Nurses that are obligated to work overtime.

Kyrshamarks, BSN, RN · Jan 26, 2014

In Texas you cannot be mandated to work overtime. If they are making you stay beyond your shift for other than a disaster situation, they are breaking the law here. The supervisor must take report and relieve you or find someone to relieve you.

Editorial Team / Admin · Jan 26, 2014

In Texas you cannot be mandated to work overtime. If they are making you stay beyond your shift for other than a disaster situation, they are breaking the law here. The supervisor must take report and relieve you or find someone to relieve you.

While some states (including the one I live in) do not allow mandation other than in disaster situations or while in the process of providing care (in other words, I can't just walk out of the OR at the end of my shift unless someone arrives to relieve me), hospitals can get around this through the use of being on call. My particular surgical specialty does require a lot of on call and subsequently call back. There have been several days where I've worked a double shift or longer. I can definitely tell you that by about hour 14 my concentration is shot; fortunately, I have yet to make any errors in that situation but most likely it is only a matter of time. I also have a very flexible supervisor who will do her best to make sure that we can either take the following day off or, if that is absolutely not possible due to a heavy surgery schedule, at the very least finding ways that the call team can come in late and have a minimum of 8 hours of non-work time.

As for whether someone is fired for making a mistake, that would most likely depend on the person's history (have they made several mistakes in the past and it's an on-going issue?) and the severity of the mistake (no adverse effects vs. major effects). I highly doubt that someone would be reprimanded by or reported to the BON for working overtime; that's more of an issue to be dealt with by the facility.

One word of caution I do offer nursing looking for jobs: find out what the expected amount of overtime will be. If it's a lot and there isn't a temporary reason for it (someone unexpectedly went out on medical leave, for example), it may be a sign of a poorly managed and poorly staffed unit that one may be better off avoiding.

By the way, what is this 9-5 nursing job you speak of? :cheeky:

whichone'spink, BSN, RN · Jan 26, 2014

If you are mandatoried and you make a mistake, you will take the fall for it, even if it means you get reported to the BON. Sadly, it's all too common on some floors to make up shortfalls by making staff stay 4-8 hours over their shift on non-weather disaster days. I work on such a floor, and I want out. Every shift I work, I always wonder if I'll be able to go home after a shift.

chevyv, BSN, RN · Jan 26, 2014

I got mandated to work nocs last year. I had been up since 0600 to get my children off to school, then I worked pms and was mandated. It was the most horrible noc I have ever had. I did the least amount of work that I could and just prayed I wouldn't make any huge mistakes. After the noc was over, I decided that I would take the write up the next time rather than put my license and pts at risk. It was scary.

Here.I.Stand, BSN, RN · Jan 26, 2014

My state has a law that says a nurse cannot be threatened or penalized for refusing to work OT *if she/he is concerned that doing so would jeapordize pt. safety.* Needing to get home to parent the kids isn't an excuse...completely ridiculous b/c little children can't beam themselves home from school or cook themselves dinner :no: ...but note to self, regardless of your real reasons for saying no, just say it's a safety issue and you're covered.

But really, it is a safety issue. Myself, the one time I stayed over from nocs into days (voluntarily--the charge nurse asked if anyone was willing to) I made a med error. The pt wasn't harmed--my replacement caught a dose of prednisone that I had missed, and the pt. got it a couple hours late, but it was a med error nonetheless...and we don't decide "I'm only going to make med errors that don't harm anyone." I can't cite studies off the top of my head, but I'm sure some have been done that have found >12 hours results in poor concentration. Plus you may be driving home fatigued which is just as dangerous as driving drunk.

KelRN215, BSN, RN · Jan 26, 2014

I just want some opinions on what happens when a nurse is obligated to work over 12 hours. Are they prone to make more mistakes then their counterparts that have a 9-5 job? What happens when they do make a mistake, are they fired? Do they have supervisors that reprimand them even if they were the person to make the RN stay late? When I say reprimand I mean report them to a board of Nursing.

Ok, well to point out the obvious, nurses who are working in situations where they work 12 hr shifts and can be mandated are working jobs that are not comparable to nurses who work M-F 9-5. I don't know any acute care nurses who work 9-5.

There is a lot of research that shows that nurses are more prone to mistakes the longer hours they work. I have never known of a nurse to be reported to the BoN for a mistake though. I believe my current workplace reported one last year but it was because she obviously falsified a patient's chart... like turned identical notes for 2 separate shifts and just wrote over the date.

MatrixRn · Jan 26, 2014

""I just want some opinions on what happens when a nurse is obligated to work over 12 hours. Are they prone to make more mistakes then their counterparts that have a 9-5 job?""

