Stop requiring nurses to work overtime

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Alexandra Wilson Pecci, for HealthLeaders Media, January 31, 2012

When one of your nurses calls in sick, or if your organization is experiencing a staffing crunch, what do you do?

The answer is different for every organization, but here's one thing you probably shouldn't do: require mandatory overtime.

More states are restricting mandatory overtime in an effort to reduce nurse fatigue, which not only jeopardizes the health of patients, but of the nurses themselves. But according to Carol Brewer, PhD, RN, FAAN, professor at the School of Nursing, University at Buffalo, hospitals shouldn't wait for state laws before they do away with mandatory overtime requirements in their organizations.

That's because safety isn't the only problem that can stem from mandatory overtime; Brewer says mandatory overtime is a "dissatisfier" that can be a factor in high turnover rates.

"There is just simply no question that mandatory overtime is repugnant to most nurses," Brewer tells HealthLeaders. "Most nurses have families, many of them have children…you tell a nurse who has to pick up her child from the daycare that she has to work another eight hours? That's just devastating to people's personal lives."

Brewer is the co-author of a study published in the journal Nursing Outlook that finds that state-mandated caps on nurses' mandatory overtime hours have been successful at reducing overtime hours for newly licensed registered nurses (NLRNs) in those states.

Overall, 11.6% of nurses said they worked mandatory overtime in a typical work week, averaging 6.1 hours of mandatory overtime. But in states that govern mandatory overtime, the study found that NLRNs were 59% less likely to work mandatory overtime than their colleagues in unregulated states.

"Mandatory overtime should always be the last option," Brewer says. Instead, nurse managers need to make sure they have resources available when they need extra staffing. For example, is there an adequate float pool? Is there an adequate use of agency employees?

Nurse managers might look into other options as well; Brewer says some hospitals are using a system that auctions off open hours to nurses who are willing to pick up extra shifts.

In fact, Brewer and her co-authors write that "nurse managers could use voluntary overtime as an alternative to mandatory overtime when regulations prohibit mandatory overtime."

"It's not that nurses don't want to do overtime, because they quite evidently do. But they want control over the overtime," says Brewer. "Having control over your work hours is a satisfier; it's something that nurses need to have to be satisfied in their job."

Nurse managers should also use in-services and other forms of education to raise awareness of the effects of fatigue on their health and job performance to be sure that nurses who do volunteer for overtime aren't overdoing it.

But Brewer also cautions against "voluntary" overtime that's really more of a requirement. If a nurse manager begs and pleads with a nurse to "do her a favor" and pick up an extra shift, or threatens to make her work on a weekend when she doesn't want to, then the overtime isn't really voluntary at all.

"I think that has more to do with the organizational culture and the relationship of the supervisors to the nurses," Brewer says. "My guess is that anybody who has kind of that relationship with their nurses is not going to have a very happy unit."

The real test for the effectiveness of these mandatory overtime laws will come during the next acute nursing shortage, Brewer says. But in the meantime, nurse managers always need to be thinking about what's important to their nurses, and ways to increase satisfaction and reduce turnover.

"I think what leaders have to think about always is the long term. Whether we're in a shortage or not, the factors that create satisfaction and longitudinal loyalty from your employees tend to stay the same," Brewer says. "Just because your staffing issues aren't as acute doesn't mean you shouldn't be paying attention to them."

Moreover, high use of mandatory overtime is likely a symptom of bigger problems.

"If you've got high use of mandatory overtime you've got other organizational issues that are also impacting the nurses' satisfaction and organizational commitment," Brewer says.

Source: HealthLeaders Media