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How Mandatory Overtime Impacts Nurse And CNA Performance

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nurse in pain 01.jpgShould there be overtime limits for nurses and other health care workers?

Mandatory overtime may expose health care workers and patients to a variety of dangers created by physical and mental fatigue, but it remains an aspect of the job for approximately 67 percent of nurses. Hospitals and clinics often scramble to meet staffing requirements, relying on nurses (RNs) and nursing assistants (CNAs) to keep them compliant via overtime.

The prevalence of mandatory overtime has prompted organizations like the American Nurses Association (ANA) and American Association of Critical-Care Nurses (AACN) to advocate on behalf of nurses. Hospital workers suffer overexertion injuries at twice the average for U.S. workers, and excessive work hours are partially responsible. Patients are at risk, too, as a study published in Health Affairs found that a nurse's error rate goes up threefold after he or she works a shift lasting longer than 12.5 hours.

The problem is serious enough that at least 16 states have enacted statutes or regulations restricting the use of mandatory overtime for nurses. Read on to learn more about the issue.

What Dangers Are Created By Mandatory Overtime In The Health Care Setting?

The following table lists some of the ways that mandatory overtime can negatively impact nurses and patients:

Ways Nurses May Be Impacted By Mandatory Overtime

  • Overexertion injuries
  • Physical and mental fatigue
  • Increased job stress
  • Increased risk of mistakes that may lead to discipline or license revocation
  • Job burnout and dissatisfaction

Ways Patients May Be Impacted By Mandatory Overtime for Workers

  • Increased risk of medication errors causing injury or death
  • Decreased quality of care and patient satisfaction
  • Decreased efficiency in care (longer hospitalizations and wait time)
  • Increased hospital/clinic worker turnover may impact patient experience

With the dangers well-documented, why does management choose to address staffing shortages with mandatory overtime (OT)?

Each situation is unique, but forcing OT on experienced and trusted nurses can be more cost-effective than hiring and training new nurses. Further, nursing shortages and unpredictable staffing needs sometimes leave health care employers with few options.

Although there are notable staffing challenges, many argue that consistent use of mandatory overtime should be considered more of a short-term approach to staffing problems.

Do you believe that mandatory overtime should be restricted?

If so, what types of limits should there be?

Pennsylvania's Prohibition of Excessive Overtime in Health Care Act allows the employee and employer to agree to a predetermined number of hours that generally may not be exceeded unless there is an emergency or catastrophic event. New York has a similar law.

Minnesota legislation lists 12 consecutive hours or less as a "normal work period" for nurses that may not be exceeded absent emergency. West Virginia prevents nurses from working more than 16 hours in a 24-hour period. It also requires eight consecutive hours off after a shift of 12 hours or more before the nurse can lawfully return to work.

Which state's approach, if any, do you prefer? Where should the line be drawn?


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