Registered Nurses and Mandatory Overtime

Registered Nurses and Mandatory Overtime

The United States is experiencing a huge shortage in registered nurses who constitute the backbone of the health care sector. As a nation with an aging population and around 1/3rd of the registered nurses above fifty, there is currently a 15% unfilled vacancy for RN, which is slated to increase further to 20% by 2020. [Gorenberg]. Compounding the problem is the increasing trend of downsizing by which many hospitals have reduced their nursing staff. Under the present scenario of an aging population requiring increased hospitalization, a dearth of nursing staff only translates to more burden on the limited number of Nursing staff. In many hospitals, mandatory overtime is a common trend and nurses are literally forced to work more or lose their benefits or, even worse, risk being fired. Though several studies have indicated dangerous consequences of mandatory overtime, it is unfortunate that not much has been done to avoid this and Nurses continue to be exploited. Despite evidence from studies suggesting the dangers involved, only a few states have passed regulations against mandatory overtime for nurses while in most states the working hours of nurses is largely unregulated. A brief overview of the problem and some studies pertaining to it would provide us better insight.

Mandatory Overtime

With increasing number of patients requiring inpatient care, nationwide, hospitals are faced with a stiff resource crisis. Invariably, this shortage of nurses is met by implementing mandatory overtime regulations for the nursing staff. However, this has proved to be an unhealthy and dangerous practice affecting the quality of patient care as well as overburdening the nursing staff. Providing extended hours of service on a regular basis, nurses become tired and stressed out which not only increases the attrition rate but also affects the outcome of the patient. Foley of the ANA says, "By far the riskiest result of understaffing is the abuse of mandatory overtime as a staffing tool," [Robert Steinbrook]. Over extended, burnt out and even underpaid, nurses develop job dissatisfaction and as statistics indicate one out of five nurses are contemplating on quitting the profession altogether. Further the increasing patient / nurse ratio directly implies a serious compromise on personal care to patients. Let us now look into some recent research studies that also confirm the negative effects of mandatory overwork among nurses.

Quality of Patient Care

Evidence from research studies suggest that the quality of patient care is considerably compromised by continuous mandatory overtime duty allocation for nurses. "Physiological factors such as fatigue, system variables such as increased work intensity, or a combination of fatigue and increased work intensity may contribute to the errors and near errors we observed," [CAN]. A nationwide study conducted by the California Nurses Association has indicated that nursing errors can be avoided if the working hours are limited to a healthy maximum of 8 hours. As per the research nurses who work for more than 12.5 hours on a day are thrice as likely to commit errors compared to nurses who work less than 8.5 hours. The study also indicated an exponential increase in the probability of error when the working hours are extended to 16, 20 or more. Referring to the study Miss Rose Ann DeMoro, the director of the CNA said, "This study verifies what CNA and RNs have known for some time - forced overtime is very dangerous for patients, and also puts RNs at greater risk of injury or accident,." [CAN] There is a clear loss of concentration and alertness once the normal working hours (8 hours) are crossed and continuing to force the nursing staff to work overtime presents a clear risk of endangering the patient.

Another study by the University in Philadelphia analyzed the work schedule of 393 full time registered nurses. Participants of the study were asked to fill up a detailed questionnaire pertaining to their working hours, sleeping patterns, on all the days that they worked. The subjects were also asked to make a logbook entry of their nursing errors immediately after their work. Statistical analysis was performed on the data thus obtained and the relationship between working hours, overtime, errors, age and the size of the hospital were analyzed. In all, a total of 5317 shifts were studied of which 2,057 shifts were for more than 12.5 hours. Within the 28-day period of the study two thirds of the nurses reported to have worked overtime 10 times or even more. There were a total of 199 reported errors and 213 'near errors' during the study period and the majority of the errors (58%) involved wrongful administration of medications. It was shown that overtime working increased the probability of committing at least a single error (or = 2.06, p =.0005) while the risk of making errors were even greater for shifts that extended for 12 hours and above (p =.005). It was found that there were not considerable differences in the error rate in terms of the age of the nurse or the hospital size. Thus commission of errors increases proportionately with the increase of the work time. [Rogers et.al] This study clearly shows the connection between mandatory overtime and error commission.