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Nursing and Mandatory Overtime, Capstone Project Example

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Capstone Project

Introduction

Modern healthcare organizations face critical challenges in their efforts to provide high quality care and treatment to patients. It is the responsibility of employees to perform to the best of their ability to treat patients using the resources, skills, and expert knowledge that are available. In particular, nurses play a critical role in shaping outcomes for healthcare organizations that serve large numbers of patients. The nature of nursing practice requires long shifts and the potential risk of high stress or burnout. It is important to consider the impact of nurses on the development of successful outcomes in healthcare organizations, but to also evaluate their commitment to these organizations and the potential for stress and long hours. When staffing is limited, many nurses are required to participate in mandatory overtime and lengthy shifts, thereby leading to excessive stress and the potential for early burnout. The nursing profession is highly rewarding, but it also introduces significant amounts of stress and frustration for nurses who are required to work long hours and mandatory overtime that limits their ability to enjoy their careers. Furthermore, these requirements may pose a danger to patients if nurses are overtired and lose their focus. It is important to identify the issues that are relevant to nurses who are required to work mandatory overtime shifts and the overall impact of these issues on nurses’ health, wellbeing, and ability to provide high quality care to patients at all times. The following discussion will address some of these issues in greater detail and will emphasize the significance of mandatory overtime and its impact on nursing quality and direct patient care. The discussion will also consider the reasons behind mandatory overtime, which include high turnover rates and limited staffing to fill available shifts. These issues continue to pose challenges for healthcare organizations and their nursing staff members as they attempt to balance the needs of patients with the nurses that are available.

Why this Topic was Chosen

The topic of mandatory nurse overtime and related issues was chosen because it represents a challenge for many healthcare organizations who struggle with nurse staffing issues on a regular basis. I believe that nurses working in healthcare organizations, particularly hospitals, face critical challenges in their daily roles, and when limited staffing is available, it is likely that the burden on nurses is greater than ever. When nursing units are understaffed, current nurses are required to work mandatory overtime shifts on a regular basis, which place a significant strain on their mental and physical health and wellbeing. These issues are detrimental to nursing practice and place additional strain on the ability of nurses to be successful in their roles. The concept of mandatory overtime for nurses is worthy of further examination because it represents many limitations for nurses in their ability to provide greater quality of care for patients on a regular basis. If nurses are required to work mandatory overtime shifts, they are likely to experience greater fatigue, stress, and frustration, thereby creating an environment that is difficult for many nurses to endure. These issues are relevant to nursing practice and are worthy of further consideration and evaluation as a potential benefit to nursing practice and the improvements that might emerge. It is important to address mandatory overtime as a quality issue because it impacts the ability of nurses to provide high quality patient care on a consistent basis. Furthermore, mandatory overtime is a cost issue that impacts nursing unit budgets when overtime costs are excessive due to limited staffing. These factors are important throughout nursing units and convey the challenges associated with

Background of the Issue

Nurses are provided with significant training in many areas in order to perform their required duties; however, the nature of nursing practice requires significant multitasking and decision-making so that patient lives do not hang in the balance. Under these conditions, it is often the case that organizations struggle with the reality of budgetary constraints that often limit the number of employees that are hired. However, when sufficient numbers of employees are not available, then it becomes difficult to provide the anticipated level of care with the employees that are available. Employees must often extend their reach in order to accommodate the needs of an organization, and this leads to significant consequences over time in the form of fatigue, high stress, and burnout. Furthermore, overtime hours represent a larger commitment to salary support that might be saved if a sufficient number of employees were available to accommodate patients. These factors ultimately contribute to the weaknesses that exist relative to patient care outcomes and the quality of care that is provided.

