
  • Diabetes
  • Weight gain
  • Loss of sex drive
  • Lowered nighttime testosterone production in men, associated with sleep apnea.
  • Clinical depression, which if severe enough can trigger suicidal thoughts. Additionally, depression often causes insomnia, which then becomes a vicious cycle.
  • Aging skin, i.e,, skin thinning and wrinkling at an earlier age than normal. Deep, unbroken sleep is needed for the body to release hormones that preserve a more youthful skin texture.

Here is a PDF of the lawsuit filed by James Jasper, widower of Beth Jasper. It sets out the particulars of her circumstances at work.

Here is an observation and a question.  Modern scientific sleep research is one hundred years old this year. Professor Henri Pieron published “Le probleme physiologique du sommeil” in 1913.  Dr. Nathaniel Kleitman, regarded as the father of American sleep research, began his work in Chicago in 1920. Many hospitals have their own sleep labs and sleep research centers. Given that so much is known about the adverse health effects of sleep deprivation and chronic fatigue, hospitals are put in the position of “knew or should have known.”  Therefore, how can a health care agency such as a hospital claim they don’t know they are literally killing their employees—and possibly their patients?

The image at the top of this story is the engraving detail on my wife’s memorial stone at the cemetery. It is the Nurse’s Caduceus. It seems appropriate for this story, about nurses like Beth Jasper, who literally give their lives for the sake of their patients. My wife had a stroke several years ago, losing part of her vision as a result. She died in 2011. I can only wonder how much longer she might have lived had it not been for her lifelong dedication as a nurse in a broken health care delivery system.

 

77 thoughts on “Worked To Death: Fatigue and the health professions, the dirty little secret.

  1. Really? Are we blaming our jobs for our lack of sleep? There is such a high demand for RNs. I can’t imagine her being unable to find another job as an RN? I used to work 10-12 hours shifts on overnights as an assistant manager for Walmart. So, many times I had to sleep in my car for an hour or two before I headed home. Eventually, I quit, and went back to graduate school.

  2. I would like people to understand these are the same issues involving our military, yet their pay is way less.

  3. RWL,
    Yes, an RN can go right down the street, or to the next town. What will change? Only the sign on the front of the hospital.

  4. I have never understood the point in working those in the medical profession so many hours — there is no logical need for it.

    My sister is a doctor, so I’ve seen it second-hand, at least — particularly during Internship and Residency they are intentionally sleep-deprived, and for no good reason. Working in an ER, perhaps, but doctors working in a standard practice are never going to be called to work for such hours without sleep…

  5. I worry on the few occasions I have been in the hospital about the lack of sleep. I asked the nurses and doctors I had when was the last time they had a good night’s sleep. Most did not like that I asked that question and told me it was none of my business. However, I told them it was very much my business; my life depended on it. They mostly would change the subject and purposely evade answering my question.

  6. Furthermore the US has 200,000-400,000 deaths every year caused by medical error.

    It’s no wonder that all other civilized countries have universal single payer health care. That system allows a much larger percent of health care dollars to be paid for actual health care rather than for overpaid health insurance administrators and stockholders.

  7. “Miss one or two hours of sleep a few days in a row, and you cannot make it up by one really good night of sleep. In fact, studies have shown it may take longer to recover from several days of sleep deprivation than the total amount of sleep lost in the first place.”

    Do you have citations for this I could share with my husband? I’ll go hunting on Google, but if you have one in mind, I’d love to have it. :)

  8. The man who lived across the street from us was a neurosurgeon. He served 3 hospitals. His wife, concerned for his fatigue due to long hours and lack of sleep, hired a driver to take him to and from home, office, and the different hospitals he served. This plan worked well for a few years but one day both the car and the driver failed to show so he borrowed a colleague’s car to get to an emergency room case that simply wouldn’t wait.

    You guessed it … he never got there. The accident reconstructionist believed he fell asleep at the wheel. The only solace his wife could take from the tragedy of his one car accident was that no one else was hurt.

