American Journal of Nursing - May, 2001 - Volume 101, Issue 5
The Health Risks of Mandatory Overtime
The hidden costs of this all-too-common practice
By Karen Worthington, MS, RN, COHN-S
Does mandatory overtime pose a health and safety risk to the nurses forced to work?
While the use of mandatory overtime should be reserved only for true emergencies, many health care facilities rely on it as a regular means of staffing. This ill-conceived strategy, meant as a solution to staffing deficits, instead creates more problems that compound the nursing shortage. In June 2000, the ANA's House of Delegates overwhelmingly agreed that the use of mandatory overtime should be reserved for true emergencies and that refusal to work excessive overtime does not constitute patient abandonment.
There are three main health and safety issues: prolonged exposure to hazards, fatigue, and stress. Extended workshifts may cause staff to exceed safe chemical exposure limits and increase risk of exposure to other hazards such as infectious agents and ergonomic stressors.
The second issue, fatigue and its influence on behaviors associated with safe work practices, is of great concern. Nurses are routinely called upon to make decisions that have potential life-and-death consequences for the patient and the nurse, regardless of the time of day or number of hours they have already worked. Additionally, nurses who are mandated to work 12 or 16 hours must then drive home while tired, often on dark roads. Traffic deaths that occur while driving home from a double shift are not counted as workplace fatalities, but very well should be. Upon arriving home, nurses frequently must continue to work in their domestic roles, a fact regularly discounted by those making staffing decisions.
Fatigue remains difficult to define and measure. There is a very complex relationship among the three main variables associated with accidents and fatigue, namely overtime, shift work, and the kind of work performed. Studies of how fatigue affects human performance in overtime situations are surprisingly limited, and the available data are insufficient to help quantify how many hours people should be required to work if they are to remain safe and healthy.
The third health and safety issue is the effect of workplace stress, which research shows is exacerbated by long hours on the job. The Nurses Health Study ( British Medical Journal , May 2000) shows that women in jobs with high work demands and limited job control--frequently the circumstances surrounding mandatory overtime--are more likely to suffer poor health than are women who have more flexible jobs with reasonable demands.
The more plentiful body of literature on shift work indicates that shift rotators, especially night shift rotators, experience a higher incidence of cardiovascular disorders, gastrointestinal disorders, and a higher incidence of work-related injuries. Enlightened employers use this knowledge to improve scheduling and work organization.
Today, many nurses' schedules defy categorization and reflect few of the lessons learned from the shift work literature. There are no uniform safety and health laws governing overtime or work scheduling in health care, although other industries with public safety responsibilities are regulated. It took true catastrophes, such as the nuclear disaster at Chernobyl and the massive oil spill from the Exxon Valdez, to begin to alert the media, the public, and lawmakers to the problems of work-related fatigue. Let's aim for legal limits on mandatory overtime for health care workers to help avoid a health care industry disaster.
For your patient's safety and yours, make sure that the ANA's Principles for Nurse Staffing are incorporated into your current staffing system. Also, follow the advice of the National Institute for Occupational Safety and Health as outlined in their booklet, Plain Language About Shiftwork.
American Nurses Association. Principles for nurse staffing. 1999. http://www.nursingworld.org/readroom/stffprnc.htm.
Women, work, and stress. Harv Womens Health Watch 2000;8(1):1-2.
Rosa RR, Colligan MJ. Plain language about shiftwork . Cincinnati (OH): Department of Health and Human Services; 1997 July. DHHS (NIOSH) Pub. No. 97-145. http://www.cdc.gov/niosh/pdfs/97-145.pdf.
Alward RR, Monk TH. The nurse's shift work handbook . Washington (DC): American Nurses Publishing; 1993.
Nurses' Health Study Newsletter. http://www.channing.harvard.edu/
Karen Worthington is senior occupational health and safety specialist at the ANA.
Apr 7, '08
The CNA/NNOC uses many studies from medicine and nursing to promote safe scheduling.
Hospital nurse managers are persuaded by the ANA position statements and articles in AJN more than other scholarly reports and studies. That leads to contract language.
And too many of us are timid, so seeing it written concisely gives nurses courage to do what they already know is the right thing.
So the ANA is helping many more nurses and other caregivers that just their membership.
I other words ANA is good at articulating while CNA/NNOC mobilizes nurses and the public to act.
Last edit by herring_RN on Apr 7, '08