Many nurses must commit to mandatory overtime due to staffing concerns and limitations; however, it is important to note that 16 states have established regulations to limit overtime, even though some organizations are not likely to comply with these regulations on a consistent basis (Bae et.al, 2011). In these states, nurses are not permitted to work overtime unless a disaster strikes, and furthermore, nurses are not permitted to work a set number of hours in a single shift, such as 12 hours (Bae et.al, 2011). These factors are indicative of an increasingly complex set of circumstances involving staffing concerns in many healthcare organizations, and it is evident that nurses may experience a sense of obligation to work overtime if requested, even if they do not want to commit to the extra hours (Bae et.al, 2011). These factors depend on the patient census on any given day; however, as many of 62 percent of nurses have experienced pressure on one or more occasions to work overtime, even when they are not seeking it (Bae et.al, 2011). When nurses are only scheduled to work an 8-hour shift, there is a greater likelihood that they will be required to work overtime to meet the 12-hour shift limitation (Bae et.al, 2011). Although overtime is favorable in the context of increased income, it also contributes to a number of potentially serious consequences, including a direct impact on patient safety when nurses experience extreme fatigue and stress (Bae et.al, 2011). These factors could lead to negative outcomes because patients are put at unnecessary risk when overtime hours are excessive (Bae et.al, 2011).

How this Problem Impacts Nursing Care

With mandatory overtime, there is an increased risk of potential harm to patients under the supervision of nurses working long shifts (Trinkoff et.al, 2011). In particular, nurses who work the night shift face the following complications: “getting insufficient sleep because long work hours reduce sleep opportunity and getting inadequate or poor quality sleep because of circadian misalignment from shift work” (Trinkoff et.al, 2011, p. 2). When nurses are unable to obtain sufficient sleep, they are unlikely to be fully alert and attentive to the needs of the patients under their care (Trinkoff et.al, 2011). Nurses experiencing sleep deprivation may also succumb to other concerns such as a risk of illness and continuous fatigue (Trinkoff et.al, 2011). These findings suggest that nurses may be subject to committing a larger number of patient errors that could pose a greater risk or harm to patients (Trinkoff et.al, 2011). Nurses who work overtime on a continuous basis are likely to experience burnout, stress, and fatigue at significant rates, thereby increasing their potential for errors (Trinkoff et.al, 2011). Since many nurses report that they are required to commit to overtime hours, their level of burnout is likely to be higher than nurses who work only the traditional required shifts (Trinkoff et.al, 2011). Nurses who work overtime on a regular basis are also subject to other critical issues, such as their ability to recognize changes in patients that could lead to serious consequences if left untreated (Trinkoff et.al, 2011). These factors play a role in shaping the development of new perspectives to evaluate mandatory overtime hours in a comprehensive manner to avoid serious complications that could impact direct patient care (Trinkoff et.al, 2011).

Overtime in nursing practice is not a new phenomenon, and it continues to persist at significant levels throughout healthcare organizations. However, the degree of overtime contributes to a number of different responses, such as fatigue, poor reaction time, limited sleep, and pain, amongst others (Bae, 2012). These factors contribute to the challenges that nurses face as they are often required to work mandatory overtime shifts in order to accommodate the needs of the unit as staffing limitations persist (Bae, 2012). These issues are significant because they place unnecessary strain on nurses and their patients that could otherwise be avoided if they were not required to work overtime shifts (Bae, 2012). The Institute of Medicine has established its own set of recommendations regarding nursing shifts, supporting the limit of 12-hour shifts for nurses and a 60-hour limit over a 7-day period as a means of preventing extreme fatigue (Bae, 2012). However, these limits do not take other factors into consideration, such as sleep deprivation, that could limit a nurse’s ability to effectively treat patients (Bae, 2012). These factors are critical in establishing a strategy that will reduce the risks of patient-related errors, such as medication errors, falls, and infections (Bae, 2012). There is also a correlation between overtime and its impact of needle-related injuries to patients (Bae, 2012). These considerations must be evaluated more closely as a means of determining whether or not healthcare organizations fully recognize the potential risks associated with nurse overtime and how it impacts patient care over time (Bae, 2012). Future studies must consider some of these factors and obtain raw data regarding the number of patient errors that might be directly attributed to nurse overtime hours (Bae, 2012). This is an ongoing problem that plagues many areas of nursing practice that requires some degree of resolution in order to achieve effective outcomes that will be favorable for patients (Bae, 2012).

