The 23 Reasons Most Insurance Agents Cant Work a 4-Day Work Week (Insurance Agency Mastery)

---

Their sleep is shorter, lighter, more fragmented, and less restorative than sleep at night Knauth et al. Workers are more likely to report greater fatigue at the end of hour work shifts than at the end of 8-hour workshifts Mills et al. There are exceptions, however: Sustained operations shifts of 12 or more hours with limited opportunity for rest and no opportunity for sleep Krueger, often occur among health care providers who staff busy emergency rooms and intensive care units ICUs , work overtime shifts on nursing units, or work as members of surgical teams that perform lengthy or consecutive procedures Krueger, The majority of anesthesiologists and anesthesia residents report having made errors in the administration of anesthesia when fatigued Gravenstein et al.

The California Nurses Association CNA website CNA, a reports several serious errors committed by nurses mandated to work hour shifts, in addition to cases in which nurses did not make errors but were at high risk for doing so. I was so exhausted that I would stop between going from one baby to the next and completely forget why I was going to the other bedside. Another time, again about 4 a. Studies have shown that accident rates increase during overtime hours Kogi, ; Schuster, , with rates rising after 9 hours, doubling after 12 consecutive hours Hanecke et al.

Finally, night shifts longer than 12 hours and day shifts longer than 16 hours have consistently been found to be associated with reduced productivity and more accidents Rosa, In one study, performance on neurobehavioral tests remained relatively stable during the first 17 hours of testing, a period the researchers called the normal working day, then decreased linearly, with the poorest performance occurring after 25—27 hours of wakefulness Lamond and Dawson, Performance on the most complex task—grammatical reasoning—was impaired several hours before performance on vigilance accuracy and response latency Although Dawson and colleagues Dawson and Reid, ; Lamond and Dawson, were the first to report that prolonged periods of wakefulness i.

The combination of sustained wakefulness and working at night is particularly hazardous Gold et al. When the Exxon Valdez ran aground around midnight on March 23, , the third mate had been awake 18 hours and anticipated working several more hours Alaska Oil Spill Commission, Although the explosion of the Challenger space shuttle occurred during the daytime, the decisions made the night before the launch by mission control staff have been cited as a major factor contributing to the explosion Mitler et al.

The lack of adequate rest periods between workshifts can also exacerbate fatigue. Sleep loss is likely to occur when there are only short durations between work shifts. Most adults require at least 6—8 hours sleep to function adequately at work Krueger, The loss of even 2 hours of sleep affects waking performance and alertness the next day Dinges et al. After 5 to 10 days of shortened sleep periods, the sleep debt sleep loss is significant enough to impair decision making, initiative, information integration, planning, and plan execution Krueger, The effects of sleep loss are insidious and until severe, usually are not recognized by the sleep-deprived individual Dinges et al.

Very short off-duty periods i. Off-duty intervals ranging from 10 to 16 hours are either suggested or already mandated for many transportation workers Dinges et al. No amount of training, motivation, or professionalism will allow a person to overcome the performance deficits associated with fatigue, sleep loss, and the sleepiness associated with circadian variations in alertness Dinges et al. Nor will training, motivation, or professionalism reduce the greater crash risk and increased drowsiness or sleepiness reported by commercial truckers after fewer than 9 hours off duty McCartt et al.

Recovery from extended work periods requires several days; schedules that require workers to return to work after an 8-hour rest period or to transition from night to day or evening shifts without at least 24 hours off are considered particularly dangerous Olson and Ambrogetti, ; Rosa and Colligan, Fatigue is also exacerbated by increased numbers of shifts worked without a day off Dirkx, ; Knauth, , and working more than four consecutive hour shifts is associated with excessive fatigue and longer recovery times Wallace and Greenwood, However, two consecutive nights of recovery sleep can return performance and alertness to normal levels, even following two or three 12 - hour shifts Dinges et al.

Workers obtain more sleep and start their next shifts with less fatigue. The first or second night in a new series of night shifts, however, may be the most fatiguing because of circadian desynchrony Rosa, Predictability of work schedules assists in planning ahead for rest periods. Unscheduled overtime, especially when added to a scheduled work shift, may require 16—20 hours of consecutive work for health care providers and those working in other professions Rosa, The work schedules of both physicians and nurses, as outlined later in this appendix, are often quite demanding.

Although the work hours of truck drivers, locomotive engineers, and pilots are regulated to protect the public from fatigue-related errors, hospitalized patients lack similar protections. At present, there are no restrictions on the number of hours a nurse may voluntarily work in a hour or a 7-day period in the United States. Nor are there restrictions on the number of hours that may be worked by other hospital employees, such as pharmacists another profession with a developing shortage , and only minimal restrictions exist on hours worked by physicians.

The hours worked by registered nurses RNs are of particular concern since they provide the bulk of direct inpatient hospital care; moreover, studies have demonstrated that the care provided by RNs is vital for maintaining the well-being of hospitalized patients Aiken et al. RNs must be alert enough to provide safe care for their patients and to recognize potentially dangerous errors in medication orders. Most previous studies evaluating medical errors took place in environments where nurses had obtained adequate amounts of sleep and were not unduly stressed by workloads, subjected to understaffing, or fatigued from working overtime Cullen et al.

Today, however, hospital nurses report extremely stressful working conditions, increased numbers of acutely ill patients, inadequate staffing, and working long hours without breaks Murray and Smith, ; Schrader, ; Seccombe and Smith, The effects of these working conditions on patient safety are unknown, but may be significant since a large number of medication errors reported in one study were attributed to poor staffing and onerous work schedules Leape et al.

