Mandatory Overtime

Abstract

Mandatory overtime for nurses is becoming one of the major nursing issues within the past twenty years. The biggest cause of this issue is nursing shortage. As a result of mandatory overtime, nurses are more prone to make mistakes, such as preventable medications errors, patient falls, high incidence of patient acuity, and less patient satisfaction. Regulations need to be implemented by the state in order to eliminate this problem and improve patient care.

Mandatory Overtime

Mandatory overtime refers to an excessive amount of hours beyond a scheduled shift. This applies to part time, as well as full time employees. One of the major causes of mandatory overtime is nursing shortage, which is becoming a very serious issue within the nursing field. This is directly related to a notorious population growth in multiple states, a decreasing pipeline of new nursing students, and an aging workforce along with a baby boom bubble that will demand health care services. Florida, New York, and California are some of the states with the highest population; however, this is a worldwide issue.

In order for nurses to deliver the best nursing care, there must be a balance between their professional life and their personal life. By practicing mandatory overtime, children and family members are getting barely any attention. These nurses are not able to have a social life or even a chance to cope with the stress from the workplace. There are many negative consequences related to this nursing issue and patients are being highly affected. Some of these negative consequences include poor patient care leading to increased patient acuity, preventable medication errors, and diminished patient satisfaction, which directly affects nurse liability.

Increased Patient Acuity

From what I have been exposed to, hospitals and nursing homes are the most affected areas when it comes to two of the biggest nursing issues from this generation: mandatory overtime and nurse to patient ratio. As part of my nursing training, I spent three weeks at a nursing home, where one nurse had to take care eighteen patients. LPN’s were doing most of the nurses’ jobs and I witnessed several nurses signing documentation right after the LPN’s- without checking for accuracy. It all comes down to knowing your duties and delegating responsibilities to the right person, but when you have eighteen patients, your goal is to survive the day without killing anyone. These nurses are being forced to work overtime, and patients are paying the price. Some of these negative consequences include:           

• High incidence of pressure ulcers, due to lack of changing position at least every two hours.
• High incidence of urinary tract infections, due to poor or lacking urinary catheter hygiene.
• High incidence of patients falls, due to delay responding the patients’ calls when they need help.
• Preventable medication errors related to high pressure at the workplace.
• High incidence of septic patients, due to poor care of PICC lines or IV lines.
• Poor nursing assessment, highly related to excessive work hours.

While I was completing my practices at this nursing home, I was assigned three patients to take care of, and I will never forget what happened to one of them. This was an Alzheimer’s patient who needed assistance with eating, and I found him crying while trying to reach for some food; however, his breakfast tray was too far for him to reach. He was so frustrated, and the nurse was too busy passing medications to her other seventeen patients. Fortunately, I was just a nursing student, and I had the time not only to provide assistance with his food, but also to carry a conversation with him. This patient was so lonely and desperate, and his nurse was not even awarded of it. The bottom line here is, who is to blame for these type of situations? What can we do to prevent these episodes from happening? From my perspective, I would blame whoever implemented the eighteen to one nurse-patient ratio, and whoever keeps putting pressure on the nurses to do mandatory overtime. It is completely unsafe for the patients, and very demanding for the nurses. Ideally, to avoid exhaustion or any patient conflicts, it is recommended that the nurses not work more than twelve hours per day and no more than sixty hours per week.                                                     