The burden of nursing shifts is particularly challenging for many organizations because it represents a difficult set of circumstances that have a negative impact on patient care outcomes in some cases (Stimpfel and Aiken, 2012). Under these conditions, the quality of care that is provided to patients is often less than desirable because nurses who work long hours may have a tendency to lose focus and perhaps commit errors that would otherwise not occur (Stimpfel and Aiken, 2012). These factors are relevant because they shape the ability of nurses to exercise sound and reasonable judgment regarding direct patient care (Stimpfel and Aiken, 2012).  These challenges are relevant because they support the continued development of strategies to improve patient outcomes and to reflect upon the needs of patients that require expert nursing care and treatment (Stimpfel and Aiken, 2012). Prior research also indicates that many nurses do not take breaks throughout the day, in spite of having them available to them (Stimpfel and Aiken, 2012). Nurses are already stretched thin and a lack of breaks in order to rest and refocus priorities does not do patients or nurses any favors (Stimpfel and Aiken, 2012). It should also be noted that “nurse managers may find it beneficial, from a safety perspective, to consider their unit type when handling scheduling and shift length issues. Our results showed differences in shift length by specialty unit, with 80% of ICU nurses working 12 to 13 hours compared with 60% of general care unit nurses”(Stimpfel and Aiken, 2012, p. 7). These factors indicate that nurses working with critically ill patients are typically required to work longer shifts, and this places a significant burden on their ability to provide expert quality care on a consistent basis (Stimpfel and Aiken, 2012). This relationship must be addressed in greater detail because it places a significant burden on the ability of nurses to promote patient safety, particularly if they place their patients at unnecessary risk on a continuous basis (Stimpfel and Aiken, 2012).

It is widely known that excessive work hours and lengthy shifts play a significant role in increasing the risks associated with patient safety (Olds and Clarke, 2010). There are a number of events that have been observed in nursing-based activities that consider the impact of overtime hours, such as medication errors and needlestick injuries (Olds and Clarke, 2010). For some groups of nurses, such as critical care nurses, it should be noted that “Among critical care nurses, error reports almost doubled after 12.5 or more consecutive hours of work and working more than 40 hours per week had a significant effect on both errors and near misses” (Olds and Clarke, 2010). These factors support the belief that patient care outcomes are likely to be placed at greater risk in situations where there is significant potential for error due to fatigue, lack of focus, and a high level of stress (Olds and Clarke, 2010). Nurses who experience fatigue on the job due to lengthy shifts are also likely to be less alert during the workday, which poses a risk to patients who might experience a greater number of falls and other events (Olds and Clarke, 2010). These considerations should be evaluated as a means of addressing the potential for errors for nurses who are required to work long shifts, including required overtime (Olds and Clarke, 2010). When nurses become fatigued as a result of long work shifts, they are likely to pose a risk to their patients that may have an impact on their ability to provide quality care at all times (Olds and Clarke, 2010). These conditions support a necessity to evaluate how nursing shifts are organized so that there is a reduced risk of harm to patients as a result of nurses who are not entirely focused and are fatigued, particularly at the end of lengthy shifts (Olds and Clarke, 2010). These factors demonstrate a strong degree of support for the development of new strategies to improve outcomes for patients that include nursing care and treatment (Olds and Clarke, 2010).