  9. Prairie Rose,
    Good question. There are scads of studies on the subject. I was first introduced to this factoid in a continuing professional education seminar sometime about 1981. I probably even still have those handouts somewhere. However, the following links are a bit more contemporary:

    http://articles.mercola.com/sites/articles/archive/2010/02/02/lost-sleep-can-never-be-made-up.aspx

    http://www.scientificamerican.com/article.cfm?id=fact-or-fiction-can-you-catch-up-on-sleep

  10. I can attest to the dangers of driving while excessively fatigued and micro-sleeps.

    am not sure what year it was, but once when I worked for the (Australian) Department of Veterans’ Affairs I attended meetings in Canberra. Usually for these meetings I traveled by plane from Sydney to Canberra and back, but this time I decided to drive. I got up very early 04:00 or thereabouts to do the 3 hour plus drive to Canberra, attended the meeting and departed to return to Sydney some time after six o’clock. After 3 hours or so of exceeding the speed limit I reached the outskirts of Sydney. By this time my eyelids felt as if they weighed as much ass a tombstone and I found that I was phasing out for 30 to 50 metres of road. Eventually I pulled over, laid my seat back and went to sleep.

    Since then I have avoided driving when as tired as I was then. It may not have been just lack of sleep, hours of driving at excessive speed result in hypnogogic images of a road unreeling in front of me at high speed, overlaying the image of the real road ahead.

  11. Do not drive too many miles in one day or be up too many hours in one day and still be driving. If you have a seizure disorder do not drive. Keep it simple sailor. Oh, and if you have an operation coming up tell them that Wed is out. That is golf day and you will get an early appointment for the surgery and a doctor in a hurry with a last name Murray. Nothing worse than getting operated on by Murray in a hurry.

  12. Diet pills, Ritalin, and other amphetamines are also the dirty secret of medical professionals. It was pretty rampant back in the 50/60’s, but it’s still an issue today. Same w/ OTR truck drivers.

  13. Exactly Otteray, hospitals and nursing homes nation wide have the same problems. It’s the nature of the beast. After 30 plus years in nursing, I’m tired of it mentally and emotionally. I work on call part time now and after a shift I thank God I don’t have to work full time anymore. If any job in this nation should never ever be done wihout union protection, it’s nursing. If a nurse reports abuse of a patient the nurse is made to feel and is treated as a criminal herself. Retaliation protection laws are not nearly strong enough, no Federal whistleblower retaliation law except for th ones dealing with Medicare/ Medicaid fraud. State laws have no teeth and are practically useless. Many a good nurse leaves the profession in disgust.

  14. Oh and forgot to say I worked night shift most of my years in nursing. My circadian rhythm is so messed up, I doubt I’ll ever be able to sleep normally again.

  15. As a tangent, wasn’t there a time when interns were expected to work long shifts and many hours each week due to the believe that such stress training was necessary for good performance in normal practice?

    And, aren’t there psychological studies that demonstrate that such stress training does not enhance performance?

    And finally, are interns treated any better today?

    Ok, this really is the final question. There is, perhaps apocryphal, advice not to buy a car manufactured on a Monday. Is there an analogous time not to go to the emergency room or a doctors appointment?

  16. After looking at the list of ailments associated with sleep deprivation, it made me wonder at what rate do medical professionals develop dementia/Alzheimer’s compared to the rest of the population?

    I’ve heard that poor sleep is associated with this condition. (Sorry no citation at present; a family member heard about it on NPR awhile back.)

  17. Thanks for this, OS. I was an ICU-CCU RN for fifteen years. Since I was single at the time, I was scheduled to work every Thanksgiving, every Christmas (except for one).If I objected, I was told, ‘But you’re single and so-and-so is married with a family.’ Whenever we were short staffed, I was the one called in because I was single. When they needed a nurse to float to another floor (especially an ortho floor) I was the one floated because, being a male, I could do more lifting. One month when I was working CCU, I went 34 days in a row without a day off. When I finally asked for one day off (when I got so sleepy on my drive home one morning that I pulled over to the side of a residential street and took a nap so I could get home in one piece), the staffing coordinator said ‘but you just had a day off, didn’t you? Oh. my mistake. You can have two days off next week.’ There were many times in fifteen years that I would work double shifts. If I said anything about it, I was told ‘Just think about all of the money you’re making.’ My standard response was ‘Money is no good if you’re dead.’ Like Annie, I worked night shift for most of the fifteen years and when I finally hung up my stethoscope, it took five years for my circadian to revert to normal. As Nick says, I lived on No-Doz and coffee that was so strong all you had to do was whistle and it would jump into your cup. I know MANY ex-nurses who left the profession for the same reasons that I left it.