Scheduled shifts may be 8, 10, or 12 hours, and may not follow the traditional pattern of day, evening, or night shifts. Although hour shifts usually start at 7 p. Shifts lasting 24 hours are becoming more common, particularly in emergency rooms ERs and on units where the nurses self-schedule personal communications, ER nurse, June , and ICU nurse, September , University of Pennsylvania Hospital.

Maintaining adequate staffing levels is a difficult problem, especially during nursing shortages. Hospitals can hire contract staff for specific periods to cover vacant positions or to cope with seasonal fluctuations in demand. Agency nurses, who are not employees of the hospital, can also be used. The use of agency nurses, however, is very expensive, and the quality of care provided by these nurses has been questioned Brusco et al. Asking regular nursing staff to work extra hours is often attractive to administrators since it costs less than hiring agency nurses, and the nurses are already familiar with the hospital Brusco et al.

Furthermore, unless specified in collective bargaining agreements, there are no federal and only a few state regulations restricting the number of hours a nurse can work in a hour period or over a period of 7 days.

To maintain adequate staffing levels, hospitals frequently offer nurses significant incentives to work extra hours. Likewise, nurses at the University of Michigan Medical Center recently approved a contract that requires the hospital to pay 2. Everyone appears to benefit. When the incentives are high enough, hospital administrators can cover open shifts without hiring additional staff, agency nurses, or traveling nurses, and nurses can significantly increase their salaries by working extra hours or shifts.

The effects on patient care, however, are unknown. The use of overtime, whether mandatory or voluntary, to cope with staffing shortages is quite common in hospital and nursing home settings. Interviews with staff members who worked at 17 nursing homes studied by Louwe and Kramer revealed that in 13 of the 17 facilities, at least one nursing staff member, and usually more, had worked between one and three double hour shifts during the previous 7 days.

In 5 of the facilities, at least one staff member had worked four to seven double shifts in the last seven days. And in one facility, more than one-third of the nursing staff had worked between eight and eleven double shifts in the past 14 days. Anecdotal evidence suggests that hospital nurses are also working large amounts of overtime because of short staffing. Only 40 percent of 2, respondents had never been required to work mandatory overtime. Another poll conducted by the American Nurses Association showed similar results: Decisions about mandatory overtime are usually made at the last minute, and nurses may receive less than 60 minutes' notice that they will not be allowed to go home at the end of their scheduled shift author's unpublished data.

No special accommodations are made for nurses working an extra shift; they are simply assigned a group of patients and expected to provide high-quality care with no additional breaks or a chance to take a short nap between shifts author's unpublished data. This practice is particularly dangerous when nurses are required to work extra hours at night. Under such conditions, the nurse may have been awake up to 24 hours, working 16 of those hours and often having only a or minute break.

The potential dangers posed by such overtime hours have been clearly documented.

EFFECTS OF FATIGUE

For example, the extensive use of overtime has been identified as a contributor to two separate outbreaks of Staphylococcus aureus Arnow et al. At the time, both hospitals were contending with an unexpected increase in patient census, coupled with understaffing. Investigations showed that the nurses, who were fatigued and stressed, compromised the usual standards of care by skipping steps or rushing through aseptic procedures. Legislation has been introduced at both the federal and state levels to ban mandatory overtime. Two bills were introduced during the th U.

Congress that would prohibit mandatory overtime for nurses and other licensed health care providers Golden and Jorgensen, The Safe Nursing and Patient Care Act of also contained provisions that would have required the Agency for Healthcare Research and Quality to conduct a study to determine the numbers of hours a nurse can work without compromising the safety of patients.

Similar legislation has been introduced in the th Congress. State legislatures in approximately 19 states have considered bans on mandatory overtime for nurses and other health care professionals. Most proposed measures prohibit hospitals from requiring nurses to work more than their regularly scheduled 8- or hour shifts. Some bills specify that nurses cannot be required to work more than 40 hours a week, while others prohibit hospitals from requiring employees to work more than 80 hours of overtime in any consecutive 2-week period Golden and Jorgensen, To date, bills prohibiting mandatory overtime for nurses have passed in only four states—California, Maine, New Jersey, and Oregon.

No measure, either proposed or enacted, addresses how long nurses may work on a voluntary basis. The hours physicians work, particularly during their residency training, are often quite demanding. Work days are typically 12—14 hours Czeisler et al. Despite recommendations that work shifts not exceed 24 consecutive hours, many interns and residents remain subject to call schedules requiring duty periods of up to 36 consecutive hours or longer on weekends Czeisler et al.

The work hours of resident physicians have been the subject of research and frequent debate over the past 20—25 years. Although errors made by a sleep-deprived resident in a New York City hospital are believed to have caused a patient's death, few studies have shown a direct link between fatigue and patient safety Asken and Raham, ; Friedman et al.

The findings of Smith-Coggins and colleagues are typical. Emergency room physicians working at night reported feeling significantly more sluggish, less motivated, and less clear-thinking than when working days. Although, they were able to maintain their accuracy in interpreting lead electrocardiograms ECGs and rhythm strips, their reactions times were slower and they took longer to intubate a mannequin when working the night shift Smith-Coggins et al.

Only a few studies have demonstrated that clinical performance is adversely affected by sleep deprivation. Unlike earlier studies, recent studies have been tightly controlled. Earlier methodological flaws e. They assume all residents have a significant sleep deficit, even those tested when not on call Weigner and Ancoli-Israel, Several studies have shown impaired performance on measures of alertness and concentration, standardized tests of creative thought processes, and cognitive performance on a standardized computerized test battery after on-call periods ranging from 24 hours to an entire weekend Leonard et al.

