Occupational Fatigue, Sleep Quality, and Patient Safety Events Among Resident Doctors in Nigeria: A Multi-Center Study

Resident doctors represent a workforce group uniquely exposed to severe occupational fatigue through prolonged shift hours, on-call responsibilities, and high cognitive demand, raising concerns about patient safety implications in Nigerian tertiary hospitals. This multi-center analytical study examined the relationships between occupational fatigue, sleep quality, and self-reported patient safety events among resident doctors in teaching hospitals in South West, North Central, and South South Nigeria. Four hundred and fifty residents from six teaching hospitals completed the Occupational Fatigue Exhaustion Recovery scale, the Pittsburgh Sleep Quality Index, and a validated clinical incident reporting questionnaire. Severe occupational fatigue was present in 67.3 percent of respondents, with poor sleep quality in 73.8 percent. Patient safety events, including medication errors, near-misses, and communication failures, were self-reported at a rate of 3.2 incidents per resident per month. Logistic regression confirmed that severe fatigue (OR: 5.43), poor sleep quality (OR: 4.17), and working more than 80 hours per week (OR: 6.89) were independent predictors of patient safety event occurrence. Gender analysis indicated female residents had higher fatigue scores but equivalent safety event rates. This study provides compelling multi-center evidence linking resident doctor occupational fatigue to patient harm risk and recommends mandatory duty hour limits, structured handover protocols, fatigue monitoring programs, and nap facility provision in Nigerian teaching hospitals. Keywords: occupational fatigue, sleep quality, patient safety, resident doctors, Nigeria.