  18. If you believe the problem is just in the hospitals think again. I am a paramedic and every problem described and then some is the same in this profession as well. Just when you thought you could go lay down and get some sleep, the pager (alarm) goes off. If it is a heart attack you have to make the same judgement calls, medication dosing calls as a nurse in the ICU and you get to do most of it on a bumpy road in the back of the ambulance UNRESTRAINED hovering over a patient while en-route to the hospital. I would have to say I and most of my partners have been affected by microsleep. I catch myself “dosing” en-route to some calls while my partner is driving.

    When I entered the EMS world years ago, I was advised by my preceptor to never sleep before the bars closed. Today, I rarely go to bed on or off duty before 3:00 am. If I am called out that time extends into the 5:00-6:00am range if that.

    Our employer has come to recognize this over the last 10-years and allows the crews when necessary to stay and sleep for a couple of hours before going home. Some crew members are now encouraged (by me as a supervisor) to have someone else drive them home at the end of a 24-hour shift. I also try to limit the number of overtime hours people are getting. Right now we have adequate staffing, but they may change at any time.

  19. bigfatmike: When I was still in the nursing biz, the Residents and the interns were worked like dogs (sorry, Barkin), too. I got to know several when they were doing the ICU-CCU rotation, and to a man (and woman) they said that the real reason they were treated like that was because THEIR instructors had been treated like that when they were residents/interns, as had THEIR instructors…you get the picture. As far as I know (and hopefully things have changed, but I doubt that they have), they still treat the residents and interns that way.

  20. sounds about right to me. especially since they have now given pc drs less then 15 mins with all patients. all drs no matter the specialty now has to see x amount of patients everyday. that is why we no longer need to go to psychs to get our meds our pcs can write those scripts. they can also do our gyn, hiv,cancer,luek,lupus, etc care.. so far only dentist are stuck sticking to dental work. but then they need them to keep implanting our teeth with caps, fillings etc that have their little tracking bugs

  21. Prairie Rose,
    I am not aware of any controlled studies that show medical professionals to be at higher risk for Alzheimer’s type dementia. However, it has been shown that sleep deprivation can and does cause a type reversible dementia.

    Another type of dementia that sleep disorders can contribute to are related to the cardiovascular problems mentioned in the story. Those are dementias of ischemic type. In other words large numbers of mini-strokes that impair blood flow to the brain.

    At any rate, it is well established that sleepiness and chronic sleep deprivation is associated with lowered cognitive function. Both the videos I posted touch on that.

  22. Chuck,

    You crammed so much into this piece that I hardly know where to begin. First, hospital staff does suffer from many shortages of staff and so they make up for it by doing the worst thing possible, which is to overwork the staff they have. As you know I’ve spent much time in hospitals as a patient and as someone whose work was involved with systems analysis I kept my eyes and ears open. One year I spent literally 4 two week periods in the Surgical Intensive Care Unit. The workloads of the staff, particular the nurses was overwhelming to observe and it amazed me how they were able to cope. As a patient one becomes acutely aware of the nursing staff and the extra hours they work because you know when shifts end and nurses move to double shifts.

    In an intelligent, humane society people would realize that this is no way to provides citizens with health care in general. Hospitals should exist to heal and not as profit centers.That all medical personnel must be able to perform at the highest level seems to be a concept that shouldn’t be hard to understand. However, when those that manage and fund hospitals are concerned merely with the bottom line, then health care is left to the luck of the draw. We see in a case like Andy Warhol’s, that being in one of NYC’s best hospitals and being a rich, major celebrity didn’t stop his life from being cut short due to medical error. The idea that private enterprise can do it better is nonsensical, yet so many have been convinced of its truth. Certain vital industry’s should not be market centered since the end result will be profit over clientele.

    Another aspect of your richly crafted piece is the reference to your wife and the effect the job had on her. For many years I worked very long, hard hours in my career. As you enumerated I didn’t realize the toll it took upon me as I also had 3 M.I’s and finally CHF. There were days I can remember driving home after work and fighting against micro sleep. Luckily, it being New York rush hours I was usually in long, slow traffic jams. However, I wasn’t a nurse and I didn’t work at a job as stressful as your wife’s, so it reinforces much of what you’ve told me off blog about what an extraordinary person she was.

    Doglover wrote”

    “Furthermore the US has 200,000-400,000 deaths every year caused by medical error.”

    What makes that figure extraordinary is that it first became publicly discussed about 50years ago although at the time the figure was only 100,000 medical error deaths a year. It makes it “comforting to know we have progressed so much in that time.