In a word, yes. This is true for all jobs, the longer we work the more tired we become and this leads to increase chance of error.

""What happens when they do make a mistake, are they fired?""

That depends upon the mistake. Each case is different. Was it a blatant mistake? Did someone die? Was someone hurt? Did the nurse go outside of policy? If there is a yes answer on any of these then here there is more chance for the nurse to be in big trouble.

""Do they have supervisors that reprimand them even if they were the person to make the RN stay late? When I say reprimand I mean report them to a board of Nursing.""

Yes. Just because the supervisor asks a nurse to stay late, this does not mean they are free to make errors. At the end of the day, the nurse is the one who is responsible for her practice. If she or he is too tired to work, this information should be reported to the supervisor up front.

Ruby Vee, BSN · Jan 27, 2014

I just want some opinions on what happens when a nurse is obligated to work over 12 hours. Are they prone to make more mistakes then their counterparts that have a 9-5 job? What happens when they do make a mistake, are they fired? Do they have supervisors that reprimand them even if they were the person to make the RN stay late? When I say reprimand I mean report them to a board of Nursing.

It depends.

When I was mandated to stay more than 12 hours, I was hyper-vigilent, and didn't make any more mistakes. But if I had to come back to work with fewer than eight hours off between shifts, I may have made more mistakes then. The supervisors were understanding -- as long as you recognized your mistakes and immediately set about to mitigate the potential harm to the patient. If you tried to cover it up, then you had problems with management.

NurseRies, BSN, RN · Jan 27, 2014

When I did a travel assignment in Texas, I was scheduled 4-5 12 hour days per week and was on call after most of those shifts. Everyone that worked for this company had those types of schedules. I worked 12-20 hour days constantly. The average shift was 15 hours, but several 22 hour days. This was in acute dialysis. I don't know how patients would have gotten treatments during busy seasons if nurses refused to work. Plus many of us remained on call after our normal 6am-6pm, so when they told us we had another treatment to do at another hospital after 6pm, you really felt like you had no choice. Someone was waiting for you with a potassium of 6.8 and EKG changes... What would you do? Maybe quit like most people did. I never made any serious mistakes. But in acute dialysis, we work 14-24 hour days at least once a week. It can be very scary when you are absolutely exhausted. I have worked 15 hour days, gotten home, had dinner, went to bed, and after being asleep for 15 minutes, gotten called back in to do an emergency 4 hour treatment, which is 6-7 hours with travel time. It can be done but it is not right and maybe not the safest.

My question is, what kinds of hours do you think physicians work? Way longer then most of us.... And talk about call time.

Ruby Vee, BSN · Jan 27, 2014

My question is, what kinds of hours do you think physicians work? Way longer then most of us.... And talk about call time.

Precisely why I chose not to go to medical school!

dudette10, MSN, RN · Jan 27, 2014

When I did a travel assignment in Texas, I was scheduled 4-5 12 hour days per week and was on call after most of those shifts. Everyone that worked for this company had those types of schedules. I worked 12-20 hour days constantly. The average shift was 15 hours, but several 22 hour days. This was in acute dialysis. I don't know how patients would have gotten treatments during busy seasons if nurses refused to work. Plus many of us remained on call after our normal 6am-6pm, so when they told us we had another treatment to do at another hospital after 6pm, you really felt like you had no choice. Someone was waiting for you with a potassium of 6.8 and EKG changes... What would you do? Maybe quit like most people did. I never made any serious mistakes. But in acute dialysis, we work 14-24 hour days at least once a week. It can be very scary when you are absolutely exhausted. I have worked 15 hour days, gotten home, had dinner, went to bed, and after being asleep for 15 minutes, gotten called back in to do an emergency 4 hour treatment, which is 6-7 hours with travel time. It can be done but it is not right and maybe not the safest.
My question is, what kinds of hours do you think physicians work? Way longer then most of us.... And talk about call time.

I'm posting my response with a vivid memory of your post in another thread. You seem to be contradicting yourself with regard to how much time working is too much time!

Bedside dialysis is common where I work, including emergent right after admission. I adore the dialysis nurses that I've worked with time and time again. That said, I believe (and I might be wrong here) that the stress level associated with acute dialysis has its peaks and valleys. You are one-on-one with a patient, and the primary hospital nurse is co-responsible for care for your patient and her other assigned patients. Maybe some of the dialysis nurses can educate me, but I wonder, given the ratio and expected assistance from the primary nurse, the relative stress level of patient demands and needs.

Don't even compare nursing to physician hours. They get paid much, much more than we do and the expectation of hours when going into nursing vs medicine is also known and expected. You cannot compare the two and be taken seriously.