Health Risks of Mandatory Overtime

[NRSKarenRN, BSN, RN]

American Journal of Nursing - May, 2001 - Volume 101, Issue 5

http://www.nursingworld.org/AJN/2001/may/Health.htm

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.

Resources

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.

[herring_RN, ASN, BSN]

Fatigued nurses jeopardize patients.

We need enough time between shifts and also rest breaks to prevent accidents and errors.

When on-call time is scheduled there must be an awareness that the nurse may work all of that time therefore sufficient rest time must be scheduled.

[RN Power Ohio]

I used to work nights and often ended up staying until mid-morning! I cannot tell you how many times I nearly crashed.

I have fallen asleep in the driveway on a regular basis. I am guilty of running over a neighbors mailbox thinking I was turning safely into my driveway.

I asked for a place to sleep at work and was told I just need to go home and get some sleep. And my hospital had a hotel! (several of them in fact).

I tried to start a program where a nurse could get a place to sleep and shower if they worked more than 16 hours. Naturally, most of the managers couldn't appreciate the need.

[Chico David, BSN, RN]

No one has really yet mentioned much the reason this topic belongs in this discussion area: That it is only nursing unions that have provided any really effective force aginst mandatory overtime. Organizations like the ANA can do a nice job articulating the reasons why it's a bad idea, but the real successes in banning it through legislation or in contracts have come from unions. Most of the organized hospitals in California have either banned or tightly restricted mandatory overtime - with appropriate exceptions for genuine disasters, of course.

[NRSKarenRN, BSN, RN]

collective bargaining can be done by any healthcare organization as part of economic and general welfare program for nurses...not limited to unions.

in my state, pa state nurses assoc been leading the fight in our legislature since this article was written in 2001. good public policy dictates having laws that protect citizens from overworked staff. that is why there are laws for airplane pilots and over the road truck drivers regarding # hours permitted to work.

what has ana done for me lately... - 29th oct, 11:12 pm - nursing ...our ongoing participation in the mandatory overtime effort ensures that the .... to update ana's position statement on cloning in humans which identifies ...

allnurses.com/forums/f100/what-has-ana-done-me-lately-11294.html

sept/oct 2002: the pennsylvania nurse archives - need to know ana info

summary: the following data are the final results based on 201 surveys received by psna from the online mandatory overtime/nursing issues survey, which posted on the psna web site from november 2001 to march 2002. the following report is a summary of the answers received from the questions that returned quantitative results. based on the information received from the survey and other sources, psna will continue to make mandatory overtime and its elimination in the workplace a priority.

nov 2003: testimony before pa house committee on mandatory overtime

d:\www\psna\\documents\hotissues\c_hotissues_testimony_10.20.03.htm

summary: my name is michele campbell and i have been a nurse and nurse administrator for many years prior to taking this position as executive administrator for the pa state nurses association. the pennsylvania state nurses association represents the nearly 200,000 registered nurses throughout the commonwealth. in this report, 46% of registered nurses surveyed stated they were likely to leave nursing within the next 6-10 years....

2004 several mandatory overtime bills introduced in legislature. find out the details of each...

2005: bill to ban mandatory overtime up for vote in pa - allnurses: a ...click here for the pa state nurses association's position statement on mandatory overtime: http://www.psna.org/c_posstat_ot.htm. ------------- ...

allnurses.com/forums/f195/bill-ban-mandatory-overtime-up-vote-pa-107930.html

2006: mandatory overtime bill passed by house; need to contact state ...

the summary of the bill: prohibits the use of mandatory overtime for ... for the pa state nurses association's position statement on mandatory overtime: ...

allnurses.com/.../f170/mandatory-overtime-bill-passed-house-need-contact-state-senators-passage-183366.html

2008 pa legislation: mandatory overtime; nursing ratios - 4th apr ...

hb 834 bans mandatory overtime for nurses supported by pa state nurses association and nursing unions: pasnap and seiu healthcare/nurse alliance

passed in house by a vote of (166-31), now stalled in the pa senate.

>>>>>>>>>>>

timing is right, ongoing energy and persistence, we hope to get this legislation passed this year in pa.

[herring_RN, ASN, BSN]

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.

[herring_RN, ASN, BSN]

nurses seek ban on mandatory overtime

members from five different nurses' unions held a rally today calling for an end to mandatory overtime and in favor of safer staffing ratios. several hundred nurses gathered at the capitol steps piercing the air with the shrill sound of whistles and wearing neon green shirts that read "save new york nurses."

"mandatory overtime has done nothing but make nurses leave their calling," said new york state public employees federation president ken brynien. "almost 30 percent of the 237,000 registered nurses licensed in new york are choosing not to practice in large part because of mandatory overtime."...

..."if you leave, you could be charged with patient abandonment and loss of your license, your career, and your livelihood," said barbara crane, a registered nurse and president of the new york association delegate assembly.

"if you stay, you're working in fear of not being sharp as you need to be and making a mistake that could cost some poor innocent soul their life. we already have laws and regulations to set the maximum hours for airline pilots, train engineers and truck drivers. why is there nothing for nurses?"...

http://www.legislativegazette.com/day_item.php?item=417

[lindarn]

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.

ACTIONS speak louder than words!

Lindarn, RN, BSN, CCRN

Spokane, Washington

[Vito Andolini]

I agree that too many nurses are too timid to stand up for themselves. They seem to expect someone else to fight the battle for them. Until they are willing to speak up and stand up and join in the fray, they will continue to allow their jobs to rule them. I encourage all of us to be bold and take a stand. Just say no.