Overtime hikes nursing errors, study shows

[Kiwi, BSN, RN]

WASHINGTON (Reuters) -- Nurses in U.S. hospitals about 40 percent of the time are working long shifts that raise the risk of medical mistakes such as giving the wrong medication or the wrong dose, a study released Wednesday said.

The likelihood of a hospital nurse making a mistake was three times higher once a shift stretched past 12.5 hours, according to a study published in the journal of Health Affairs.

The study, led by researchers at the University of Pennsylvania, tracked 393 hospital nurses and found about 40 percent of their shifts exceeded 12.5 hours over a four-week period.

Extended nursing shifts are growing more common as hospitals struggle with a shortage of registered nurses. Working more than 40 hours per week or working unscheduled overtime also made errors more likely.

The researchers called for fewer long shifts and less overtime. "Routine use of 12-hour shifts should be curtailed, and overtime -- especially that associated with 12-hour shifts -- should be eliminated," they wrote.

Data on the impact of long nursing shifts have been limited, although many studies have linked sleep-deprived physicians to medical mistakes, the study's lead author said.

"There are over 50 studies of physicians' work schedules, but we have never looked at our largest group of health-care providers, which are registered nurses," Ann Rogers, the study's lead author, said in an interview.

Medication errors

Rogers, an associate professor at the University of Pennsylvania's School of Nursing, and colleagues reviewed logbooks from 393 registered nurses throughout the country who worked full time in hospitals. The study analyzed data from 5,317 shifts over a four-week period. The longest shift lasted 23 hours and 40 minutes.

During the 5,317 shifts, there were 199 medical errors. Most were medication errors such as administering the wrong drug or the wrong dose, or giving medication later than scheduled. The study did not assess the impact of the errors on patients.

The nurses also reported 213 near errors, cases in which the nurses caught themselves before they made a mistake.

Working overtime raised the chances of making at least one error, regardless of how long the shift was originally scheduled to last, the study said.

In most cases, overtime was not scheduled in advance, Rogers said. On average, the nurses worked 55 minutes longer than scheduled each day. One-third of the nurses worked overtime every day they worked during the four weeks.

The research was funded by the federal Agency for Healthcare Research and Quality and the Robert Wood Johnson Foundation, a philanthropy devoted to health issues.

The Institute of Medicine, an independent organization that advises the federal government on medical matters, also has recommended easing nurses' schedules, including limiting their workday to 12 hours.

[Spidey's mom, ADN, BSN, RN]

I heard this on Paul Harvey today as I was pulling away from the ice cream store. Interesting.

steph

[ayndim]

WASHINGTON (Reuters) --

The researchers called for fewer long shifts and less overtime. "Routine use of 12-hour shifts should be curtailed, and overtime -- especially that associated with 12-hour shifts -- should be eliminated," they wrote.

12 hours shifts are one of the things that got me interested in nursing (there are more important things too). I cannot imagine having to work 5 8 hours days. Want to bet those 8 hour days turn into 10-12 hour days anyway. But then you don't have more days off. I do like the limiting the hours to 12 per day but save me from 8 hour shifts.

[LisaG21]

Wow that is so intresting to know! I am for a 12 hour shift!!! I fell the 8 hour shift is just too short... by the time you get in and get everything settled its time to go. I feel you might make extra mistakes then too because you are rushing around!! Especially on day shift its like omg! Lunch trays are already here? I have 2 hours to do my notes, roadmaps, and medications! lol I think maybe 16 hours is too long but a 12 hour shift is just right!

[Hellllllo Nurse, BSN, RN]

Great articles. I'm impressed that the author of the first article actually referred to nurses as "our largest group of health-care providers". Usually, we are referred to as "angels of mercy" or some such bs.

[Kiwi, BSN, RN]

I'm all for the 12-hr shifts, myself. Nursing is a very different type of work. I think I'd get exhausted / burnt out if I had to go 5 days per week instead of 3.

[-jt]

>

So theyre saying that we dont get out on time & we end up staying an average of 55 minutes past our shift --- and we make more errors when we work more than 12 hrs --- so we should have shorter shifts so that we can do the overtime with less errors. Amazing turn of logic there. How about concluding that if we have safe ratios & enough staff to have manageable assignments, we can finish our work within our 12 hrs & not have to do any overtime??? That makes more sense.

These authors seem to be telling us that we should just accept the fact that we cant leave at the end of our shift so we should change our hours to safely accomodate the overtime. They missed the point.

Understaffing is what should be curtailed & then all that unsafe overtime can be eliminated.

[AER]

As lead author on the study in question, I'm finding this discussion fascinating. I am a sleep researcher so our focus was on fatigue, and the effects of fatigue on errors. There is no doubt that workload is a factor-and that nurses have very heavy workloads (I've worked neuro-med, neuro-surg, neuro ICU and on rehab floors as a staff nurse). But our study didn't examine that, only fatigue. Our next study will look at workload, shift duration and errors. And if we're funded, we plan to ask a couple of questions about whether or not you're being paid for all the times you stay late (if not, and you're paid an hourly salary, the hospital is in violation of the law).

What we recommended was that 12 hour shifts be eliminated or curtailed unless nurses could get out on time. In fact, the error rate was lowest for 12 hour shifts that ended on time. Unfortunately, 78% of the 12 hour shifts involved overtime (and 85% of the 8 hour shifts involved overtime)!

From a physiological perspective, there is no justification for scheduling nurses to work 14 hour or even 20 hour shifts. As you can imagine, even when working 20 hour shifts, nurses ended up putting in overtime!

[rollingstone]

Nothing new here.