Organisational Responsibility

Wellbeing is the responsibility of organisations as well as individuals. Employers must assess and control risks to health and safety, including stress and tiredness.^[1][6]

Putting duty into daily practice

Risk assessments should look at workload, fatigue and people working alone.^[1][2]

Break policies need to be clear and consistently applied^[3].

Working time rules set minimum standards, but safe practice often needs more generous limits. Occupational health and counselling should be easy to access.^[3][4]

Manager actions that help

Managers can design appointment schedules with some flexibility and plan cover for sickness.^[5] Staff working alone need easy access to advice.^[2] When risks rise, a clear “pause” rule helps the team stop and check before carrying on.^[4] After difficult events, short debriefs that focus on learning can steady the team and protect care.^[8]

Two useful tools

• A rota policy that sets out fair and clear rules for how shifts are shared out.
• A simple log for recording big changes to rotas or staffing, showing which options were considered and the reasons for the decision.^[4]

Helpful leader behaviours

• Take your own breaks, so others see it’s acceptable.
• Ask for help openly, showing it’s normal and safe to do so.
• Thank people when they raise concerns early.^[4]

Fairness, clarity and escalation

Rota decisions should take into account workload, mix of skills and a fairness check across requests for religious observance, caring duties or health needs.^[5][9] Any adjustments should be clear about their scope, length and review dates.^[9] Ongoing high pressure should be escalated with a business case that shows the link to patient safety.^[6]

Keeping track across sites

Organisations should watch for patterns in sickness, repeated incidents linked to tiredness, overtime hours and exit feedback.^[7] Small steps—such as extra admin time after system changes, scripts for tough conversations or quiet spaces for recovery—often bring quick benefits and reduce staff leaving.^[5]

• Two tracking prompts: add a wellbeing risk to the risk register with a named owner and review date; include fatigue in incident reports so patterns can be seen.^[1][7]

References (numbered in text) Why we include references

1. What are the Management Standards? - Health and Safety Executive Find (opens in a new tab)
2. Protecting lone workers: How to manage the risks of working alone - Health and Safety Executive Find (opens in a new tab)
3. Rest breaks at work - GOV.UK Find (opens in a new tab)
4. Looking after your team’s health and wellbeing guide - NHS England (2023) Find (opens in a new tab)
5. Good rostering guide - NHS Employers (2018) Find (opens in a new tab)
6. Hall LH, Johnson J, Watt I, Tsipa A, O’Connor DB. Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review - PLoS One (2016) Find (opens in a new tab)
7. The impact of staff fatigue on patient safety - Health Services Safety Investigations Body Find (opens in a new tab)
8. Evans TR, Burns C, Essex R, et al. A systematic scoping review on the evidence behind debriefing practices for the wellbeing/emotional outcomes of healthcare workers - Frontiers in Psychiatry (2023) Find (opens in a new tab)
9. Religion or belief discrimination: key points for the workplace - Acas (2018) Find (opens in a new tab)