Nurses must demonstrate their ability to be effective communicators and providers of care to all patients. However, when there are significant obstacles in place, these efforts are likely to be disrupted and are very difficult to overcome. It is necessary to develop an understanding of the mandate for overtime and whether or not it is appropriate under some conditions, and how it impacts patient outcomes (Raso, 2012). From this perspective, it is believed that mandatory overtime should not be mandatory, and other options should be considered prior to a commitment to overtime that could play a role in reducing quality of care when nurses experience fatigue (Raso, 2012). Mandatory overtime, however, might be considered in cases where there is a disaster or serious weather event and staffing is limited (Raso, 2012). Some nurses may be unable to come to work due to environmental conditions or other concerns, and those already at work may be required to remain there and put in additional hours (Raso, 2012). The caveat with this alternative is the potential impact of fatigue on quality of care, as well as the options that are available to support effective patient outcomes, even under difficult conditions (Raso, 2012). In cases where there are significant issues related to patient outcomes, an evaluation of current methods should be reconsidered in order to establish a positive precedent that will facilitate positive results for patient care, rather than increasing the burden placed on patients with poor quality of care (Raso, 2012). The impact of fatigue as a result of overtime is difficult to accept, given the challenges associated with providing care that will minimize patient risk as much as possible. In essence, a balance must be established between staffing needs and patient needs, as there are considerable issues associated with poor outcomes for patients who are subject to poor quality of care (Raso, 2012).
It is also important to identify the challenges that are associated with poor sleeping patterns and their impact on nursing practice, as these concerns have a significant influence on patient care and wellbeing (Niu et.al, 2011). In particular, night shift nurses must recognize that they possess considerable disruptions to their sleeping patterns, including issues related to circadian rhythms (Niu et.al, 2011). From this perspective, nurses who work the night shift on a regular basis often experience poor sleeping patterns and sleep deprivation when they attempt to acquire sleep during the daytime hours (Niu et.al, 2011). These factors address the challenges associated with limited sleep from a biological perspective, such as the involvement of cortisol in sleep patterns (Niu et.al, 2011). Unfortunately, nurses who work the night shift on a regular basis face issues such as lack of mental clarity and malaise (Niu et.al, 2011). These factors play an important role in nursing performance and how nurses respond to the tasks that they are given, including direct patient care (Niu et.al, 2011). To be specific, it is known that “Shift workers who sleep during the day (day sleepers) experience cortisol secretion increases, which diminish the healing power of sleep and enjoy 1 to 4 hours less sleep on average than night sleepers. Sleep debt accumulation results in chronic fatigue. Prolonged fatigue and inadequate recovery result in decreased work performance and more incidents” (Niu et.al, 2011). For nurses who consistently work the night shift, it becomes very difficult to establish a sound and appropriate pattern of sleep that will allow for sufficient sleep and limited sleep deprivation, and these instances limit the ability of nurses to be effective providers of patient care when they lack regular sleep (Niu et.al, 2011). Nurses who work the night shift are more likely to pose a risk to their patients if they have not had sufficient sleep prior to their shift, and over time, if this pattern continues, they are likely to experience chronic fatigue that may lead to considerable issues for nurses that could involve direct patient care, including the potential risk of patient errors (Niu et.al, 2011).

Mandatory nurse overtime is a challenging phenomenon because it demonstrates a lack of understanding and focus regarding the levels of stress and fatigue that build up when nurses are required to work long shifts and/or mandatory overtime (Bae, 2013). From this perspective, the impact of potential errors is too great to ignore, as patients are subject to nurses’ fatigue and stress at excessive levels, thereby leading to potentially devastating outcomes (Bae, 2013).In areas where mandatory overtime legislation is in place, it is possible that this legislation is not enforced, and instead of providing an environment that embraces quality of care, the core foundation of nursing practice is put to the test on a regular basis (Bae, 2013). Prior studies have considered the impact of work weeks that constitute over 40 hours of service, and the statistics largely demonstrate that healthcare environments do not take overtime hours seriously and their potential impact on quality of care (Bae, 2013).Furthermore, one issue to consider is the potential increase in abusive circumstances, which could pose a greater risk on nursing relationships when nurses are verbally and/or physically abusive towards other nurses due to extreme stress and fatigue (Bae, 2013). These factors are critical because they emphasize the importance of negative outcomes in nursing practice as a result of mandatory overtime, rather than a consideration of the challenges of organizing staffing to ensure greater quality and fewer conflicts (Bae, 2013).Based upon these revelations, nursing overtime could be an active contributor to many adverse events, some of which are not directly related to patient care (Bae, 2013). Regardless of the circumstances, the negative impact of mandatory overtime is too great to ignore and requires further consideration and evaluation (Bae, 2013). These factors must be evaluated more closely in order to capture an effective understanding of key principles associated with staffing problems and what issues are likely to occur when staffing for nurses is limited or otherwise challenged within an organization (Bae, 2013).

