Mandatory Overtime Essay

Though nurses complain about having to work mandatory overtime, unfortunately, it is not a new problem to nursing. Mandatory overtime occurs when a nurse is demanded to work past scheduled hours. Mandatory overtime may happen because of a natural disaster, staffing turnover, or employee absences due to sickness. Some health care managers propose that mandatory overtime has caused

ANA rejects the adoption of overtime as a staffing solution and joints the Congress to establish national legislation to approach concerns about safe staffing and prohibition of mandatory overtime. ANA concludes that overtime is not a reasonable answer and has driven to various matters such as reduce patient satisfaction, an increase in adverse patient events, preventable medication, and medical errors and increased patient mortality. Besides, mandatory overtime reflects on job satisfaction, on nurse recruitment and retention, nurse fatigue and deficits in nurse’s work

For over a decade researchers have been performing studies examining the effects patient-to-nurse ratios have on adverse outcomes, mortality rates, and failure-to-rescue rates of patients and on job dissatisfaction and burnout experiences of nurses. Aiken, Sloane, Sochalski, and Silber (2002) performed a study which showed that each additional patient per nurse increased patient mortality within 30 days of admission by 7% and increased failure-to-rescue by 7% as well. This same study also showed that each additional patient per nurse resulted in a 23% increase in nurse burnout and a 15% increase in job dissatisfaction. Additionally, Rafferty et al. (2007) performed a study in which the results showed that patients in hospitals with higher patient-to-nurse ratios had a 26% higher mortality rate and nurses were twice as likely to have job dissatisfaction and experience burnout. Blegen, Goode, Spetz, Vaughn, and Park (2011) performed a study where results showed that more staffing hours for nurses resulted in lower rates of congestive heart failure morality, infection, and prolonged hospital stays. The same study also showed that increased nursing care from registered nurses resulted in lower infection and failure to rescue rates and fewer cases of sepsis.

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

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

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)

Nurse staffing have an effect on a variety of areas within nursing. Quality of care is usually affected. Hospitals with low staffing tend to have higher incidence of poor patient outcomes. Martin, (2015) wrote an article on how insufficient nursing staff increases workload and job dissatisfaction, which in effect decreases total patient care over all. When nurse staffing is inadequate, the ability to practice ethically becomes questionable. Time worked, overtime, and total hours per week have significant effect on errors. When nurses works long hours, the more likely errors will be made. He also argued that inadequate staffing not only affects their patients but also their loved ones, future and current nursing staff, and the hospitals in which they are employed. An unrealistic workload may result in chronic fatigue, poor sleep patterns, and absenteeism thus affecting the patients they take care of.

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.

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.

Hospitals nationwide are experiencing nurse shortage and increased workloads because of shorter hospital stays, fewer support resources and higher acuity in patients (Vahey, D. C., Aiken, L. H., Sloane, D. M., Clarke, S. P., & Vargas, D., 2004). Higher nurse workloads are directly associated with job burnout and job dissatisfaction which in turn causes more voluntary nurse turnover and relates to the increased nursing shortage. According to the Missouri Hospital Association the turnover rate of nurses has increased by fourteen percent in the last five years (Browning M., 2012). Nursing shortage is a real threat to the patient population. According to the Quality Health Outcomes Model by the American Academy of Nursing by Donabedian, effects of the healthcare interventions are characterized by the environment the staff works in (Vahey et al., 2004). Donabedian describes that quality metrics can be divided into three broad categories, structural, process, and clinical.

173). For many workers the schedule was an outlet for discontent; this is because many were forced to work six days a week, some weeks without a day off (Lynaugh, 2000). Nowadays, “60% of U.S. nurses surveyed work at least one type of overtime […] 54% work less than 12 hours a week overtime and 46% work 12 hours or more per week” (Wheatley, 2017, p.213). In addition, traditionally nurse’s shifts were eight hours long; however, in 1980’s -1990’s when structural changes in healthcare occurred and cost containment was put in, nurses started working 12-hour shifts. Because it was less expensive to work 12-hours shifts, instead of 8-hours, this became prevalent in most hospitals in the United States (Weathley, 2017).

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)

The reality is that human’s make mistakes. Caregiver’s fatigue and stress plays a huge role in medication error. It is reported that fatigue and stress increased the risk of medication error. In a study comparing nurses who worked a 12 hour shift in different age groups, older nurse’s experienced sleeping trouble and were not able to focus on maintaining their performances during their shift (the average age of US registered nurses is 46.8). Fatigue is related to misreading labels, because somehow one is not fully conscious, a nurse who worked a 16 hour shift went into the medication