Fatigue Policy

Resident Fatigue Management Policy
1. Goal: The goal of this policy is to prevent, identify and relieve resident fatigue that may present
a danger to themselves, a patient or the work environment.

2. Fatigue Prevention:
a. Strategic Napping: Every resident and intern will be required to take a 45 minute nap
during a 28 hour call period. During this time, the intern/resident will be relieved of all
clinical duties other than true emergencies that require their presence. If their nap is
interrupted due to an emergency, rest time will be restarted for 45 minutes when the
emergency has resolved.
i. MICU/PCS
1. The resident and intern will designate specific times during their shift
when each will nap. This will be decided as a team at the start of the
shift
2. Residents will forward their pager to another resident or to the covering
fellow

3. Interns will forward their pager to their supervising resident
ii. Oncology
1. Residents will inform nursing that they are taking their strategic nap.
Nursing will page only for emergencies during this time.
iii. Blue/Pink
1. Residents will forward their pager to VA‐University night float resident
(VUNF).
iv. Overall resting on a 28 hour call may last longer than 45 minutes. Residents and
interns on 28 hour calls are encouraged to rest when there is an opportunity to
do so.
v. VUNF will help facilitate napping for interns and residents for all services in
emergent situations.

3. Relief of Recognized Fatigue: This can be done by either the resident or a colleague. This may
occur on any service. Fatigue is recognized when the resident feels unable to continue working
due to feeling tired, or a colleague expresses concern about the resident continuing to work due
to feeling tired. Colleagues may include but are not limited to co‐ residents, interns, attendings,
fellows, or nursing.

a. The PGY‐1 intern experiencing fatigue will:
i. Inform their senior resident.
ii. Be excused from all clinical duties, without repercussion, for a minimum of 30
minutes, with all pages being forwarded to their senior resident during that
time.
iii. Rest in one of the internal medicine call rooms during this time.
b. The PGY 2+ resident experiencing fatigue on a rotation with teammates will:
i. Discuss with a PGY‐1 or inform a co‐ PGY 2+ resident on the service.
ii. Be excused from all clinical duties, without repercussion, for a minimum of 30
minutes, with all pages being forwarded to their co‐resident during that time,
either intern or senior level.
iii. Should a PGY‐1 resident have emergent questions or issues related to patient
care, they will escalate to the VUNF, fellow, or attending.
iv. The PGY‐2 + resident experiencing fatigue on a solo rotation (i.e. cancer center)
will:
1. Inform the charge nurse on the unit with the goal of holding all nonurgent
pages for a minimum of 30 minutes.

2. Inform and forward their pager to the VUNF. The VUNF on‐call resident
will cover in an emergency.

3. The time is expected to be used for resting in one of the internal
medicine call rooms.

4. Additional Resources: In the event that a resident experiencing fatigue is unable to safely return
to clinical duties, or unable to arrange for coverage as above, they will contact the chief
residents who will arrange for coverage.

5. Call rooms:
a. Are located within department – specific areas of the hospital in the ICU, Cardiology,
and Cancer Center.
b. Additional call rooms are located on the 11th floor of the north hospital and 10th floor of
the north hospital and may be accessed by key. It is the resident’s responsibility to
obtain a key to the call rooms.

6. Extra Services: Taxi services are available for all residents and interns who are too tired or feel
unsafe to drive home. Must turn in receipt to be reimbursed.
Effective: 7/2/2017

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