Working Overtime And Its Effects On The Healthcare Facility

In the past two decades, a lot of changes have been characterised in the healthcare working systems. One of these changes has been the assimilation of shift work systems and the flexibility in work schedules. The need for 24 hour care makes the healthcare professions to work with different shift systems such as 12 h, 8 h, 9 h or 10 hour shifts. However, the common shift work systems divide a 24-h day in two (12-h) or three (8-h) shifts. Nonetheless, this requires the staff to be adapted with the various forms of shift work schedules.

With the concern of work-related injuries associated with mandatory overtime, many research studies have been piloted to examine the impact of overtime on nursing. A particular study conducted with 655 registered nurses in the Philippines reveals significant results in regards to the effects of nurses working mandated overtime. Results show 65% of nurses involved in the study report working over 40 hours per week. Also, 83% report working mandatory or unexpected overtime at least once a month and 15% state working overtime more than seven times each month. Furthermore, 37% of the nurses have suffered an occupational injury and 41% acquired an occupational related illness within a year span (de Castro, Fujishiro, Rue, Taglog, Samaco-Paquiz, & Glee, 2010). Mandatory overtime increases staffing absences.

West, Ahern, Byrnes and Kwanten (2007) indicate that the new graduate nurses may have not worked full-time in the past; given that graduate nurses begin their career with a full-time job can lead to exhaustion. It was discovered that shift work leads to desynchronisation of physiologically determined circadian rhythms which has a major psychobiology effect and it is commonly perceived the effects of shift work contribute to graduate nurses attrition rate. The NGNs often have a high level of stress due to disturbed sleeping patterns, as they find to adaption to shift work or rotating work hours difficult. Eventually, it leads to feelings of lack of job satisfaction, exhaustion and spending of less time with their friends and family, which can eventually could lead to burnout (West et al., 2007).

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

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.

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.

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)