NARD Recommends 48-Hour Work Week, Two Calls For Doctors

• NARD has proposed a nationwide 48-hour maximum work week for doctors and other healthcare personnel, saying the move is necessary to tackle burnout, fatigue and the growing threat to patient safety.

• The new framework limits doctors to two on-call duties weekly, prescribes mandatory post-call rest, regulates shift durations and requires compensation for all authorised overtime worked.

• The recommendations, developed after a nationwide assessment involving 6,350 healthcare workers, have been forwarded to hospital managements for implementation while awaiting approval by the National Council on Health.

• The association says it is also preparing a second policy to address the casualisation of doctors and what it described as exploitative locum appointments across health institutions.

August 18, () — The Nigerian Association of Resident Doctors (NARD) has recommended a comprehensive overhaul of doctors’ working conditions across the country, proposing a 48-hour maximum work week and limiting on-call duties to two per week in a bid to combat burnout, fatigue and the growing risks posed to patient care.

The association announced the new work-hour framework in a statement posted on its official X account on Monday, explaining that the recommendations followed extensive deliberations by the Federal Ministry of Health and Social Welfare’s Ministerial Committee on Work Hour Regulation and Casualisation of Doctors.

The committee carried out a nationwide situational assessment involving 6,350 healthcare personnel drawn from Nigeria’s six geopolitical zones.

According to NARD, the assessment exposed the urgent need to address excessive working hours, inadequate rest, burnout and fatigue among healthcare workers, warning that the current situation poses significant risks to both medical personnel and patients.

Under the proposed framework, healthcare workers would work no more than 48 hours each week, including weekends, while every authorised hour worked beyond the approved limit must be properly documented and compensated.

“Healthcare personnel shall work a maximum of 48 hours per week, including weekends. Any authorized excess hours shall be appropriately compensated,” the association stated.

The guidelines also prescribe a maximum of eight hours for regular day shifts and six hours for afternoon shifts. Extended shifts exceeding 12 hours would only be permitted during genuine emergencies where continuity of patient care is essential.

On call duties, NARD proposed that healthcare personnel should undertake no more than two calls per week, including weekend calls, while limiting weekend call duty to a maximum of one per month. It also recommended that call schedules be distributed fairly among eligible personnel.

The association further stipulated that no healthcare worker should remain on continuous duty for more than 24 hours, including call duty.

To improve staff welfare and reduce fatigue, the proposed regulations mandate a minimum of 12 hours’ rest between regular shifts and compulsory 24-hour post-call rest following weekday, Saturday, Sunday and public holiday calls.

Healthcare personnel would also be entitled to at least one uninterrupted hour of rest after every six hours of continuous work, with hospital managements expected to stagger such breaks to ensure uninterrupted patient care.

NARD stressed that institutions must not exploit overtime provisions, insisting that every authorised excess work hour should either attract enhanced remuneration above the normal hourly rate or be compensated through structured time off.

Beyond working hours, the association recommended protected time for research, academic activities and professional development, subject to approval by the relevant National or Institutional Health Research and Ethics Committees.

It, however, clarified that the recommendations would not prevent hospitals from making exceptional arrangements during genuine emergencies where patient safety requires temporary deviations from the prescribed limits.

NARD disclosed that the work-hour guidelines have already been forwarded to Medical Directors and Chief Medical Directors of health institutions nationwide, urging hospital managements and Heads of Departments to commence steps towards full implementation.

The association also directed its state branches and hospital chapters to engage managements, monitor compliance and document violations for appropriate intervention.

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It revealed that a second policy document addressing the casualisation of doctors and what it described as abusive locum appointments would soon be released as part of ongoing reforms to improve the welfare of healthcare professionals.

NARD expressed appreciation to the Coordinating Minister of Health and Social Welfare, Prof. Muhammad Ali Pate, and the Minister of State for Health and Social Welfare, Dr Iziaq Adekunle Salako, for supporting the committee’s work, expressing confidence that the National Council on Health would formally adopt the recommendations.

For years, resident doctors have complained about excessively long shifts, chronic manpower shortages, poor welfare, and inadequate compensation in Nigeria’s public health sector.

The conditions have been blamed for widespread burnout, declining morale and the increasing migration of Nigerian doctors abroad in search of better working conditions. NARD has consistently argued that regulating working hours is essential not only for protecting healthcare workers but also for improving patient safety, reducing medical errors and strengthening the country’s fragile healthcare system.