It is widely known that healthcare organizations place significant demands on practicing nurses in the form of long shifts and possible overtime hours; furthermore, these principles have a significant impact on patient care outcomes in many cases (Sharp and Clancy, 2008). It is important to identify the issues that are most important to nurses as they struggle with long work hours and extra shifts as necessary (Sharp and Clancy, 2008). Unfortunately, nurses who work in critical care units face unique challenges as they attempt to care for critically ill patients using quality-based techniques and frameworks: “Long work hours also can impair the vigilance needed by critical care nurses, who must be alert to subtle changes in patients’ conditions and able to respond appropriately. Patients in CCUs may be more vulnerable to the effect of medical errors because they are more seriously ill and are exposed to more medications and treatments than patients in general care units. Of the 5 million patients admitted to CCUs each year, all will experience at least 1 preventable adverse event” (Sharp and Clancy, 2008). These factors play a significant role in supporting the demands of nurses and their ability to be consistent in their efforts to achieve greater quality of care and treatment on a consistent basis (Sharp and Clancy, 2008).When nurses are put into situations where they face a serious risk of complications, it is possible that they might be subject to intense scrutiny in the level of care that they provide (Sharp and Clancy, 2008). Critically ill patients require a greater level of attention and evaluation on a regular basis, and when this is compromised by errors in technique or judgment, nurses are subject to critical concerns by management that could limit their performance, even if the number of hours and shifts worked is a consequence of regulations set forth by healthcare organizations (Sharp and Clancy, 2008). In nursing units where shifts are long and minimal sleep time is available between shifts, these conditions pose a significant risk to patients that are difficult to overcome (Sharp and Clancy, 2008).

Safety in the workplace setting is of critical importance in order to minimize risk and to reduce injury. In the nursing work environment, safety is particularly critical because unsafe conditions pose a serious risk to patient health and wellbeing (Nahrgang et.al, 2011). Furthermore, these concerns represent a challenge to patients in the form of unnecessary medical errors and other concerns that impact their wellbeing (Nahrgang et.al, 2011).When nurses are required to work long shifts and are exposed to high demands in the workplace, there is an increased risk of high stress and other dangers that have a negative impact on patient outcomes (Nahrgang et.al, 2011). They are exposed to many different situations on the job and face the reality of exposure to a number of different scenarios, all of which contribute to negative influences that have an impact on patient care outcomes (Nahrgang et.al, 2011). It is also important to identify how nursing-related risks pose a threat to patient safety because they have a direct impact on quality of care and the techniques that are utilized (Nahrgang et.al, 2011). The general demands of nursing practice require nurses to make significant efforts to treat patients, which may lead to high levels of stress and other limitations that could impact direct patient care and pose safety risks (Nahrgang et.al, 2011). A model known as the JD-R Model, which represents job demands and resources relative to engagement and burnout is applicable to nursing practice and provides a basis for exploring new methods to promote workplace safety that have a direct impact on patient care (Nahrgang et.al, 2011).The demands of nursing practice require a delicate balance between the needs of patients and the rewards that are generated through patient service (Nahrgang et.al, 2011). However, nurses work in a high stress environment where burnout is likely to occur over time; therefore, roles and responsibilities may be excessive and pose significant restrictions on employees in their ability to promote safety with their patients at all times (Nahrgang et.al, 2011). In the case of burnout, “ an employee’s mental and physical energy is depleted. Thus, employees are more likely to commit mistakes and injure themselves. Likewise, employees are unlikely to have the mental or physical energy to perform safe behaviors” (Nahrgang et.al, 2011, p. 5). These factors demonstrate the importance of employee engagement and support for patient needs and the challenges that nurses face in their workplace roles (Nahrgang et.al, 2011).It is important to identify the resources that are available to nurses in order to obtain a greater level of satisfaction in the work environment and to demonstrate an important step towards reducing risks for patients (Nahrgang et.al, 2011).

Nurses face critical challenges in their efforts to balance their roles as nursing professionals and their dedication to patients (Holden et.al, 2011). These factors contribute to the overall scope and direction of practice settings as nurses are required to provide direct patient care that is safe and effective (Holden et.al, 2011). Above all else, nurses are human beings, and therefore, may experience humanistic challenges and approaches that are difficult to manage in their nursing roles (Holden et.al, 2011). The demands of nursing practice also influence patient care outcomes and have a significant impact on approaches to workload and other performance measures that impact patient care quality (Holden et.al, 2011). Nurses who are subject to long shifts, who are dissatisfied with their roles, or who do not fully realize the impact of their behaviors are likely to place patients at unnecessary risk, even when they have no intention of these actions (Holden et.al, 2011). These factors contribute to the overall effectiveness of nurse performance in a physical environment and also impact behaviors in different ways (Holden et.al, 2011). These concerns may be problematic in some situations because over a period of time, nurses are likely to experience burnout due to long work hours and stressful conditions, all of which could hinder their ability to provide patient care at the highest possible level (Holden et.al, 2011).