    Without sounding like an old codger I do believe that we have lost a vital sense of community in this country at least abstractly. In this new paradigm poor hospital care, decaying infrastructure and a lack of concern for those who work has become the rule.

  23. Sleep deprivation is a serious workplace issue. I had a job which more or less demanded that I work overtime assignments at all hours of the day and night. The money I was making did not compensate me for the toll the work took on my physical and mental health. I finally retired just about as early as I could and have never regretted doing so. I was just lucky enough to survive to retirement age.

  24. Mike,
    Thank you for that. Y’know, when I first saw the story about Beth Jasper and decided to write this, I had a flash. Something that had occurred to me years ago. When all the stuff about harmful second hand smoke came out. I thought then that any employer allowing smoking on the premises is literally asking for a lawsuit. Once the employer knows there is a medically harmful working environment, that employer is ethically, morally and legally on the hook for cleaning it up. Most employers have done that, and in many areas there are laws about smoking in public places.

    It is my opinion the same legal principles need to apply here that applied to tobacco in the workplace. Since I am only a consultant to lawyers on trial tactics when it comes to issues like this, and not a lawyer myself, I am very interested in what our lawyer teammates have to say about it.

  25. OS,
    Great article and a great discussion. Sleep deprivation can and does kill. As you stated, I hope this latest death will bring some discussion on the need to stop killing ourselves on the job.

  26. Raff,

    Exactly the point that I was trying to make. We can’t blame others for ‘killing ourselves on the job.’ We need to remember that the company/corporation/hospital, etc. doesn’t care about you. We are just another number. As my old man use to say: ‘You are here today, and gone tomorrow.’ When I started sleeping in Walmart’s parking lot for an hour or 2 after I got off work, and feeling chest pains (felt like someone was stabbing me with a knife in the chest), I knew it was time to look for another job and/or go back to school, (after telling my store manager about my chest pains, her response: ‘well you knew what you were getting yourself into, when you took the job.’). I did both!

    You do have a choice: your career or your life? I took a $12k pay cut to work for the state of missouri, but I was off every holiday, weekends, and no more overnights!

  27. Here is an observation and a question. Modern scientific sleep research is one hundred years old this year. Professor Henri Pieron published “Le probleme physiologique du sommeil” in 1913. Dr. Nathaniel Kleitman, regarded as the father of American sleep research, began his work in Chicago in 1920. Many hospitals have their own sleep labs and sleep research centers. Given that so much is known about the adverse health effects of sleep deprivation and chronic fatigue, hospitals are put in the position of “knew or should have known.” Therefore, how can a health care agency such as a hospital claim they don’t know they are literally killing their employees—and possibly their patients?” – OS

    The negligence standard, “what would a responsible person do in the same circumstances?” comes to mind.

    Of course the hospital profit motivation is going to skip over the traces, get into the habit of so doing, and invite disaster.

    Perhaps the growing right-wing practice of putting caps on recovery in lawsuits is an additional factor.

    At least in some states.

    You know, the “cost of doing business” thingy.

  28. The issue of sleep deprived docs and nurses is not a new problem, and the new rules governing how much time trainees are allowed/forced to spend at the hospital were meant to address that. Unfortunately, once you are no longer in training, those rules no longer apply to you.

    Then, a whole new set of rules come into play.
    The rules of the marketplace.
    Yeah, here’s that glamorous/dedicated/respected life in medicine we all dreamed about.
    What a load.
    What you find in the ‘real world’ is that for the most part, if you work in the ER, you work for a staffing company. The days of independent group practices in the ER are pretty much over. Now, the staffing company tracks every metric you can possibly imagine. How many patients you see per hour, the acuity of each patient, the level of each patient encounter you have, how much ‘critical care’ you provide, what your documentation levels are, your patient complaint levels, and most importantly (no, not how many lives you save) what your DOWNCODES are. A downcode is when you inadvertently don’t document enough ‘crap’ in the chart, and the staffing company can’t bill for the highest conceivable level of charge for whatever complaint the patient has This has absolutely nothing to do with what kind of care you provide, nor whether the patient got the correct treatment, or even whether they left the ER happy. It’s all about the money. You get measured against an imaginary national standard ER doctor/patient encounter, and you are expected to hit that mark. Every time.

    The hours you work is a whole other issue. In the bigger cities, (and in say, resort areas) it’s not really that much of an issue, because none of the new residents want to have to hie themselves out into the hinterlands to work, so mostly the larger hospitals are fully staffed, and also they try to keep you fresh, so you can see more people per hour, so usually in the cities and at larger med centers, you get restricted to 10 hour shifts, and 16 or so shifts a month.
    Out in the heartland, it’s a whole different ballgame.

