Overtime Issues

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Background
In order to provide the best care possible to patients, the physical and mental well-being of the nurse is essential. Evidence has shown that working long or extensive hours, or beyond a scheduled shift can lead to negative patient and nurse outcomes. Studies have also shown that nurse overtime has been used as a solution to treat chronic understaffing and variations in patient census.

What is Overtime?
ANA defines overtime as hours worked in excess of an agreed upon, predetermined, scheduled full-time or part-time work schedule, or working beyond established one’s regularly scheduled hours.

ANA believes that the elimination of overtime for the nation’s nurses is crucial in order to improve the quality of patient care and the health of the nurse. The elimination of mandatory overtime is important to improve nurse working conditions and for the delivery of safe and effective patient care.

Many health care organizations engage in mandatory overtime as a solution to understaffing. ANA opposes the use of overtime as a staffing solution. Overtime is not a sustainable solution and has led to:

  • Reduced patient satisfaction
  • An increase in patient adverse events (falls, pressure ulcers, catheter associated urinary tract infections)
  • Preventable medication and medical errors
  • Increased patient mortality
  • Decreased job satisfaction
  • Decreased nurse recruitment and retention
  • Nurse fatigue
  • Deficits in nurse’s work performance
  • Job related injuries (needlestick injuries and musculoskeletal problems, sleep disturbances, exhaustion)
  • Chronic illness of nurse (hypertension, diabetes, heart disease)
  • Health care Litigation

How to Decide When to Work Overtime
ANA encourages individual nurses to make informed decisions about when to work overtime and avoid work related injuries. Please refer to ANA’s Code for Ethics for Nurses with Interpretive Statements.

  1. “The nurse’s primary commitment is to the patient, whether an individual, family, group, or community.” (Provision 2)
  2. “The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.” (Provision 3)
  3. “The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care.” (Provision 4)
  4. “The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action.” (Provision 6)

Implications for Practice
The Institute of Medicine Report (IOM) Keeping Patients Safe: Transforming the Work Environment of Nurses (2004) recommend that nurses work no more than 12 hours in a 24 hour time frame, and no more than 60 hours in seven days in order to avoid nurse fatigue that may lead to preventable patient care errors or nurse injury. In addition, the effects of overtime and nurse fatigue on work performance demands that health care organizations establish policies and procedures that clearly address work hours and nurse overtime. The health of both the nurse and the patient depends on staff nurses and nurse managers to recognize the negative effects of working mandatory or voluntary overtime.

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