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Mandatory Overtime: Patient Safety on the Line?

Ashley Kane

Youngstown State University

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Abstract

There has been a recent increase in the number of nurses who have been subjected to

mandatory overtime. Many health care facilities mandate overtime as a solution to being

under-staffed. Although it seems necessary, there is a potential compromise in giving safe

and effective patient care. This both negatively affects the patient and the nurse; whereas,

the patient is not receiving optimum care that they need and the nurse is susceptible to

decreased work performance, fatigue, chronic illness, and more. This also leads to job

dissatisfaction, and difficulty in nurse recruitment and retention. As of June 2015, there

are 14 states with restrictions in law and 2 states with provisions regarding nursing and

overtime.

Keywords: Mandatory overtime, understaffing, Negative effects

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Mandatory Overtime: Patient Safety on the Line?

To cope with a current nursing issue, many clinics and health care facilities use

mandatory overtime. As defined by AMSN, mandatory overtime or forced overtime is

when employers require an employee to work more than 40 hours per week, even if the

employee does not want to work the additional hours (Kohn, 2012). As nurses don’t

typically work the 9-5 shifts, they are working eight, twelve, even sixteen hours and can

be mandated on top of their already scheduled shift. Working twenty-four hour shifts are

becoming more common specifically in specialized units and emergency rooms (Rogers,

A., Scott, L., Aiken, L., & Dinges, D., 2004).

When nurses are working extensive hours they can suffer from multiple things

including: exhaustion, fatigue, decreased job satisfaction, increased amount of errors,

decreased patient comfort, decrease in nurse recruitment and retention, increased hospital

length of stay and increased legal liability issues (Mandatory Overtime, 2013). One study

found that more than half of hospital staff nurses work more than 12 hours per day and

17% work mandatory overtime (Faller, 2008). Marcia Faller, MSN, RN likes to call

mandatory overtime “The Vicious Cycle” and this is why; Excessive work hours reduce

staff morale, which in turn contributes to job burnout. Job burnout reduces staff retention

and creates more nursing vacancies, forcing the remaining nurses to work more overtime.

Thus, mandatory overtime increases nurse dissatisfaction and burnout, ultimately

worsening the staffing shortage (Faller, 2008).

With working excessive hours, fatigue is a major issue. There are many risks that

go unnoticed when telling a nurse that they are mandated for overtime. When you are

tired, your brain isn’t functioning, as it normally should. When the brain is fatigued, it is
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a symptom showing that the brain is reaching a point of dysfunction (Dobberstein, 2014).

When nurses are working so many hours, it doesn’t leave much time for sleep. The brain

is greatly affected when it doesn’t receive ample amount of rest. With too little sleep, the

neural pathways are disrupted and the information is not travelling smoothly from one

part of the brain to another. With that being said, cognitive thought processing, motor

skills, decision making are affected (Dobberstein, 2014). So, when nurses are working

overtime, it is likely that they are fatigued and their brain is not functioning, as it should.

Therefore, when caring for patients, especially in tedious and critical situations, nurses

are not performing as sharply as they should, or as they need to be. They are more apt to

making mistakes, giving incorrect amounts or incorrect medications and have procedure

errors or charting errors. These errors made could potentially be life threatening

depending on the severity.

Patient care is first and foremost the number one priority at all times. When

hospitals and health care facilities are understaffed, the nurses they have are being forced

to work not only longer hours, but they are required to care for a greater number of

patients. Where as on a typical shift with enough staff they may have to care for 3-4

patients, when understaffed they may have to care for 5-6 (Faller, 2008). With the extra

workload they are not giving as much attention to each individual. This could potentially

increase the length of stay at the hospital. It could also increased discomfort and decrease

the patient and family’s satisfaction with the hospital and staff.

The reason that patient’s care is being compromised should be enough in itself to

put a halt on mandating overtime, yet it still happens every day. Although there are not

many solutions to the issue, it is evident that there is a significant need for nurses, and the
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rate of retention needs to increase. Another temporary solution would be only allowing

voluntary overtime, where the nurse decides whether or not he or she is capable or

willing to work the extra hours. That could potentially reduce the number of fatigued

nurses, reducing the amount of errors made.

As one of the most common nursing issues that get swept under the rug,

mandatory overtime should not be taken lightly. It causes negative effects on both the

patient and the nurse and it could be potentially life threatening. The viscous cycle will

only come to an end when the need for nurses is decreased. Working nurses to the point

of exhaustion and fatigue will not fix the problem that facilities are understaffed; it will

only make the problem worse. Mandating nurses should only be used in true incidents of

emergencies rather than on a regular basis.

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References

Dobberstein, L. (2014, August 25). Brain Fatigue 101. Retrieved October 26, 2015.

Faller, M. (2008, December 11). Stopping the vicious cycle of mandatory overtime -
American Nurse Today. Retrieved October 26, 2015.

Kohn, L. (2012, November 7). Mandatory Overtime. Retrieved October 26, 2015.

Mandatory Overtime. (2013, March 1). Retrieved October 27, 2015, from
http://www.aacn.org/wd/practice/content/publicpolicy/mandatoryovertime.pcms?menu=p
ractice

Rogers, A., Scott, L., Aiken, L., & Dinges, D. (2004). The Working Hours Of Hospital
Staff Nurses And Patient Safety. Retrieved October 26, 2015.