In studies using virtual-reality simulations, surgical residents made more errors and were slower to complete electrocoagulation of bleeding tissue as sleep loss increased Taffinder et al. Moreover, error rates were higher among residents after a night on call than during normal daytime hours Grantcharov et al. Realistic patient simulators have also been used to evaluate the performance of anesthesiologists at night when fatigued and during regular workdays Ou et al. Videotapes from the latter study showed sleep-deprived residents actually falling asleep while administering anesthesia.

Despite evidence that patient care may be compromised if a fatigued, sleep-deprived clinician is allowed to operate, administer anesthesia, manage a medical crisis, or deal with an unusual or cognitively demanding clinical presentation Weigner and Ancoli-Israel, , there is significant resistance to limiting the hours worked by resident physicians. Concerns have been expressed about reduced learning opportunities if resident work hours are curtailed Greenfield, ; Holzman and Barnett, ; Suk, , as well as decreased professionalism and commitment to patients Holzman and Barnett, Current resident work hours have also been defended on economic grounds Green, ; Patton et al.

Only the state of New York limits the hours worked by resident physicians. Her death triggered an aggressive media campaign questioning the quality of care in teaching hospitals, as well as a grand jury investigation into her death Asch and Parker, ; Kwan and Levy, Although neither the hospital nor physicians were faulted, the grand jury did find fault with the residency training system and physician staffing patterns that allowed Libby Zion's death to occur.

Five specific factors were identified as contributing to her death: The committee, chaired by Dr. Bertand Bell, reviewed the grand jury's report and issued several recommendations to the New York State Department of Health, including that residents should not work more than 80 hours per week, more than 24 consecutive hours, or more than 6 days without at least one hour period off duty Holzman and Barnett, ; Kwan and Levy, Rest periods of at least 8 hours between shifts were also mandated Holzman and Barnett, ER residents and attending physicians were limited to hour shifts Kwan and Levy, The committee's recommendations were then incorporated into the New York State Code in Although the New York Hospital Association immediately filed suit contending that the regulations were arbitrary, had been improperly adopted, and failed to provide adequate reimbursement for the increased costs of their implementation, 6 its appeal to the State Supreme Court failed Patton et al.

Also in , the ACGME amended its regulations to require accredited internal medicine residency programs to limit the hours worked by residents. Internal medicine residents could spend no more than 80 hours per week providing patient care, could be on call no more than every third night, and on average would have to have the opportunity to spend at least 1 of every 7 days free of patient care duties Green, Today there are 26 sets of different guidelines, each developed by a different Residency Review Committee.

Not only are the guidelines inconsistent across the various specialties, but they are also voluntary, not mandatory. In a survey conducted almost 10 years after the Bell Regulations were enacted, residents in all New York teaching hospitals reported working an average of 95 hours per week Anonymous, In , a surprise investigation conducted by the New York State Department of Health found all 12 hospitals visited to be violating resident work hour limits.

Over one-third of the residents 38 percent had worked in excess of 24 consecutive hours, 37 percent were working more than 85 hours per week, and 20 percent had exceeded 95 hours per week, while 60 percent of surgical residents had exceeded 95 hours per week Kennedy, Despite increased fines and stepped-up enforcement efforts, some residency programs in New York continue to violate daily and weekly work hour limitations Committee of Interns and Residents, b.

Although none have lost their accreditation solely for overworking residents Kwan and Levy, , 20 percent of the residency programs reviewed in were cited for noncompliance with work hour standards Kwan and Levy, In , only 8 percent of the programs reviewed that year were cited Lamberg, During the past year, increasing attention has been paid to hours worked by resident physicians. Congress during the th session. The Patient and Physician Safety Act of 7 would have required any hospital receiving Medicare funding to limit the hours worked by postgraduate trainees to no more than 80 hours per week and 24 hours per shift.

If the bill is passed by the state senate and approved by the governor, on-call duties during night shifts will also be limited to no more than every third night, and hospitals will not be able to require residents to work more than 6 days per week. Although the services of police officers and firefighters are required 24 hours a day, 7 days a week, their typical work schedules are quite different.

Can I afford a four-day week?

Only limited research is available about the effects of fatigue in these two occupational groups. Although overwhelming fatigue was described by police officers testifying at hearings conducted by the National Commission on Sleep Disorders Research in DHHS, , it was not known whether the witnesses' experiences were representative of the larger population of police officers. Over the past 10 years, newspaper reports of automobile accidents due to police officers falling asleep and running red lights, running off the road and hitting trees or joggers, or crashing while chasing fleeing motorists have provided anecdotal evidence that at least some police officers have significant problems with fatigue Vila and Kenney, Results of a recent study of four medium-sized metropolitan police departments suggest that 6 percent of officers on duty at any one time are severely impaired by fatigue, and that nearly half have clinical sleep pathologies Vila, Fewer than 26 percent of the participating officers reported averaging 7 hours of sleep a day, and nearly 12 percent obtained less than 5 hours per day.

Nearly 16 percent reported trouble staying awake during normal activities such as driving, eating meals, or engaging in social activities.

There are no regulations limiting the number of hours worked by police officers. Surveys have shown that at least a few officers in most departments work substantial overtime, and that more than half of the officers in many departments moonlight Vila and Kenney, Mean overtime hours range from Several studies suggest that lengthening work shifts and decreasing the number of days worked per week may reduce fatigue among police officers. Officers working and hour days reported that the longer shifts were less fatiguing.

