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Exploring the Multiple Dimensions and Contributors to Occupational Fatigue


By Taylor Watterson, PharmD, PhD

The Quadruple Aim emphasizes that the work life and well-being of healthcare professionals is critical to ensure safe and quality patient care.1 A fundamental aspect of well-being is occupational fatigue. Occupational fatigue is the body signaling its need for rest as a result of excessive workload—when work demands exceed the individual’s capacity.2,3 Occupational fatigue is crucial to study in healthcare professionals because it can impact downstream outcomes such as:

  • Employee burnout and well-being
  • Employee safety
  • Patient safety and quality of care
  • Patient satisfaction and experience
  • Organizational quality of care and profit
  • Organizational retention and turnover

Our article in the September 2023 issue of The Joint Commission Journal on Quality and Patient Safety, “Sociotechnical Work System Approach to Occupational Fatigue,” outlines a conceptual framework to describe, explore, anticipate and address healthcare professional occupational fatigue.

Beyond a diffuse sensation of lack of energy or need for rest, researchers have attempted to classify occupational fatigue into several dimensions:

  • Physical fatigue: physical exertion, physical discomfort4
  • Mental fatigue: lack of motivation, sleepiness
  • Acute fatigue: short-term fatigue, often within a shift5
  • Chronic fatigue: enduring fatigue without appropriate opportunities for recovery
  • Active fatigue: conditions of continuous and prolonged work overload6
  • Passive fatigue: conditions of work underload and under stimulation

There are numerous methods to identify and measure fatigue. Some examples include the Swedish Occupational Fatigue Inventory (SOFI), Multidimensional Fatigue Inventory (MFI) Psychomotor Vigilance Tests (PVT) and the Occupational Fatigue Exhaustion/Recovery (OFER) scale.

Both personal and organizational work system factors contribute to a healthcare professional’s experience of fatigue. Personal factors may include an individual’s:

  • Amount of sleep and energy
  • Physical, mental and emotional health
  • Social support network
  • Knowledge, experience and training
  • Other non-work responsibilities such as caregiving roles

Work system factors that impact fatigue include the types, quantity and nature of work tasks; tools, technology and resources that may help or hinder capacity and demands; organizational culture and policies including shift-length, scheduling, staffing and social support; the physical environment; and external environmental factors such as COVID-19.

Solutions to Occupational Fatigue 
Solutions that aim to address and prevent occupational fatigue in healthcare professionals need to consider the multiple dimensions of occupational fatigue as well as the many factors that can impact an individual’s experience of work capacity and demands. Often, popular strategies aimed only at addressing individual contributors of fatigue – such as encouraging healthy sleep hygiene – miss underlying causes of fatigue including task overload, understaffing and unhealthy scheduling practices. 

Organizations are encouraged to consider fatigue risk management systems (FRMS) and strategies that eliminate excessive demands, improve work capacity and mitigate the opportunities for fatigue to cause professional and patient harm.7 

Ultimately, considering occupational fatigue supports quality and safety of patient care by ensuring the well-being of the healthcare professional, addressing a critical tenant of the Quadruple Aim.

1 T. Bodenheimer, C. Sinsky, From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider, The Annals of Family Medicine. 12 (2014) 573–576.
2 L.M. Steege, J.G. Dykstra, A macroergonomic perspective on fatigue and coping in the hospital nurse work system, Appl. Ergon. 54 (2016) 19–26.
3 R.R. Rosa, M.J. Colligan, Plain language about shiftwork. Washington (DC): US Department of Health and Human Services, National Institute for Occupational Safety and Health. (1997).
E. Ahsberg, Dimensions of fatigue in different working populations, Scand. J. Psychol. 41 (2000) 231–241.
P.C. Winwood, A.H. Winefield, D. Dawson, K. Lushington, Development and validation of a scale to measure work-related fatigue and recovery: the Occupational Fatigue Exhaustion/Recovery Scale (OFER), J. Occup. Environ. Med. 47 (2005) 594–606.
D.J. Saxby, G. Matthews, J.S. Warm, E.M. Hitchcock, C. Neubauer, Active and passive fatigue in simulated driving: discriminating styles of workload regulation and their safety impacts, J. Exp. Psychol. Appl. 19 (2013) 287–300.
L.M. Steege, B. Pinekenstein, Addressing Occupational Fatigue in Nurses: A Risk Management Model for Nurse Executives, J. Nurs. Adm. 46 (2016) 193–200.

Taylor Watterson, PharmD, PhD is an Assistant Professor in the Department of Pharmacy Systems, Outcomes and Policy at the University of Illinois Chicago College of Pharmacy.