From isolated countermeasures to organizational practice: A systematic review of workplace fatigue-management strategies in healthcare

Occupational fatigue poses persistent workforce and safety risks in healthcare. Other safety–critical sectors manage fatigue through structured fatigue risk management systems (FRMS), but whether healthcare’s evidence supports similar system-level claims is unclear. This systematic review synthesized evidence on the effects, implementation, and certainty of workplace fatigue-management strategies in healthcare. PubMed, CINAHL, the Cochrane Library, and Scopus were searched through 1 June 2026. Studies were appraised with Joanna Briggs Institute tools, synthesized narratively per Synthesis Without Meta-analysis guidance, and assessed for implementation and certainty using Proctor’s framework and GRADE. Thirty-four publications representing 32 studies were included across four strategy groups: work-schedule and duty-hour controls; multicomponent programs and education/coaching; nap and restorative-break practices; and digital monitoring and real-time countermeasures. No included study evaluated a complete, formally governed fatigue risk management system; the evidence concerned isolated or bundled workplace strategies. Naps and restorative breaks showed the most recurrent short-term signals for reduced fatigue/sleepiness and improved vigilance or cognitive performance, though findings were inconsistent; evidence for other strategies was weaker, and patient-safety, organizational, and economic outcomes were rarely evaluated. Implementation evidence concentrated on acceptability and fidelity; organizational governance, structured risk assessment, reach, cost, and sustainability were unexamined, and certainty was predominantly low or very low, with one moderate-certainty exception for increased sleep duration under reduced-duty schedules. Healthcare has thus tested individual countermeasures rather than embedded fatigue risk management within organizational practice; advancing the field requires linking local hazards to supported controls, with particular attention to the governance and risk-assessment structures that remain least developed.