They also reported fewer sleep problems and significantly less fatigue at the beginning of their shifts Vila and Kenney, Switching to a compressed work week three Finally, changing the direction of shift rotation from backward to forward , speeding up the rate of shift rotation, lengthening the shift to 8. Agencies are being encouraged to review their policies and procedures related to shift scheduling, moonlighting, and number of consecutive days worked and to provide in-service training on the importance of adequate sleep, the hazards associated with shift work, and strategies for managing those hazards Vila, , Information is scarce on whether these recommendations are being adopted and if so, how effective they are.

Firefighters typically work approximately 9 to 10 days per month and average 52—56 hours on duty per week Anonymous a,b. Although they are on duty for longer periods than most people, not all hours spent at the firehouse are devoted to working; part of the time is devoted to meal preparation, housekeeping chores, recreational activities, and sleep.

During normal conditions at post, camp, and duty stations where personnel can go home at night, work hours are quite similar to those of civilians. When personnel are deployed in the field or at sea, they tend to work about 70 hours per week U. Congress Office of Technology Assessment, c. Combat operations impose unique demands. Work demands are often continuous, requiring individuals to maintain performance for 12 hours or more. Sleep may be difficult or impossible. Nighttime operations, jet lag due to rapid aerial deployments, extra tasks associated with the first day or two at sea, and a faster-than-usual tempo of operations can further limit endurance U.

Tasks requiring physical activity and effort e. Several days of sustained operations will degrade the vigilance, memory, and cognitive task performance of infantry soldiers, tank crews, and artillery fire direction teams Krueger, , while performance on tasks requiring constant vigilance e. Long flights and sustained operations involving aircraft can be quite hazardous.

Fighter pilots can maintain physical coordination despite extreme sleepiness Krueger et al. Although not studied, the performance of other tasks, such as maintenance, preparation, and operation of equipment e. The Army, Air Force, and Navy have regulations governing flight times and duty periods for pilots. The Army specifies both the maximum amount of time pilots are allowed to fly and their maximum duty periods. Flight times are adjusted for such factors as time of day flying 1.

Flight times for Air Force pilots are longer up to 12 hours in duration for a single crew. Total flying time is limited to 75 hours per day period and hours per 90 consecutive days.

A minimum rest period of 12 hours is mandated between flights and must include 8 hours of uninterrupted, continuous rest. If a crew member is interrupted and cannot get 8 hours of rest, he or she must be given 8 more hours of uninterrupted time for rest, plus additional time for other activities. Flight surgeons and aviation safety officers are usually involved in scheduling missions.

However, the commanding officer can waive the regulations for high-priority missions and in combat situations. Naval regulations are quite similar, but specify that pilots cannot be assigned to flight duty on more than 6 consecutive days or assigned continuous alert or flight duty for more than 18 hours.

If the hour rule is exceeded, 15 hours of continuous off duty time must be given to the crewmember. Any deviation from this protocol requires that the individual be closely monitored and cleared for each flight by the commanding officer in consultation with the flight surgeon U. Flight surgeons also have the authority to issue stimulants and hypnotic medications to pilots to facilitate sleep and maintain alertness during combat conditions. Crewmembers are encouraged to defer non—flying-related duties in the days before a mission, take short frequent naps, consume nutritious meals, and use caffeine judiciously Naval Strike and Air Warfare Center, If a long flight or compromised alertness during a flight is anticipated, pilots may be issued several tablets of amphetamine 5 mg at the beginning of the flight.

No one is required to take amphetamines, and any leftover doses are collected at the end of the flight. Hypnotics are never issued prior to a flight to prevent their inadvertent use in place of a stimulant. According to Performance Maintenance during Continuous Flight: British pilots used sedatives during the Falklands conflict, and both Air Force and Navy pilots were given amphetamines in Viet Nam and most recently during Desert Storm.

Flights during Desert Storm often exceeded the legal durations, sometimes lasting up to 15—18 hours. Amphetamine use was most common in the early morning hours or just after dawn during extended combat air patrol missions.

Although there are no specific guidelines for work and duty schedules for most Army activities and operations, commanding officers are responsible for ensuring that personnel under their command are rested and fit for duty. Commanders are encouraged to plan for at least 6 hours of rest for combat personnel those doing the fighting U. However , actual conditions dictate the nature and scheduling of rest periods during combat conditions, reinforcement operations, and special operations. The Air Force has maximum duty limits for all personnel e. Staff can work 10 hours a day, 6 days a week, for a total of hours a month during continuous operations, and up to 12 hours a day, 6 days a week, for a maximum of 30 days during sustained operations U.

Crews manning intercontinental ballistic missile silos are on alert duty for hour periods. Regulations require that all crewmembers have at least 6 hours for rest or sleep during their duty period. Crews are rotated and tend to be on duty every third day U. At-sea schedules for nonflight naval personnel can be quite rigorous. Workweeks of 70—80 hours are not uncommon.

Even under noncombat conditions, rotating watch schedules can cause significant circadian disruption U. Submarine crews typically use hour watch schedules involving three sections of personnel rotating 6 hours on and 12 hours off. Because of maintenance tasks and administrative and training requirements, crewmembers sleep on average only 4 hours out of every hour period U.

Although hour watch schedules are typical, this does not imply that personnel on surface ships have 12 consecutive hours off duty. Instead, crewmembers usually work for 6 hours, then have 6 hours off for other tasks, including sleeping and eating. During normal conditions, crewmembers average about 6 hours of sleep in 24 hours U. Although crews manning aircraft carriers usually do not follow a rotating watch schedule as do crews on other surface ships, they usually work for somewhat longer periods 14—16 hours.

