Causes And Consequences Of Mandatory Overtime

Various factors have negatively influenced the nursing field. Those factors involve, but not limited to staff shortage, staffing ratios, mandatory overtime, violence issues, etc. In 2011, 16 states established limitations on the practice of mandatory overtime operated by nurses (ANA, 2011). Forced overtime laws monitor either nurse mandatory overtime or cumulative work hours. As prevention for nurses working mandatory overtime, state law permits employees to decline the offer of overtime by healthcare organizations, except during a medical emergency, which requires increased need for medical personnel unexpectedly. The overall goal of achieving mandatory overtime regulations is to produce supported practicing circumstances for nurses, as well as improve the quality of care for the patients.

Reasons for mandatory overtime varies from natural disaster to lack of staff. Many companies, organizations, and hospitals require mandatory overtime because of staffing issues. “Increasingly, however, nurses are reporting that mandatory overtime has become standard operating procedure instead of a last resort to short staffing. In fact, in some hospitals, mandatory overtime is routinely used in an effort to keep fewer people on the payroll, as well as to alleviate immediate shortage needs.” (Huston,

Whether or not mandatory overtime is required varies from facility to facility. Like many other issues, there are both pros and cons to this topic. Witkoski,S, Sloane, D, and Aiken L (2012) did a study and concluded that nurses who worked 10 or more hours a shift were more likely to experience burnout and were dissatisfied with their jobs with an intent on quitting. Burnout can affect the quality of care a nurse provides to patients. Burnout can be the cause of a nurse not noticing subtle changes of patients which could potentially lead to patient neglect. Although there are cons to working long shifts there are some pros. When nurses work 12hour shifts, they often meet or exceed their weekly hours over the course of a 3day work week. Since they would only be working a three-day work week, it provides nurses with a better work-life balance and flexibility (Witkoski,S, Sloane, D, and Aiken L 2012), giving nurses more time outside of their job to do whatever they would like. Getting this kind of flexibility is great for nurses like myself who are either back in school or have families to take care of, or just need a little more time to recover and

McIntyre’s framework is a method of conducting in depth analysis that emphasizes understanding issues in healthcare as complicated and multifactorial problems, while exploring barriers to resolving the issue (McIntyre & McDonald, 2014, p. 5). Using this framework, this paper will provide an in depth analysis of the issue of mandatory overtime for nurses, and why it should not be eliminated from use by hospital management.

I am very fortunate to be serving as a Registered Nurse (RN) in our community for the past 17 years. For years, my RN colleagues here in Michigan have expressed frustration and concern when working chronically understaffed shifts and the when using mandated overtime to cover staffing shortages. Safe staffing levels

After all, hospitals and nursing facilities are required to have nurses around the clock, right? I totally understand this point of view. However, instead of mandating nurses to work overtime, have a back up agency to use to call on for help when shifts need covered. Some may argue that mandatory overtime is great because of the extra money being earned and incentives offered. Once a nurse is "burnt out", money doesn't mean much to him or her. They would rather go home to their families, sit down for dinner and have a goodnights sleep over any amount of money. Hospitals and nursing facilities argue that it cuts cost to mandate over time rather than hiring new employees. I agree with this statement to some extent. As long as mandatory overtime isn't being used often, it may cut some costs. Hospitals and nursing facilities have made this, over time, a standard of practice, so in the long run mandatory overtime is not saving any money. In reality, it is costing more. Nurses being paid time and a half for overtime, the increase in accidents from nursing errors, increase in sick days and more nurses quit so there is a need to hire new nurses. Whenever a new nurse is hired at a facility, that nurse needs to be trained. Each facility has their own protocol and the new nurse needs to be educated on that protocol, as well as simple things such as where supplies are kept, where

As a result, overtime can compromise patients ' health or safety. Medical residents cited fatigue as a cause for their serious mistakes in four out of 10 cases (Boodman 2001), and two studies linked infection outbreaks at hospitals to overtime work (Arnow et al. 1982; and Russell et al. 1983). Indeed, the California Nurses Association reports that more nurses are refusing to work in hospitals with unsafe conditions, in which they include being forced to work unplanned overtime. The American Nurses Association (ANA), in a national survey of 7,300 of its members, found, disturbingly, that 56% of nurses believe that the time they have available for care for each patient has decreased, and 75% feel that the quality of patient care at their own facility has decreased in the last two years. The cited inadequate staffing as the chief reason.