Preventable Mediations Errors

             Preventable medication mistakes are also directly related to mandatory overtime. As a nurse, it is hard enough to work twelve hours a day, being forced to work sixteen hours a day just pushes the nurses to the edge leading them to make all kinds of mistakes. Hospitals have tried to come up with different strategies to make the medication administration process safer, such as MAR (Medication Administration Record) and scanners, but so far none of these have been able to eliminate the mistakes (Spetz, 2013). Nurses are still required to choose the right patient, right medication, right dose, right time, and right route. Many of these medication errors can potentially be fatal, leaving the family members with an irreplaceable loss and a million questions. In relation to this matter, I have a personal testimony to share. My husband’s grandfather had Diabetes Mellitus type I, and he was hospitalized to replace his pacemaker. The nurse was supposed to administered his Insulin as he would normally do every day. Instead, she administered him twice as much as his daily dose was, which prompted him into a diabetic coma. After that incident, he had one complication after another, and two weeks later he died from Pneumonia. What was supposed to be a relatively uncomplicated surgery, turned out to be the last few days of his life. This happened about 13 years ago, back when I was living in Cuba, where nurses still work twenty-four hours per shift. After so many years, his family is still wondering if it was mean to be that way or maybe he died because of the nurse’s mistake.

Diminished Patient Satisfaction

Over the years, nurses have earned a lot of respect. Patient satisfaction is one of our major priorities. What we do is not just an ordinary job, is a job that can change people’s lives. Frequently, we have to know more than nursing skills; we have to be counselors, social workers, or just someone that has the time for our patients. When nurses are doing mandatory overtime, they just want to do the minimal required. Meaning, they can possibly dismiss important information just because they were too tired or too busy. When I had my C-section, I was discharged without any instructions on how to take care my incision. Luckily, I knew what to do, but my satisfaction as a patient was very low. As nurses, we must never assume our patients know what to do. It is part of our job to make sure our patients understand every aspect of their care and that they stay highly satisfied.

In order to minimize the use of mandatory overtime, more states have been implementing regulations: no more than twelve hours per day and no more than sixty hours per week (Benson, 2012). However, some questions come to my mind: are all the hospitals and all the medical facilities going to follow these regulations? Can the nurses refuse to work more than they are supposed to? How are they going to handle a shift being short of staff? This nursing issue not only has a negative impact for patients, but for nurses as well. In fact, an excessive amount of work hours for nurses has been related to needle sticks injuries, muscle skeletal problems, sleep deprivation, and poor neurobehavioral functioning. Years ago, when I was working for Shands Hospital, I always tried to avoid working with what we called “pool nurses”. These nurses had no benefits and they made their own schedule. Some of them, worked more than seventy hours a week and some of them barely worked twenty hours a week. They had limitations as far as how many hours they were allowed to work, but they were the only ones to call to cover for any nursing shortage. Another down side of these “pool nurses” was the fact that sometimes, they were pulled to work on areas they were not familiar with. Several preventable medication errors have been related to pediatric nurses working as a medical surgical floor nurse and vice versa. This is an extremely unsafe nursing practice, every nurse should be confident and familiar with the area she or he is providing care. 

Conclusion

The ultimate goal of using mandatory overtime regulations is to provide better working conditions for nurses as well as to improve the quality of patient care. Working conditions in the nursing field refers to the number of patients that the nurse is providing care for, the amount of patients within a unit, the incidence of nursing shortage, and the management’s strategies to prevent mandatory overtime, and or nursing shortage. Mandatory or unplanned nursing overtime should be avoided at all times in order to avoid negative consequences for patients, as well as to improve patient satisfaction.  

References

Benson, A. (2012, November) Labor Market Trends Among Registered Nurses. Retrieved from: Linccweb Catalog Search.

Spetz, J. (2013, August) The Research and Policy Importance of Nursing Sample Survey and Minimum Data Sets. Retrieved from: Linccweb Catalog Search.

Serratt, T., Meyer, S., & Chapman, S. A. (2012, February) Enforcement of Hospital Nurse   Staffing Regulations Across the United States: Progress or Stalemate? Retrieved from: Linccweb Catalog Search.

Sung, H. (2012, March). Nurse Overtime, Working Conditions, and the presence of Mandatory Nurse Overtime Regulations. Retrieved from: Linccwebb Catalog Search.

(2015). ANA State Government Affairs on Mandatory Overtime. Retrieved from: http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/NurseStaffing/OvertimeIssues/mandatory12761.html