    Out here, on the perimeter, to borrow from Jim Morrison, emergency medicine has a whole different face. That face has sagging jowls and red, bloodshot eyes. We are mostly older, and we work all the time, because there simply is no one else. Where I am, we are over an hour from one large city and over two and a half hours from the nearest other large city. We cannot recruit new grads to come here. We pay better than the cities, but still, they won’t come. Signing bonuses are offered, but the millenial doctors are not like us…they are far more concerned with their quality of life, no matter what the money is. Hell, maybe they are smarter than we were.
    The upshot of this is, we work. A lot. This month, I will put in twenty 12 hour shifts. In fact, I am typing this in the ER call room, while I wait for lab and xrays. Typically, I will work 6-9 days and then have a handful of days off, then come back and do it again. And I am no longer a spring chicken, to say the least.
    I may be getting some help though…this week we interviewed a guy from a much smaller ER…he is in the real backwoods, in a small 3 bed ER in a tiny town, and he and another guy work 6 day stretches without ever going home. 144 hours in a row. At places like this…and I have worked at them too…usually there are periods where you can catch some sleep. But it’s intermittent, and you really don’t know how much or long. He was relating to me about a recent period where he went 26 hours without sleep. I could totally relate. It happens.

    What’s the solution?
    Hell, I don’t know. You can’t force people to work where they don’t want to. And don’t tell me about passing legislation restricting doctor’s hours. Where do they expect they will get the replacements to fill in the gaps when we all hit the end of our mandated time, and have to go home?
    Right now…and for the foreseeable future…we are what passes for the medical safety net in this country.
    People who don’t or can’t get medical care anywhere else come to us. People who CAN get medical care elsewhere come to us.

    Other than closing half the ER’s in this country, and making people drive longer distances to get to the emergency room, so all the ER’s in this country are fully staffed, I have no ideas. And that’s not a workable one, because people who are having MI’s or strokes, or trauma will die, because there is no care within a reasonable distance, And people get sick in inconvenient places.

    In the meantime, when you go to an ER you may well be seen by a doctor or nurse that is bone tired. We will try to do our best. We will try to be nice, and attentive, and give you the best care we possibly can. Because, tired or not, we are professionals, This is what we do.
    This is who we are. .

  29. There are other jobs besides the ones already mentioned where this is a problem. Trucking, for one. I have worked off an on as an over-the-road truck driver for the past few years. Some of these dispatchers think they can send you to do a pickup or delivery at any hour of the night, and as long as you schedule your legally required 10-hour break sometime (regardless of whether it matches your body’s sleep schedule) you will be just fine. They seem to be totally oblivious to the idea of having a regular sleep schedule. But there are also some truck drivers who think they can keep going all night long, with sometimes fatal consequences.

  30. “There are other jobs besides the ones already mentioned where this is a problem. Trucking, for one. I have worked off an on as an over-the-road truck driver for the past few years.”

    Edwin,

    You are correct in adding over-the-road trucking to the mix for the sleep deprivation part of this piece. The bottom line takeaway is that companies will rarely consider the effect of work schedules on employee health, when it could possibly cut into profits. In an era where profit is King, we all become peasants.

  31. Very pleased to see this. While I’ve had little contact with Healthcare and hope it continues that way, no offense meant by that, it happens in other industries as well. In my work we call it working while stupid (yeah, we’re a crass lot).

    I’ve seen more people nearly killed by electricity, and just plain hurt by carelessness on storm duty than at any other time. From carelessly grabbing an energized (unknowingly) conductor to setting a truck’s outrigger on someone’s foot. If you are overtired you don’t belong on the job.

    In electrical work, we can’t seem to attract the type of people we need, we end up competing with the colleges because there is little simple in our world anymore either.

    I suspect that the medical mistakes, that we all hear about are quite simply caused the same way, when one is too tired, one screws up, and if the team you work with is as well, there is likely no one to catch it.

    Answers? I don’t have any really, but I think it something we all need to work on, because at least in my field, it’s getting worse each year, and suspect it to be the same way in all the skilled technical fields, and healthcare is near the top of that list.

  32. “OUTSTANDING” isn’t the word*!*!*!* Everything, in a nutshell….Thanks beyond words O.S. for this tribute to those so dedicated who have fallen.