Combat conditions, which require the entire crew of a ship to remain on duty without relief or rest periods, can induce significant acute fatigue, especially after 1 or 2 days. Many Marine Corps missions are planned to begin before dawn, when the enemy is believed to be less vigilant and effective. There is generally a very intense period of sustained operations, usually the first 36—48 hours, after an amphibious assault, when personnel are almost continuously active U.

Marine air forces, which provide air support for amphibious assaults and other ground operations, are normally governed by the same flight regulations as other Navy flight crews, although these regulations may be waived during the first 36—48 hours of an amphibious assault U.

WHEN LESS CAN BE MORE

Although the dangers of a nuclear power plant accident have been recognized from the industry's inception in the s, regulations have focused exclusively on reactor design, training programs, and licensing requirements. The dangers of operator fatigue were not acknowledged until U. In addition, workers could not work more than 24 hours in any hour period or more than 72 hours in a 7-day period.

Although further clarifications were issued in Eisenhut, , no substantive changes were made to these guidelines. It is important to note that these are guidelines or recommended policies, not regulations. Nuclear power plant operators can choose to incorporate the recommendations into their technical specifications and administrative procedures, but are not required to do so U.

Congress Office of Technology Assessment, b. Once incorporated into a plant's technical specifications and administrative procedures, however, these policies can be, although rarely are, enforced by the NRC. Most nuclear power plant employees work 8-hour shifts, although a growing number of power plants have sought permission to implement hour shift schedules U.

Workers usually rotate shifts and have every other weekend off. Overtime is common, especially in outage situations, when every day off line not functioning costs the utility revenue U. Staff shortages, usually associated with an employee failing to show up for a scheduled shift, often result in employees being required to work a double shift if on 8-hour shifts or split a second shift with another worker. Plant workers' claims that they often work more than 70 hours a week when the reactor is operating and 80 or 90 hours a week when the plant is shut down for refueling or other tasks TiredNukes.

Org, have been substantiated. For example, data collected by the Nuclear Energy Institute showed that one-third of nuclear power plants were authorizing more than 1, and as many as 7, approvals 10 a year to exceed the guidelines Travers, In addition, over one-quarter of the sites surveyed reported that more than 20 percent of their personnel covered by the guidelines were working more than hours per person of overtime per year U.

Nuclear Regulatory Commission, a. Nuclear Regulatory Commission, Other plants were also criticized in Information Notice No. Four events occurring within an 8-month period apparently stimulated NRC staff members to begin investigating the impact of worker fatigue in nuclear power plants. In February , the Chairman of the NRC received a letter from three congressmen expressing their concerns about staffing levels and excessive overtime in nuclear power plants Markey et al.

After reviewing several options, the NRC recommended expanding Part 26 of the Fitness for Duty Program to include a broad range of possible impairments, including fatigue. Proposed work hour limits would apply regardless of the plants' operating state e. Some deviations would be allowed if the plant could demonstrate that the extra hours of work would cause no undue risk. A final rule is not anticipated until at least December U. Significant opposition to any efforts to regulate work hours is expected. Operator fatigue was recognized as a danger over years ago, long before scientists were able to demonstrate the adverse effects of fatigue on performance.

Traditional modes of passenger transportation, such as railroads and ships, were the first to be regulated. Aviation and trucking were added to the list of industries with work hour restrictions during the s. The aerospace industry, which developed during the latter half of the twentieth century, has no statutes or regulations limiting work hours.

Despite the Department of Transportation's acknowledgment that current work hour rules are outdated and that fatigue remains a significant factor, none of the regulations or statutes limiting hours of service have been modified since Attempts to incorporate the findings of recent research on fatigue into hours-of-service regulations have not been successful.

Although railroads were the predominant mode of intercity travel at the beginning of the twentieth century, rail travel was dangerous for employees and passengers alike. Between and , over 19, employees and passengers were killed in railroad accidents, and another , were injured U. Congress Office of Technology Assessment, Four years later, the number of fatalities had risen to 37, and the number of injuries to , Deaths and injuries did not decline until the early s, when the last of the early safety laws, 11 the Signal Inspection Law, was enacted U.

The contribution of fatigue to these early accidents is unknown. Although various sources mention the extended or excessive hours worked by railroad employees of that era Adams, , the actual hours worked by employees is not known. Employees could not be required or volunteer to either go on duty or remain on duty if these limits would be exceeded.

It is not known how Congress arrived at these limits on railroad employee work hours; there were no studies of fatigue and railroad safety to guide their decision-making process. Perhaps they had read some of the accounts referred to by Munsterberg —as cited in Intermodal Transportation Institute, a: Congress and other writers at the beginning of the twentieth century were aware that working for long hours without adequate rest periods had an adverse effect on public safety. Although some modifications have been made to the Hours of Service Act over the past 95 years, 13 the basic provisions remain the same.

Railroad employees are entitled to 8 consecutive hours off duty in the preceding 24 hours, or 10 consecutive hours off duty after working 12 consecutive hours 49 U. Although compliance with the Hours of Service Act has been quite high the U. Over 30 studies U. DOT, and numerous reports on fatigue among railway employees have been published since Grant's initial study. Even though studies and accident investigations have shown that current hours-of-service regulations are not sufficient to prevent fatigue-related accidents, additional modifications of the Hours of Service Act are not planned.

The development of new, scientifically based standards is also hampered by a lack of scientific consensus on the best way to manage shiftwork schedules, difficulties in translating research findings into operational environments, and recognition that the wide variety of settings commuter rail, long-haul freight, and short-haul lines makes it impossible to develop a single set of standards. Educating employees about fatigue management is considered more acceptable to all stakeholders e. As a result, most railroads now offer training modules in fatigue countermeasures for all employees, scheduled days off, confidential screening for sleep apnea, and improved sleeping facilities at railroad terminals Intermodal Transportation Institute, a,b.

