Position Paper Example on Nursing Mandatory Overtime
Nurses are among the highest in demand professions and if this demand is not met the current work force of nurses will be needed and expected to pick up the slack. Nurses are already working long hours with minimal down time between shifts but with mandatory overtime hitting nursing staffs the down time is becoming increasingly less. High paying incentives are being offered to nurses willing to work beyond their full-time hours but what is lacking in consideration is the long term mental and physical effects that mandatory overtime can have on today’s nurses. With staffing shortages across the country mandatory overtime seems to be the hospital norm for addressing these shortages. There are many things that need to be considered here; first being employee burnout, with more than half of the registered nurses across the US working over 39 hours career burnout is almost inevitable. Second, how does working these increased hours with less time off impact patient care. These two critical factors could be a huge detriment to the nursing community if the staffing shortages are not addressed.
In an article by Melissa Brodeur and Alisha Laraway, it was discussed that state initiatives and bills as well as federal regulations are being passed with hope to alleviate the stress of mandatory overtime due to nursing staff shortages. One of the first states to take action was California. In 1999 the governor signed off on the Safe Staffing Law, which required a state minimum nurse-to-patient ratios within acute care setting. Unfortunately, many of the hospital administration was opposed due to California’s high vacancy and low return rate of hospital nurses. The argument from the American Hospitals of America was that this was a one size fits all approach and due to specialties are this was not feasible for many hospitals to upload ((Brodeur & Laraway, 2002).
Many believe that mandatory overtime due to staffing issues leads to nurse fatigue on shift and ultimately poor care of patients. Although there is little evidence to support this outside of nurse anecdotes, research is being conducted to compare nursing fatigue due to overtime shifts with patient care and outcome. The positive is that state governments are now passing bills that allow nurses to either accept or refuse overtime without the fear of discharge. Although some states believed the guidelines were too strict in case of emergencies, states like New Jersey called out extreme circumstances where immediate action is needed would be an exception to the refusal of mandatory overtime (Brodeur & Laraway, 2002).
Between October of 2010 and January of 2011, a survey was conducted of just under 200 nurses from North Carolina and West Virginia. This survey measured, self-reported nurse injuries, adverse patient events, presence of mandatory overtime, nurse overtime, total hours of work and work settings. In this survey it was found that more than half of the nurses worked some type of overtime. Although the findings from this survey did not indicate any correlation between nurse injuries there was statistically significant correlation between patient adverse events and overtime. There was not enough evidence to link regulations to these adverse events. Unfortunately, there was not strong enough evidence to link regulations with patient outcomes and nursing quality of life. However, this study did open the door of exploration oh what different state regulations look like and what work conditions are like in the overtime setting. The positive reflection from this was the caution raised around the impact that poor nursing conditions and working overtime can negatively impact patient care and lead to higher adverse events (Bae, 2013).
The American Nurses Association alongside nurse leaders are collaborating to find a solution to mandatory overtime. An eye catching comment that was made is that many nurses feel obligated to stay and work an overtime shift or their patient will lack care. Nursing a field where a larger majority love what they do and find passion in caring for patient. This does not bode well for the larger issues of short staffing. With the true desire to care for patients, many nurses take over time shifts to help provide better patient care (Trossman).
In other research found by author Susan Trossman, RN she discovered that nurses were three times more likely to make a mistake than if their shift lasted more than 12.5 hours. It was also noted that not only are nurses working beyond the 40-hour work week their works days are not filled with adequate time for meals during the course of their shifts and time to rest between shifts. Knowing in their own that nurses are working through fatigue and overwork and that mistake can and may be a higher probability this really raises the red flag of ethics. In this case ethics is a double-edged sword. On one side you have the nurse’s ethical responsibility to care for a patient but on the other end you have the nurses ethical responsibility to provide the highest standard of care which cannot be done in a greatly fatigued state (Trossman).
As research is evolving and there are people are taking a closer look at the work life balance of nurses across American it was noticed the lack of down time between shifts. With mental health being at the for front of today’s culture appropriate work life balance is crucial to good mental health not only in nurses but all health care workers. This is likely one of the leading causes of lacking in retention of nursing staff. Burnout is more likely when work life balance is not in place (Bae & Yoon, 2014).
A study using NSSRN data, focusing on mandatory overtime and patient outcomes, was put through statistical analysis to take a closer look at work hour policies. This study found that banning nurse mandatory overtime did in fact decrease overtime and a consecutive work hour policy lead to more nurses working only 40 hours per week. Although this data was interpreted with some caution due to variables out of experimental control. On the positive side this study did find that many states are continuing efforts to promote better working conditions for nurses (Bae & Yoon, 2014).
Over the years it seems legislation is being passed with hopes to alleviate the staffing shortage and cutdown on overtime and long hours for nurses, unfortunately with the continued staffing shortage a cyclic pattern is seen. A staffing shortage leads to over worked nursed, over worked nurses become burnt-out, burnt-out nurses quick and staffing shortages are being filled and the cycle starts over. The common concern here is patient care. Nursing is a tremendously empathetic and passionate career path and the constant care for other and lack of care for their own is something that needs to be mitigated. Whether that be with additional personal support or shorter work hours for more downtime between shifts or potentially more paid vacation for nurses, but something needs to change.
Conclusively, it is a clear problem that mandatory overtime, unless emergent need, will not solve the staffing shortage of nurses. As a health care community, there needs to be collaboration and cohesiveness to work together and share the care. A little bit can go a long way and small changes that stick are better than radical changes that fall apart. Clearly, more research needs to, and is being done but this fight is far from over.