  33. Why is management overworking workers, is it profits, incompetence or something far worst?

    Well, I know where I’m at on the things stand on that last issue.

    Half the damned US work force has no work & is setting on their thumbs, what’s up?

    But for this topic here please note the fact that in the mid-late “””1970s”” I’m reading “Publicly Disclosed US Military Labor Efficiency Ratings”.

    I’ve been using those basic findings personally & for profit ever since.

    Best I can recall: A person can continue almost indefinitely working a schedule of 9 1/2-10 hours work a day 6 days a week. Something like 85-90% work efficiency.

    That’s the target goal I’ve use.

    The 2 other key pieces Efficiency Rating looks fair working 6 12 hour days for 3 weeks.

    “””After 3 weeks the workers efficiency falls towards 50-60%.”””

    Now thats key info! Why the hell would any management keep a worker working too many hour if the company’s ROI is only about 1/2 of what it was working normal hours?

    And of course Swing Shifts suck completely at any kind of efficiency as there is none/almost.

    Anyway, I don’t have a link to the 1970’s, but I saw it & it’s still out there, maybe even a better one now.

    OT, I really think Hollywood should do a big screen remake of the movie Idiocracy.

    As one of the best talking points the Jehovah Witnesses have is everyday day with most every issue we see mankind is shown to be to incompetent to manage himself.

  34. I used to do cost engineering for one of the Oshkosh facilities. Worker efficiency was central to the operation of the plant. Hospitals have no such thing, because the correlation between worker fatigue and unacceptable product isn’t direct.

  35. Nurses are over worked…. I agree…. There might be a way out IF she was voluntarily working rather than mandatory….. Hence… Wanted the overtime vs someone not showing up to cover the shift…. And hence she couldn’t leave….. Not sure if she was a floor nurse or in critical care….. That might make a difference as well….

  36. **What you find in the ‘real world’ is that for the most part, if you work in the ER, you work for a staffing company. The days of independent group practices in the ER are pretty much over. Now, the staffing company tracks every metric you can possibly imagine. How many patients you see per hour, **

    lol, As the late Russel Means sarcastically reminded us a few years ago: Welcome to the Rez! (Native American Reservation)

    So now the rest of you are realizing the gift of what’s called a “Flat Rate Book”. The best part is the bean counters keep working the numbers lower & lower each year.

    (The Amount of Tyranny you will live under is equal to the exact amount you will stand for!” TJ I believe.)

  37. The connection between sleep deprivation and our country’s poor health care ranking is obvious for all to see.

    The solution is tort reform. There is no question that America’s quality of health care ranks far behind that of other less developed nations, which underscores how desperately we need tort reform.

    Then, and only then, will America have the quality of health care God intended us to have.

  38. Mouth-Breathing Republican. Your attempted connection to the poor private health care to tort reform is almost comical. Tort actions are a very small percentage of the costs of health care, plus many of the tort actions result in improvement of care by hospitals and medical professionals.

  39. IMHO, looks as if the “Mouth Breathing Republican” comment above was snark. Beating the ‘baggers to the punch as it were, with a bit of biting sarcasm.

  40. **Juliet N. 1, November 17, 2013 at 12:18 pm

    The only tort reform we need is universal health care.
    **

    Juliet,

    Is there no one out there with a better plan then UHC?

    I can see it, why can’t others.

    With this ACA or UHC we as the USA might as well go ahead place a Hammer & Sickle or a Swastika on the flag.

    Have you ever pondered what the real meaning of Individual Rights & Sovereignty is?

    Have you studied what’s happening across Europe/Britain the last 5-7 years?

    Did you see last week the Federal Reserve could find no buyers for mortgage paper & had to buy it itself?

    Do you realize the US govt will have to borrow ,(On our Credit Card), 7-10 Trillion dollars to keep their Ponzi Scam alive for a few more years to pay all those welfare payments to Wallst Banks/Insur co’s?

    Do you know why so many of us call it a Ponzi Scam?

    And last but not least, do you really think that those foreign sociopath Billionaires are not setting there watching all this unfold & preparing to gut you & the US of all of it’s assets/savings accounts & pensions?

    If you are unsure of what I’m trying to say go look at the recent news from places like Greece & Spain where many of the people are so desperate they’re committing suicide as their businesses & pension plans collapse.

    What’s happening in Europe is already happening here, today!

  41. More of the same, what’s notable is the headline & I’m pointing out the the tempo of events is increasing rapidly.

    In the past few years people & websites have been organizing & finding their voice & hitting their stride.