Although the programs are varied in the material presented, scheduling approaches, management of emergencies, and outcomes measured, several best practices have emerged. These include 1 assigned days off, particularly after an extended period of work; 2 allowing napping on duty under predetermined and controlled circumstances; and 3 educational interventions tailored to the needs of employees at a specific location Intermodal Transportation Institute, a.

Coast Guard studies indicate that fatigue is a contributing factor in 16 percent of critical vessel casualties 14 and 33 percent of personal injuries McCallum et al. Sleep is often severely restricted by traditional watch schedules, particularly the 1-in-4 schedule 15 Comperatore et al. The 1-in-5 schedule, while allowing for longer periods off duty, still requires crewmembers to start work 4 hours earlier every day. Advancing sleep and wake-up times by 4 hours each day is difficult if not impossible for most people. Long workdays, reduced time between watches, sleep disruptions, and fragmented sleep are also common Comperatore et al.

Coast Guard Research and Development Center, All-hands drills and other conditions further fragment sleep. Manning requirements for Great Lakes vessels, ocean-going vessels, coastwise vessels vessels that travel only along the coast , offshore supply vessels, towing vessels, and tankers are spelled out in Title 46 of the United States Code, Part F, Manning of Vessels, Section The grounding of the Exxon Valdez on March 24, , dramatically changed 46 U.

The Oil Pollution Act of , which amended 46 U. Work hours in port as well as at sea are spelled out in the regulations. Seamen cannot be required to work more than 9 out of 24 hours while in port or more than 12 out of 24 hours at sea on oceangoing or coastwise vessels of not more than gross tons.

Crewmembers on vessels operating in the Great Lakes can work up to 15 out of 24 hours, but cannot work more than 36 out of any 72 hours Clifton, Work while anchored in a safe harbor is limited to 8 hours per day.

more on this story

Administrative duties, whether performed on board or on shore, are to be counted as work by vessel operators. Workers on other types of vessels are limited to working 12 hours in a hour period. The number of watches per day e. Restrictions, however, can be waived in emergencies, such as if work is necessary for the safety of the vessel or to save a life on board another vessel 19 U. Congress Office of Technology Assessment, d. Finally, an officer in charge of a deck watch when a vessel leaves port must have been off duty at least 6 of the 12 hours prior to the ship's departure U.

These regulations apply to all vessels registered in the United States, as well as those from other countries using U. Owners, charterers, or managing operators can face civil penalties if the U. S Coast Guard discovers that work hour limits have been exceeded Clifton, Individual mariners are expected to obey work hour limitations and to report suspected watchkeeping and work hour violations to the Coast Guard.

Tips are kept confidential, and those who report code violations are protected from discrimination, including discharge, by 46 U. The Oil Pollution Act of also directed that the U. Coast Guard undertake the development of a research program to establish safe manning levels U. Congress Office of Technology Assessment, a , and that results of research on the effects and reduction of fatigue be disseminated to industry personnel National Transportation Safety Board, Although safe manning levels have not been established, research over the past 10 years has confirmed that fatigue among mariners is quite common e.

Specialized programs for fatigue countermeasures have been developed and tested by the U. Coast Guard [Comperatore et al. Coast Guard has also begun working closely with the International Maritime Organization to highlight the issue of fatigue and collaborated in the development of the Amendments to the International Convention on Standards of Training, Certification, and Watchkeeping for Seafarers NTSB, a.

These regulations, which apply to all employees sailing on ocean-going vessels, specify that an officer in charge of a watch or a rating forming part of a watch be provided with a minimum of 10 hours of rest in a hour period and that two rest periods be given, one of these being at least 6 hours in length International Maritime Organization, Despite efforts to publicize their recommendations and work with industry personnel to implement effective programs for fatigue countermeasures, vessels are still running aground because crewmembers are asleep at the helm.

Unfortunately, falling asleep at the helm is not a rare or isolated event. Within a 1-week period in , three fishing vessels out of South-eastern New England ran aground after a crewmember fell asleep at the helm Harrington, One of the boats was broken apart by the action of the waves; the other two were severely damaged but salvageable, and two of the three crews had to be rescued by the U.

Work hours of long-haul truckers have been regulated since the s, when Congress passed the Motor Carrier Act of This act authorized economic regulation of the trucking industry and directed the Interstate Commerce Commission ICC to establish qualifications and maximum hours of service for drivers working for private and for-hire interstate property carriers and for-hire interstate passenger carriers Federal Motor Carrier Safety Administration, ; United Transportation Union, Although safety was included in the mission of the ICC, the major focus of the agency in was on the financial plight of the trucking industry United Transportation Union, Drivers could not be permitted or required to be on duty more than 15 out of 24 hours, only 12 hours of which could be spent working e.

The extra 3 hours was intended for meals and rest breaks. The need for off-duty time was also recognized:. It is obvious that a man cannot work efficiently or be a safe driver if he does not have an opportunity for approximately 8 hours sleep in It is a matter of simple arithmetic that if a man works 16 hours a day he does not have the opportunity to secure 8 hours sleep. Allowance must be made for eating, dressing, getting to and from work, and the enjoyment of ordinary recreations.

A hour rest period was mandated once a driver reached the maximum weekly work limit. Weekly on-duty limits were set at 60 hours in any 7 consecutive days or 70 hours in 8 consecutive days, depending on whether the carrier operated 7 days a week or less 20 Federal Motor Carrier Safety Administration, Revisions to the regulations allowed drivers to work up to 16 hours a day as long as they drove only for 10 of those 16 hours.

