Fatigue as a sociocultural problem in paramedicine: A qualitative study of attitudes and behaviours related to fatigue in Australian paramedics

• Fatigue-related attitudes and behaviours among paramedics were explored to understand experiences. • Role duty and stigma promoted normalisation of fatigue, fostering covert fatigue management. • Formal fatigue reporting was uncommon, possibly concealing the true scale of risk. • System-level constraints reinforced norms of continuing work to uphold service delivery. • Supportive culture and co-designed strategies may support effective fatigue management. Fatigue in Australian paramedics is prevalent, with negative implications for the safety and well-being of patients and workers, occupational performance, and organisational service delivery. To best inform supportive strategies, this study sought to understand attitudes and behaviours connected to fatigue and fatiguing experiences in the current healthcare context. We used a qualitative methodology involving semi-structured interviews and a scenario invention task with Australian paramedics ( n = 30). Data were analysed inductively using reflexive thematic analysis through a constructionist lens. Seven themes of the paramedic experience of fatigue were constructed under two overarching themes: Working in the trenches and Don’t drop the F-bomb . Themes centred around attitudes and behaviours, exploring an experience of fatigue that is shaped by personal identity, organisational culture and broader systemic constraints. Attitudes and stigma related to resilience, camaraderie, and role duty influence paramedic behaviours related to acting on fatigue and/or engage with organisational fatigue management processes, promoting a normalisation of fatigue and use of covert rest strategies potentially obscuring the true scale of fatigue-related safety risks. This study highlighted paramedic fatigue as a sociocultural problem in Australian paramedic work contexts. Complex relationships between paramedics and their identities, role duties, and organisations influence how they appraise and respond to fatigue, with consequences for fatigue risk management and safe practices. Alongside addressing social and cultural norms, co-designed fatigue management approaches and improved managerial support may be important for positive worker engagement with individual and organisational management strategies to enhance safe outcomes.