    Wallst/DC may think they can continue to hide from reality & play the same old game, but they are delusional to believe they can hide from We the People in the day of video/audio & the Internet.

    http://www.zerohedge.com/news/2013-11-16/have-we-lost-our-common-sense

  42. Oky, what about Germany? They seem to be doing well financially and can manage their health care system without turning it into a hammer and sickle country, or swastica! Oh heck, what about Massachusetts? I see no hammer and sickle flying over the state. 85% of state residents in a recent poll stated they liked their health state’s health care plan.

  43. The corporate death march of profits, not people continues. Corporations are people, friend. Yes, uncaring, soulless, heartless, manipulating, fear mongering, diabolical people, my friend.

    I would also imagine that these corporations have purchased employee life insurance policies, so working these wonderful people to death is also a piece of the profit stream!

    There was an article published here recently that spoke to the fact that a certain percentage of CEOs are psychopaths. It’s possible they get the biggest bang for their psychotic tendencies as CEOs in the healthcare field……

  44. oky: “Why is management overworking workers, is it profits, incompetence or something far worst?”

    Yes. All of the above.

  45. Annie,

    I still have question about Obamacare myself.

    What’s up with the Medical Military Security Force contained within it. Another Armed (With Guns) govt group?

    And whats up with the section about RFID computer chips?

    Are you going to allow the govt to forcibly put a chip in you?

    I understand clearly from history what action a tyrannical gov’t put’s into place.

    Capital Controls, yep check, USA has those firmly in place.

    Armed Military force to be used against the citizens, yep check, DHS, FEMA, Combined Violent Task Forces all across the country, Etc.,

    This ACA/Obamacare seems more headed toward a complete confiscation of individual’s private identify info.

    Violating the Preamble to the Bill of Rights, the 4 amd, 5 amd, equal protection clause, General Welfare Clause, Interstate Commerce Clause & a bunch other basic individual protections that are there for good reason.

    Let me give you an example. Say I’m a bad, a crook, (aka govt), & I get you to tell me you are not going to be home between 8am & 6pm & your house key is under the mat. Well it’s obvious the crook knows exactly the best time to rob your house or say where & when to attack you.

    (Drone Attack? The Govt is already doing that against Americans as note by Professor Turley)

    Now none want that do we!

    We don’t hang that sign out front on the road so why would anyone trust to give the govt details like that. The Constitution is explicitly meant to protect us from being force to give out that type info to the govt.

  46. We know Oil/Chemical/Nuclear companies, etc are giving people Cancer & other illnesses.

    Instead of the citizens filling forms & paying premiums for insurance it would be far more productive to have those Corporations causing the injuries to fill out the forms & pay the premiums!!!

    If they think the bill is to high maybe they’ll figure out how to clean their act up!

    Just like this thread’s topic, if the courts order the medical community to pay huge amounts for their negligence/incompetence then hopefully those outfits would clean up their acts.

  47. At some point one would think that at least the highly skilled workers, the ones not easily replaced, being grossly abused as a group would start considering the virtue of a strike or a massive work slowdown. I guess things aren’t bad enough yet for a resurgence of the labor movement.

  48. @rafflaw ” Tort actions are a very small percentage of the costs of health care, plus many of the tort actions result in improvement of care by hospitals and medical professionals.”

    The cost effects of torts would seem to be divided into the direct – what is paid out when a case is lost- and indirect – the cost associated with changes in the way medicine is practiced, including tests and treatment due to the threat of a law suit.

    The direct costs of torts, while large in dollar terms, are far down the list in causes for the increase in health care costs. The indirect costs are far harder to identify and quantify.

    But it is hard to see how reducing tests and treatment, for any reason, will improve the results of health care. The argument that reducing testing and treatment by reducing torts will improve health care is counter intuitive at best.

    If there is a compelling argument that reducing the threat of torts improves health care by reducing test and treatment, I would like to read about it here or have someone cite a source for that argument.

  49. Otteray:

    I cannot thank you enough for this article.

    I worked as a trauma psychologist doing talk therapy at a rural hospital, and after 4 months, my caseload was only half of what the hospital said I needed to carry in order to “earn my keep,” meaning that because insurance reimbursements for mental health are so low, I had to work a lot of overtime to see enough clients for the hospital to break even financially. With only “half” a caseload I was already working overtime. When I asked my supervisor how in the heck I was supposed to handle twice as many clients, I was told to see clients for 30 minutes once every 2 or 3 weeks. As a trauma therapist, the treatment sessions are often intense and need an hour a week to properly care for clients. In addition, I often saw clients coming directly out of 24/7 inpatient care in a psychiatric ward after a suicide attempt — seeing such a client for only 30 minutes every other week seemed like malpractice to me.