The mandated rest period was also decreased from 9 to 8 consecutive hours. Total work hours per week remained capped at 60 and 70 hours 3 FR However, no substantive changes were made in the regulations until , when the ICC dropped the hour limit. By alternating hour driving periods and 8-hour rest periods, drivers were now legally permitted to drive 16 out of 24 hours Federal Motor Carrier Safety Administration, Drivers were to maintain logbooks documenting driving periods and mileage.

Neither the original regulations nor the amendments were based on scientific evidence. Although the ICC expressed hope in that changes in the Hours of Service regulations would not be used to lengthen drivers' hours, truckers engaged in interstate commerce generally work longer hours than any other group of employees in the United States. Not only are hours-of-service violators more likely to speed or drive longer hours when given unrealistic driving times, but they are also more likely to report having fallen asleep at the wheel Braver et al.

Higher crash rates have also been reported by hours-of-service violators Braver et al. A notice of proposed rulemaking to update the Hours of Service regulations was issued in May , generating over 50, comments and significant controversy NTSB, b. To date, none of the following changes have been adopted: Although Charles Lindbergh was not the first pilot to experience the effects of fatigue, his description of fighting fatigue during his transatlantic flight graphically illustrates the dangers of tired pilots:. My mind clicks on and off. I try letting one eyelid close at a time while I prop the other with my will.

But the effort is too much, sleep is winning, my whole body argues dully that nothing, nothing life can attain is quite so desirable as sleep. My mind is loosing resolution and control. Lindbergh landed safely near Paris after flying for Others have not been so lucky, either flying across the Atlantic or within the borders of the United States. Air Mail Service was founded in , 15 years after the Wright brothers' initial flight. Accident rates were extremely high: By , the aviation industry, worried that the airplane would not reach its full commercial value without federal action to improve and maintain safety standards, convinced Congress to pass the Air Commerce Act.

This act established the Aeronautics Branch of the Department of Commerce, and charged the Secretary of Commerce with fostering air commerce, issuing and enforcing air traffic rules, licensing pilots, certificating aircraft, establishing airways, and operating and maintaining aids to air navigation Federal Aviation Administration [FAA], Lighted airways became more common, and aeronautical radio communications were improved through the use of radio beacons. Hours-of-service limitations were not established by the FAA until Patton et al.

The duty schedules for pilots, air traffic controllers, engineers, flight attendants, airline mechanics, and various other types of crew members are regulated by the FAA under statute 11 C. Rules on duty hours for pilots vary by the size of the flight crew e. Pilots working during both scheduled and unscheduled operations e. When larger flight crews are used, pilots are allowed to work an additional 2 hours Patton et al. Domestic air carriers are not permitted to issue, and pilots are not permitted to accept, an assignment for a flight if the crew member's total flight time will exceed hours in a calendar month, 30 hours in 7 consecutive days, or 8 hours between required rest periods U.

Congress Office of Technology Assessment, a. Rest periods are also mandated and vary according to the length of the scheduled flight time. If the scheduled flight is less than 8 hours in duration, 9 consecutive hours of rest are mandated between flights; if the scheduled flight is 8—9 hours in duration, 10 consecutive hours of rest are mandated; and if the scheduled flight is 9 hours or more in duration, 11 consecutive hours of rest are mandated U.

Longer rest periods are also mandated if pilots exceed the daily flight time limitations because of circumstances beyond their control e. If flight time limitations are exceeded by less than 30 minutes, a pilot cannot be assigned or accept an assignment that does not allow for 11 consecutive hours of rest. If the flight time limitations are exceeded by more than 30 minutes, but less than 60 minutes, 12 consecutive hours of rest are mandated. And when flight time limitations are exceeded by 60 minutes or more, 16 consecutive hours of rest are mandated before the next flight Patton et al.

Although commercial airline pilots typically work only 13—15 days a month Meenan, , there is ample evidence that fatigue remains a significant problem. Surveys, observational data, and anecdotal reports have documented that flight crews frequently experience unintentional sleep episodes while flying Co et al. Maintenance of vigilance, particularly at night, is quite difficult. Pilots are expected to remain alert despite high levels of automation, low light levels on the flight deck, and regulations that require the pilots to remain in their seats for the duration of the flight unless their absence is necessary for the performance of duties in connection with the operation of the aircraft or biological needs, or if the crew member is taking a rest break and relief is provided.

Getting up just to stretch or walk around is not allowed Circadian Information, ; Neri et al. Fortunately, only one crash has been attributed to fatigue—that of American International Airways flight , which missed the runway at the U. According to the NTSB's investigation, the probable causes of that accident included the following factors: However, several NTSB reports have played down or omitted the role of pilot fatigue even when the agency's own investigators have considered it a significant factor Circadian Information, For example, even though the NTSB report on a China Airlines Boeing flight in February omitted any mention of crew fatigue, a later analysis of the accident by the Aviation Human Factors Team at NASA concluded that inattention caused by crew fatigue was a key factor in the near disaster.

Air traffic controllers obviously have an essential role in maintaining airline safety. Almost all air traffic controllers rotate shifts, and are limited to working 10 consecutive hours or 10 hours during a hour period unless they have been allowed a rest period of at least 8 hours before or at the end of the first 10 hours of duty.

