Background
Mandatory overtime is one of the many workplace issues that may be contributing to nurses leaving the workforce. Overtime is defined as the hours worked in excess of an agreed upon, predetermined, regularly established work schedule, as identified by contract; usual scheduling practices; policies or procedures.
Concern for the long term effects of overtime leading to fatigue include potential for diminished quality of care, errors or near misses, as well as the negative impact on the care-givers health. Research indicates that risks of making an error are significantly increased when work shifts are longer than 12 hours, when nurses worked overtime, or when they worked more than 40 hours per week.[1] Other industries have been aware for many years of the links between fatigue and accidents, mistakes, errors and near errors. For instance, the airline and trucking industries limit the number of hours pilots and truck drivers can fly/drive. They also require a certain number of hours between "flights" or "runs".
By virtue of licensure, nurses are responsible and accountable for their decisions, actions and/ or inactions. By removing the ability of the nurse to determine fitness for duty, patient safety is not only jeopardized but so is the nurse's ability to fulfill their legal obligations of licensure. The American Nurses Association (ANA) has taken the position that regardless of the number of hours worked, each registered nurse has an ethical responsibility to carefully consider his/her level of fatigue when deciding to accept any assignment extending beyond the regularly scheduled work day or week, including mandatory or voluntary overtime assignment.
To help nurses make the case against working when fatigued, the ANA has added this issue to its’ Nationwide State Legislative Agenda the support of state laws and regulations prohibiting the use of mandatory overtime as well as pursued federal legislation
ANA’s position on Mandatory Overtime may be found at its
ANA Workplace Advocacy page.
States with Restrictions
- Sixteen states have restrictions on the use of mandatory overtime for nurses
- Fourteen identified restrictions in law: AK, CT, IL, MD, MN, NJ, NH, NY, OR, PA, RI, TX, WA, and WV.
- Two states have provisions in regulations: CA and MO.