    The other mental health clinicians there were in similar situations, and the stress level was palpable. The paperwork load was immense, due to the ever-increasing government push for “more data.” I would work late, leave work physically and emotionally exhausted, angry, irritable, depressed, and demoralized. I quit the job for my health, but quitting was hard because I felt terribly guilty leaving my clients. I just knew I could not do my clients justice in that setting.

    I can fully understand medical professionals’ dedication and need to attend to patients no matter what, but like your wife and you experienced, the pace and long hours can be deadly. And the stress on family members can leave the medical professional feeling guilty for not having time to spend with his/her family. I’ve seen marital relationships destroyed by required long work hours in high-stress medical professions. And when we see our colleagues “handling it,” we ourselves can feel like we’re wimping out if we struggle with the long hours and work pace.

    Thank you for sharing the story of you and your wife, and of people like Nurse Jasper, who have given their very lives to an honorable profession because they loved humankind, despite the terrible state of our health care system.

    May your article reach the ears of those who have the power to change the current system.

  50. MabelM,
    Thank you. I never really understood the comic strip “Dilbert” until I tried going to work for a mental health center. Talk about a contradiction in terms! That didn’t last long.

    Your experience and the experience of the ER Doc who commented upstream is exactly why the profit motive needs to be removed from health care. The money is there, but it is drained off for executive pay and bonuses, plus stockholder dividends. Even when a health care agency is “nonprofit,” that is a paper charade. The profits are there, but there are lots of ways accountants can shelter them.

  51. One more comment I will make about trucking. Every trucking company I have worked for, give them credit, will tell you that if you start getting too tired or sleepy to drive, then pull over somewhere and stop and get back in the sleeper compartment and go to sleep, and it is your decision to make. I know they would much rather deal with a driver being late somewhere than deal with an accident.

    I had to do that one time, and I sent them a message and told them I was stopping because I was getting too tired to drive, and I was going to be late, and nobody ever said a word to me about it.

    But probably there are plenty of truck drivers out there with their own horror stories. I’d hate to think what some of these companies would do (or try to) if they did not have these hours-of-service rules about how long you can drive before having to take a break.

  52. O S

    i know of several top tier nurses who have left working in hospitals because of the hours and low pay. hospital administrations seem to think the best way to cut costs is to reduce the number of nurses.

  53. Brerrabbit:

    Thank you for taking a nap. I wonder about driver exhaustion whenever I share the road with truck drivers. Driving can be so mind-numbing, especially at night.

  54. brerrabbit,
    The truckers I have come across seem to be under pressure to be on time, no matter what the risk might be. I wish that all drivers would take your advice and pull over when they are getting sleepy.

  55. OS,

    Excellent post!

    I’ve always wondered why bus drivers and airline pilots had stricter guidelines for sleep than health care professionals.

  56. pcm,
    I didn’t see anything in the spam filter. The spam filter has been emptied several times so far today. Whenever a comment is left over from the previous day, keep in mind that several hundred spams come in overnight. Whoever empties the spam filter in the morning always checks to see if there are any familiar usernames, but it is easy to overlook individual comments in all the clutter. Sorry ’bout that; suggest you try again.

  57. There is literally not one piece of paper that
    must be passed between hands in order forr the economy the facrory might
    be bad for the ecology. What if they are coal plants or oil plants, or gas, and
    coal. I encourage everyone to be paft of our culture. Or when we look into the real reality in communication, media,
    information, reporting has taken on a new significance.
    Also, these communities have different and vital parts environmental protection
    ork of the house owners.

  58. Some footballs say Sri Lanka cannot do it. Good over for Sri
    Lanka as many of the off the beaten track places that you should visit for
    an experience that he will be genuinely sharing their knowledge about Sri Lanka?
    Tue, footballs 3 Mar 2009VIDEO: Armed men attacked
    the Sri Lankan treatment of Tamils. Yala is believed to
    be from Lord Brahma, the God of Creation. Four singles keeps the footballs scorecard ticking over.
    Asteya: non-covetousness, to the vacation escapist,
    Sri Lanka, he said.

Comments are closed.