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Dr. Adriano Friganovic
Dr. Adriano Friganovic

In light of the Patient Safety Conference taking place in Stockholm in October, Dr. Adriano Friganovic, President of the European Specialist Nurses Organisation (ESNO) and member of the board of directors of the European Patient Safety Foundation (EUPSF), takes a fresh look at the fatigue of the medical staff across Europe and highlights an alternative approach to tackle the crisis.

What if the fatigue – real and widespread – of the medical staff across Europe was only a symptom of a deeper malaise, the extent of which our societies have difficulty in grasping?

What if our belief that the dedication and commitment of medical staff would allow them to get through all pandemics, all hospital shortages, and then get back up again stronger than ever, was in fact pure wishful thinking? What if simple solutions, mainly based on basic recognition and financial incentives, were still needed but no longer enough? What if our healthcare systems were really in danger?

Organisations such as ESNO and EUPSF are determined to address these questions with all the necessary lucidity at the upcoming Patient Safety Conference and to outline courses of action to bring about real change.

What is hiding beyond the real and widespread fatigue of medical staff? What is the problem?

It is not easy to put words to this, and the best thing would probably be to ask them, but I think there is a strong feeling of being misunderstood and of not being supported in professions that are very challenging. I am obviously talking about nurses, whether specialists or not, but also about all the other professions directly involved in medical work, from doctors to nurses’ aides. These are very committed people, concerned to the highest degree with the well-being of others, and confronted with difficulties that we do not even suspect, or that we do not want to see. As potential patients, we are perhaps too easily led to believe that there will always be a dedicated professional who will take care of us with motivation and professionalism. We take it for granted, and this is probably the hardest thing for the medical staff to accept.

Why do you think it is important to look beyond fatigue and draw attention to this malaise?

I am not saying that the fatigue of the medical staff is not a problem in itself. Not a week goes by without a new regional or national survey confirming the very high level of fatigue, or even exhaustion, among health professionals, which can be traced back to the COVID-19 pandemic, pre-existing shortages, or particularly challenging working conditions. This is a real problem, especially as the current inflation and the pressure on the financial balance of health systems do not offer any prospect of improvement. What is important to understand is that if we stop at this reading of things, at a form of temporary and circumstantial tiredness, we are not posing the problem properly and the solutions developed will necessarily be insufficient.

Measures intended to boost the medical worker by recognising the right to fatigue and perhaps granting some financial incentives would already be a good start. But it will not be enough. The problem is far deeper, more structural, and we must go further. We must dare to reexamine the societal and cultural representations of the reality of medical staff, which have gradually led to policies of under-investment in his or her well-being, or even in his or her safety.

What do you mean by policies of under-investment in the well-being and safety of the healthcare worker?

Do you know many professions in which you have to deal with sometimes grueling working conditions such as long or night shifts, undersized teams, an unsustainable staff/patient ratio, sometimes really abusive patients, a very rigid and legally framed division of roles, the responsibility for your actions that can be engaged at any moment because you have the well-being and sometimes the lives of people in your hands, a work culture that often does not allow you to share the burden of your fatigue or of the mistakes that you may have made? And yet, it is in this environment that we mistakenly think that medical staff will continue to find meaning in their work every day. As if the satisfaction of helping others was a reward that would get them through it all. As if their sense of dedication would immune them from any harm. How can we honestly imagine that physical and psychological insecurity, exhaustion, and even deep weariness will not follow? If need be, one only has to look at the statistics on the number of voluntary departures in hospitals to be convinced.

What do you propose as courses of action to deal with the problem in depth and to curb this weariness that you describe?

At ESNO, we have launched an online campaign ‘Don’t let them go’ focusing on specialist nurses, pointing out different elements on which a real societal evolution is needed: rethinking working conditions, respecting the right to rest or establishing a real work-life balance. But we need to go further and reach out to other medical professions throughout Europe. To do this, we need a coordinated approach, at national and European levels, which takes a comprehensive look at the conditions under which medical professionals can fulfil their potential and the support they need to invest in their careers. It takes scientific organisations and patient representatives working together to advocate for concrete changes in legislation or in hospital management policies. This is the dynamic that EUPSF would like to initiate at the Patient Safety Conference hosted by FOKUS Patient, by opening a dialogue with other potentially interested or supporting organisations.

What is actually the link between the well-being of the healthcare staff and patient safety?

Only cared-for healthcare professionals can effectively ensure safety and well-being of the patient. Results of my study**1,2,3 about burnout in critical care nurses, published in several journals, showed higher results of emotional exhaustion (22.1%) as well as lower results of personal accomplishments (34.5%). And another study recently published in the British Medical Journal has just confirmed the obvious link with patient safety, finding that NHS doctors suffering from burnout are far more likely to be involved in incidents where patients’ safety is compromised. To care for the patient, let’s start by caring for the medical staff.


  1. Friganović A, Selič P. Where to Look for a Remedy? Burnout Syndrome and its Associations with Coping and Job Satisfaction in Critical Care Nurses-A Cross-Sectional Study. Int J Environ Res Public Health. 2021 Apr 20;18(8):4390. doi: 10.3390/ijerph18084390. PMID: 33924271; PMCID: PMC8074906.
  2. Friganović A, Selič P. Levels of Burnout Syndrome in Croatian Critical Care Nurses: A Cross-Sectional Study. Psychiatr Danub. 2020 Nov;32(Suppl 4):478-483. PMID: 33212452.
  3. Friganović A, Kurtović B, Selič P. A Cross-sectional Multicentre Qualitative Study Exploring Attitudes and Burnout Knowledge in Intensive Care Nurses with Burnout. Zdr Varst. 2020 Dec 31;60(1):46-54. doi: 10.2478/sjph-2021-0008. PMID: 33488822; PMCID: PMC7780766.