The goal of the LeadingAge Texas is to implement higher direct staffing hours for each resident allowing for positive outcomes, which is what the government was trying to accomplish through Texas Quality Incentive Payment Program (QIPP). QIPP implemented the goals of decreased pressure ulcers, decreased usage of antipsychotics, decrease in falls, and physical restraints (Texas Quality Incentive Payment Program, 2016). While these incentives assist in improving quality care, quality care starts at adequate quality staffing. Staffing is the key to quality care and is what consumers advocate; however, the nursing industry would rather implement incentive programs (Harrington et al., 2016). As shown by the failure of QIPP and NHQRE, quality staffing is needed to improve the quality of care.

For some nurses, mandatory overtime can be an advantage due to financial instability but mostly mandatory overtime can cause fatigue, burnout, injuries, errors, inadequate sleep and deficits in performance. According to research working long hours which consists more than 40 hours a week or over 12 hours a day leads to an increased medication errors and patient mortality. The probability of making medication errors increases tremendously when nurses work longer than 12.5 hours a day. During surveys regarding reasons of overtime, 60 % of nurses stated that overtime was obligatory as part of their job, 29 % of nurses stated that they volunteered and 41% of nurses stated that they were “on call hours” (Bae, 2012)

Mandatory overtime in the field of nursing is described as forced overtime to maintain an adequate amount of staff present to meet the needs of the hospital. With a normal work schedule, a nurse usually works 12-hour shifts, usually three times a week. With the obligatory hours that are extended with overtime due to the continuation of nursing shortages, a nurse’s shift can be continued ranging from 12 to 16 hours, with very short notice. This mandatory action is related to putting not only nurses, but also patient’s health at risk. The advantages that accompany mandatory overtime are overshadowed by the disadvantages that surpass the benefits of working extended hours, therefore, mandatory overtime should not be allowed in the nursing work place.

Mandatory overtime has become an increasing problem for nurses who work in many hospital settings. Mandatory overtime is defined as additional hours added to a nurse’s current shift, making the nurse feel as if it’s a threat of being fired or disciplinary action will be taken in some form if they refuse to stay and work. Extensive overtime studies have established and confirmed that there are serious dangers to both the nurse and the patient being cared for in all types of healthcare settings.

Patients in a hospital and/or healthcare facilities have to be cared for all day and all night, everyday of the week by nurses. The usual way to fulfill this need is to divide up the day into three 8-hour shifts. Different shifts have been put into place to help improve nurse satisfaction, decrease the nursing shortage and save the hospital money. The 24-hour day is made up of two 12-hour shifts; 12 hours in the day and 12 hours at night. There has been quite an ongoing debate over the years regarding this issue of nurses working over 8 hours in a single day. Many people, such as hospital nursing administrators, have reason to believe that working long hour shifts causes more errors in

Limited attention has been paid to the hours worked by nurses, or the effects of these hours on patient safety (Rogers, 2008). Even though most nurses favor 12- hour shifts and overtime, it is associated with difficulties staying awake during times of duty, reduced sleep times, and triple the risk of making an error (Rogers, 2008). The most significant risk of making an error occurred when nurses were scheduled to work 12.5 hours or more.

The risks of making an error were significantly increased when work shifts were longer than twelve hours, when nurses worked overtime, or when they worked more than forty hours per week. (Trossman, 2009). Working longer hours in a high stress area will always increase the error rate. Designating an adequate number of RN positions to ensure nurses work an appropriate schedule without overtime and that their workload allows for breaks. Managerial staff must work to develop specific policies about the length of work times based on the setting, patient and provider needs. Those policies should limit nurses from working more than 12.5 consecutive hours. Provide education for all care providers on the hazards and causes of fatigue. Continue to document unsafe staffing conditions and work with others to change the current work culture so that it recognizes the effects of fatigue on patient safety, as well as the nurse. (Berger, et al. 2006)

Neighborhood’s hospital is filled with patients who are ill with exacerbations of asthma and emphysema related to the poor air quality and smoke. The hospital’s emergency department calls for in-patient beds but there are no beds available. There are more patients needing beds than there are beds available. The emergency room nurses keep calling the floors to request beds, and none are available. The staff morale is low because they all feel the stress related to the pressure of early discharge for patients to make beds available. The nurses are kept busy with discharges and admissions, and are feeling overwhelmed and under-staffed. Hospital administration has decided to implement mandatory overtime adding to the stress of the staff.