Employment Resources
Fatigue Management
Fatigue management is important in all employment situations, but especially so where the impact of fatigue can be poor patient health outcomes.
Under the NTCER, GPRA and GPSA have enshrined the management of registrar fatigue as a responsibility that needs to be shared equally between the registrar and the training practice.
Training practices and supervisors are charged with responsibility for the safety of not only their registrars but also that of the registrar’s attending patients.
HOW DO WE MANAGE FATIGUE IN THE PRACTICE?
The practice manager, supervisor and registrar should work together to develop a relationship that encourages open communication and feedback.
The registrar should be encouraged to speak with their supervisor and/or practice manager about ways they can manage workload and study and still maintain a healthy work life balance.
Supervisors should model a healthy work/life balance to the Registrar.
OUR REGISTRAR IS REALLY STRESSED ABOUT THEIR UPCOMING EXAMS AND TELLS THEIR SUPERVISOR THAT THEY ARE STUDYING EVERY NIGHT FOR AT LEAST 5 HOURS. HOW CAN WE HELP THEM SO THEY DON’T BECOME FATIGUED?
Fatigue management is important in all employment situations, but especially so where the impact of fatigue can be poor patient health outcomes.
Under the NTCER, GPRA and GPSA have enshrined the management of registrar fatigue as a responsibility that needs to be shared equally between the registrar and the training practice.
Training practices and supervisors are charged with responsibility for the safety of not only their registrars but also that of the registrar’s attending patients.
The supervisor and other newly Fellowed GPs have much to offer from their own experience of exam pressures and juggling a variety of priorities.
GPSA has resources to help members of the supervision team guide the registrar to employ better study habits and improve their time management skills.
IS THE REGISTRAR REQUIRED TO LET US KNOW IF THEY HAVE ANOTHER JOB?
Yes – the NTCER emphasises the need for open and respectful communication between the practice and registrar, and clause 16.2(c) requires the registrar to advise the practice manager of any work they are doing outside of their engagement with the training practice.
It is important that the practice manager shares this information to ensure there is a whole-of-practice approach to monitoring the registrar for any impact on their performance or health.
WHAT SHOULD WE DO IF THE REGISTRAR TAKES ON ANOTHER JOB? DO WE HAVE TO SUPPORT THEM IN THIS?
Registrars and training practices should consider themselves a team, with each wanting the best outcome for the other.
Whilst the registrar is responsible for their own behaviours, training practices can assist with fatigue management when they are aware of the issues the registrar faces.
Consider the following example:
Kelly, a GPT3 registrar, has just bought a new home and the mortgage impact has hit hard. In the middle of her 6-month employment contract with Seaside Medical, she decides to take on occasional extra weekend shifts at the local hospital. She lets her practice manager know immediately about her decision and advises when the shifts will be happening and for how long.
Kelly’s practice manager considers the patient demand, room availability, access to supervisors and consulting profile of other GPs at Seaside and finds that there is the option for her to change her normal day off on Tuesdays to Mondays instead. This is a win/win: assisting the registrar in managing their time and fatigue, with no detrimental impact on business operations and patient access. More importantly, the practice’s willingness to accommodate her scheduling needs has enhanced Kelly’s training experience and elevated Seaside Medical as a potential long-term fit post-Fellowship.
OUR HOURS ARE 7.00AM–10.00PM, MONDAY TO FRIDAY. CAN I ROSTER A REGISTRAR TO FINISH AT 10.00PM AND THEN START AT 8.00AM THE FOLLOWING MORNING?
This is question that needs to be considered on a case by case basis – applying logic and open communication with the registrar. Remember the point of fatigue management is not to be restrictive for either the practice or registrar, but to facilitate patient safety and registrar and wellbeing.
Clause 19.2(e) of the NTCER requires a clear period of rest of no less than ten hours between the registrar’s shifts. Although this clear rest period is achieved in the example provided, the practice needs to be mindful of any travel time the registrar might incur between work and home.
We would suggest that this roster not be a regular occurrence but happen only in the case of an emergency or workforce shortage.
OUR REGISTRAR IS WORKING AT THE LOCAL HOSPITAL IN E.D. AND HAS COME TO WORK SOME MORNINGS WITH LITTLE OR NO SLEEP... IS THIS OK? WHAT ARE OUR OBLIGATIONS HERE? WHAT ARE THE OBLIGATIONS OF THE REGISTRAR?
Under clause 16.2(f) of the NTCER, the registrar is responsible for ensuring that they have a clear rest period of no less than 10 hours between shifts, including those worked at the training practice and any other workplace. This is for the protection of the registrar, the registrar’s patients, and the training practice.
The registrar has a responsibility to prioritise their commitment to the training practice over other employment – clause 19.2(g). Treating the training practice as their principle place of employment, the registrar must refuse any shifts with another employer that they know or suspect will impact on a clear 10-hour rest period before a rostered shift at the practice. An exception to this would be an on-call shift, which should be considered on a case by case basis and treated with a logical approach and open communication between practice and registrar. In many instances, an on-call shift might result in a 20-minute attendance at the hospital – if this is in the middle of the night and involves travel time, this could have the same effect as a full shift in terms of fatigue; if the same call-out happens only an hour or two before the start of the registrar’s shift in the practice, or mid-evening, this may have no impact on their fatigue and be perfectly acceptable.
If a registrar does attend the training practice and advises you that they are struggling after having an inadequate rest period, together the practice and registrar should undertake a risk assessment to determine if the registrar is safe to consult. Wher the decision is that the registrar is not safe to consult, the practice must direct them to return home and take the day off drawing on annual leave (paid or unpaid), or to make up the missed hours throughout that pay period.
THE HOSPITAL HAS ROSTERED THE REGISTRAR ON A SHIFT THAT FINISHES AT MIDNIGHT, BUT THE REGISTRAR IS ROSTERED TO COMMENCE AT THE PRACTICE AT 8.00AM THE FOLLOWING DAY. WHAT HAPPENS IN THIS SITUATION?
We all know there need to be a few options for every scenario…
A) The registrar acknowledges their responsibility under Section 19.2(e) of the NTCER, namely to ensure they always have at least 10 clear hours of rest before commencing work at the practice, and declines the hospital shift; or
B) The registrar advises the practice of their dilemma – the hospital is short-staffed and patient waiting times are blowing out – and the practice agrees to reschedule the registrar’s appointments for the first 2 hours of their day to later in the week when a member of the supervision team runs an after-hours clinic; or
C) When the registrar advises the practice of their dilemma, they are asked to take the first session off as annual leave so that a locum can be brought in to attend patients who can’t be rescheduled.
Date reviewed: 16 September 2024