January 13, 2016

Is Mandatory Overtime Hurting Nursing?


In many healthcare institutions around the country, requiring nurses and other medical staff to work overtime hours each week is a very common practice. The underlying reason for this is very clear. Healthcare has for a long time, and still does, suffer from a chronic case of understaffing.

Therefore, the only way to have enough nurses working at all times to care for patients around the clock, considering that there are seemingly never enough nurses available, is to have employees work overtime.

According to the American Nursing Association (ANA), in order to both improve the quality of care being offered to patients and improve the health of nurses, mandatory overtime needs to be eliminated.

Many experts seem to be in agreement. In fact, there are many states that have already put an end to the practice of requiring nurses to work overtime. Here are some of the reasons why many people who are very familiar with the situation believe that conditions in healthcare would be better both for patients and employees if there was a better solution than requiring nurses to work extra hours every week.

It’s Expensive

The New York City Health and Hospitals Corporation recently released a report that showed how expensive it truly is to pay nurses for overtime worked on a weekly basis. According to the analysis, it is not uncommon that some nurses make more money in overtime payments than they do in annual pay.

In a study that included the earnings of 54 healthcare employees, overtime pay totaled at least 50 percent and as much as 183 percent of their yearly base salaries.

The obvious question then is, “wouldn’t it be better to focus efforts on hiring more qualified nurses and improving nurse retention?”

It certainly seems to be a logical question. The study also states that many employees end up working more than three overtime shifts per week and that some even end up working for ten consecutive days.

It’s obvious from these findings that the problem is not money. There is enough money to go around. The problem is the lack of nurses on staff. Of course, this does not mean that there are simply not enough nurses to go around on the job market. It means that there is a disconnect in the process that does not enable healthcare institutions to employ and retain the needed number of employees.

It Decreases Safety and Quality of Care

One of the biggest problems associated with mandatory overtime is what is referred to in healthcare circles as “nurse fatigue.” Many might not be aware of the fact that a nurse’s shift without overtime included usually lasts 12 hours. This would not be a problem if these nurses would be able to get an adequate amount of rest between the end of their 12-hour shifts and their next shifts. This usually requires the nurse to have a day off after working a 12-hour shift, which hardly ever happens when they are needed to work overtime.

Certain studies have shown that working more than 40 hours a week can lead to cognitive impairment that is fatigue-related. This type of impairment has been linked to “adverse events” and errors that can potentially cause harm to both patients and healthcare workers.

Minor medical errors such as needlestick injuries increase in probability when a nurse is working more than 40 hours a week.

According to an HCAHPS survey, patients were less satisfied with the care offered by nurses who work shifts that last longer than 13 hours.

A study performed by the the Interdisciplinary Nursing Quality Research Initiative recommends that reducing overtime hours for nurses would improve the patient experience and also decrease readmissions. The study showed that having more registered nurses employed at a hospital, rather than having a smaller number of nurses work longer hours, directly reduces both patient readmissions and emergency room visits within 30 days of the patients being discharged.

The bottom line is that when nurses are working more than 40 hours a week, safety related issues for both the employees and patients are more likely to rear their heads.

It Decreases Job Satisfaction and Retention

A previously mentioned Health Affairs study found that nurses who work shifts longer than 12 hours and more than 40 hours a week are not only more prone to making mistakes and compromising the safety of the staff and patients, they are also more likely to be dissatisfied with their jobs and have a desire to quit them.

The study claims that nurses who work shifts longer than 12 hours are almost 1.5 times more likely to quit within a year of taking the position. A ripple effect can also be seen in these studies. Not only are the employees dissatisfied, so are the patients.

According to the study, patients who have experience with nurses working more than 13 hours are not only unlikely to ever return to that hospital, they are also very likely to dissuade friends and family from getting treated their.

There are also studies that have been conducted that confirmed that healthcare institutions operating in states that restrict mandatory overtime show an increase in job satisfaction and better retention. The study was conducted in 2010 and showed that restricting, or at least limiting overtime, improves nurse safety and job satisfaction.

Nurses, just like everyone else, have lives outside of work. It isn’t hard to understand from any perspective why nurses would prefer to have a more regular schedule that is both less taxing on them physically and mentally and more reliable.


Along with the many studies that have been conducted on the problems associated with mandatory overtime for nurses, there are also concrete cases that have shown that hospitals do not have to insist on overtime in order to take care of patients the right way.

Just last April, a federal court rules against a hospital in Rhode Island that insisted nurses should not be able to refuse working overtime. The hospital claimed that if its nurses did not work overtime, patients would have to be diverted to other hospitals, which would end up causing irreparable reputational harm, harm to patients and lost revenue.

The court found that none of the hospital’s evidence backing those claims was sufficient enough to require nurses to work overtime.

Another case followed in September in which the Community Health System’s Northside Medical Center in Ohio was ordered to cease and desist the use of nurse mandatory overtime over 33 hours per calendar year.

Whether or not mandatory overtime for nurses ends up becoming a thing of the past, it’s important for hospitals to take a look at the management of their overtime situation and to find the best possible solutions.

Federal regulations exist for limiting work hours in order industries, such as commercial driving and airlines, in which public safety is of great importance. It would be hard to argue that the nursing industry does not fit into that same type of category in which the lives of others depend on the employees serving them.