Many air traffic controllers appear to have a significant sleep deficit Marcil and Vincent, The air traffic controllers studied by Rhodes and colleagues obtained only about 6—6. And controllers may get even less sleep if their mandated rest period of 8 hours falls at a time when it is difficult to sleep. The accident investigation following the crash of a United Airlines DC-8 freighter into the side of a mountain in Utah at 1: No regulations or guidelines limit work hour durations in the aerospace industry.

Most employees work a traditional hour week, then dramatically increase their hours in the weeks before a launch or during the mission. Early missions were short, lasting only a few hours or days. Today's missions, by contrast, may last weeks or even months, placing more demands on mission control staff and astronauts.

Shuttle launches frequently occur at night, requiring flight controllers at Kennedy Space Center to switch from day to night shifts Kelly et al. After launch, responsibility for flight operations switches to the Missions Operations Directorate at Johnson Space Center in Houston, Texas, where three flight control teams FCTs are used to staff the Missions Operations Directorate for flights of less than 10 days. When flights of 10 days or longer are planned, a fourth FCT is added to allow team members time off. Although shift lengths vary, hour shifts are not uncommon. Flight controllers average less than one break per shift range 0.

Flight controllers are responsible for a wide range of cognitive tasks, including sustained trend analysis, monitoring of multiple voice channels, and rapid responses to emergency situations. Cognitive processing and vigilance must remain high because even small mistakes can be operationally significant Kelly et al. In contrast, the sleep patterns of astronauts have been monitored since the early days of the space program Aschoff, ; Pittendrigh, After just a day or so in translunar drift, the astronauts got accustomed to the constant flickering and went about their sleep-wake, work-rest schedules as if the sun were rising and setting outside their craft just as it did outside their homes in Houston.

As long as the crew maintained that schedule, NASA's flight surgeons had learned, their circadian rhythms would remain largely un-disturbed. Even on a routine flight, no one expected the pilots to sleep a full eight hours. The almost total lack of physical exertion in space and the almost constant output of adrenaline that accompanied the business of flying to the moon made five or six hours of sack time the most the medics could hope for.

Those five or six hours, however, were absolutely essential if a crew that was flying even a nominal mission was going to make it through their day without making some serious, and perhaps disastrous, mistake. A crew that was flying a less than nominal mission would need even more rest.

Lovell and Kluger, In the second row of Mission Control, the flight surgeon had been copying down the answers the men gave, and the totals had begun to alarm him. Since Monday night, the crew had been averaging about three hours of sleep apiece per day. These anecdotal reports of shortened sleep times have been confirmed by both subjective and objective studies Dijk et al.

Keeping Patients Safe: Transforming the Work Environment of Nurses.

Despite preflight circadian adaptation measures and in-flight schedules to optimize circadian adaptation and minimize sleep loss, astronauts typically sleep only 6 to 6. Polysomnography sleep studies using electroencephalogram [EEG], electro-occulogram [EOG], and electromyogram [EMG] recordings have shown more wakefulness and less slow-wave deep sleep in the final third of sleep episodes while in space and marked increases in rapid eye movement REM or dreaming sleep after return to earth Dijk et al.

Astronauts frequently use hypnotics during flights Putcha et al. Like Air Force pilots, as discussed earlier, astronauts are allowed to decide whether to take stimulants usually dextroamphetamine. A final selection from Apollo 13 illustrates one astronaut's decision-making process regarding the use of stimulants:. In the spacecraft, Lovell, Haise, and Swigert were in their accustomed places, all awake and all feeling reasonably alert.

She intended to make the cut in working hours — and pay — for a year, but has now dropped to two-and-a-half working days since having her son, Indie. She says she will never go back to a five-day week. Butler is among those reducing their working hours to improve their quality of life. Their main reasons tend to be to gain more time with children; to study or learn other skills; poor health or, perhaps increasingly, to reduce stress.

But how practical is dropping a day? For a lot of people the drop in salary will be too much, but for others, especially those who would see their childcare and commuting bills drop, the salary cut can work out better than expected. You may also be entitled to working tax credits. Not meaningless by any means, and if we'd been on one income, that could have been a show-stopper.

Self-employed people might not experience a pay cut at all when moving from five to four days a week, depending on the nature of their business and how well established it is, says independent financial adviser Martin Bamford, of Informed Choice. If you are reducing your working hours and therefore pay, you will also take a corresponding cut in the amount being paid into any workplace pension scheme.

Connolly suggests first getting a written projection from your company pension provider, which he says is important to look at in today's terms with inflation taken into account. This is, of course, only if you can afford it," he says. Other things that may be affected could be any life insurance or income-protection insurance you get from your employer.

As these are based on multiples of your salary, the amount that would be paid out will reduce. The fact that you are working part-time doesn't mean you should be treated less favourably than your colleagues. If you commute to work , either by car or train, then doing so less will save you money. If you drive, cutting your working week will save you petrol, and might reduce your car insurance costs, too, if you can declare a lower annual mileage when applying for a policy.

For rail season-ticket holders, the picture is not always as clear. At present, part-time workers who commute by train must either buy a season ticket and lose money on the days they don't use it , or buy individual peak-time tickets, which are more expensive. At the moment, one of the only ways to reduce peak-time rail fares is to pay by carnet tickets, which typically give you 10 journeys for the price of nine and are valid for three to six months.

• Baby Words and Pictures: Christmas!
• Bioenergy Economy: A Methodological Study on Bioenergy-Based Therapies
• Viagem à Superfície da Terra... (Portuguese Edition)
• Wow! Più Knitting Patterns per gli afgani (Italian Edition)
• You Walk With Me
• Urban Growth Analysis and Remote Sensing: A Case Study of Kolkata, India 1980–2010 (SpringerBriefs in Geography)