Errors in the nursing work environment require a detailed analysis and evaluation in order to identify the cause of these errors and their outcomes for patients (Keepnews and Heinrich, 2000). The Institute of Medicine has recommended that errors in healthcare practice, including those involving nurses, are a product of a very large and serious problem throughout the healthcare system (Keepnews and Heinrich, 2000). An individualized approach to this problem is not the solution; rather, a systemic evaluation must be considered as a potential opportunity to address widespread problems and concerns that impact the incidence of errors (Keepnews and Heinrich, 2000). The concept of a “culture of safety” is integral to the success of a change effort to minimize patient-related errors and to consider why they occur using systemic approaches (Keepnews and Heinrich, 2000). It is not surprising that errors occur, as human beings make mistakes; however, when similar problems occur on a consistent basis and impact similar patient populations, it is likely that larger system-wide problems are to blame, such as the possibility of excessive stress and fatigue due to mandatory overtime hours (Keepnews and Heinrich, 2000). It is important to identify the systems-based approaches that might be useful in supporting effective outcomes for patients and for nurses (Keepnews and Heinrich, 2000). Systems-based changes require a strategy that will encompass the different perspectives of change that have a positive impact on patient care and on nurses’ wellbeing, while also considering how an organization might embrace widespread change, which typically requires a lengthy period of time for acceptance and execution throughout the institution (Keepnews and Heinrich, 2000). Under these circumstances, it is likely that organizations will largely benefit from an examination of work hours and shifts for nurses so that they do not face significant burden and high levels of stress, as well as the challenges of putting patients at unnecessary risk (Keepnews and Heinrich, 2000).

Patient safety poses many serious risks for the wellbeing and integrity of healthcare organizations. A number of approaches have been considered as a means of reducing safety risks and the challenges of minimizing patient-related errors (van Beuzekom et.al, 2010). In this context, it is necessary to evaluate different strategies that are designed to facilitate positive outcomes for patients by examining person-centered and systems approaches to promote patient safety (van Beuzekom et.al, 2010). A person-centered strategy examines the responsibility of individuals in making errors, ultimately placing the blame on these individuals for the problems that occur (van Beuzekom et.al, 2010). Another strategy emphasizes systems-based concerns that impact the entire organization and contribute to patient errors (van Beuzekom et.al, 2010). The latter approach is more appropriate because it does not specifically blame employees for errors and places the burden of error on the entire organization and its key practice methods (van Beuzekom et.al, 2010). These circumstances are relevant because they examine the activities taking place throughout the organization in order to determine where improvements might be made that will address widespread deficiencies and other concerns that impact many areas (van Beuzekom et.al, 2010). These concerns as examined using a system-wide approach provide a basis for evaluating patient care outcomes in a manner that is consistent with realistic outcomes (van Beuzekom et.al, 2010). When a systems-based strategy is adopted, it is likely that the organization will make positive decisions to encourage favorable outcomes (van Beuzekom et.al, 2010). Furthermore, the organization will recognize that system-wide changes may be effective indicators of collaboration and growth throughout the organization (van Beuzekom et.al, 2010). It is important for organizations to evaluate how to best approach their nursing needs effectively so that nurses are protected from unnecessary risk or harm and do not face critical challenges that could be avoided under the conditions set forth through collaboration and communication (van Beuzekom et.al, 2010).

Possible Solutions to the Problem

One of the critical areas of nursing overtime hours is to identify a balance between the activities required by nurses on a 24 hour/7 day basis, while also considering a strategy that provides nurses with flexibility in their scheduling in order to improve outcomes (Clark and Walker, 2011). By developing strategies to improve nursing staffing issues, the following is observed: “allowing nurses to have some choice about the shifts they work can improve their perception of the shifts which in turn improves morale and has a positive effect on the nursing staff. This not only helps retain staff, but also assists in reducing the number of people calling in sick which can obviously have an impact on already stretched nursing staff. It can also help to reduce the number of temporary nurses employed to cover gaps in schedules, which can be expensive both in monetary terms and the continuity of patient care” (Clark and Walker, 2011, pp. 149-150). These issues represent a means of examining the different perspectives that involve nurse scheduling to improve satisfaction rates and subsequent quality of care (Clark and Walker, 2011). Nurses possess considerable challenges in the workplace environment; therefore, they must be provided with a framework that supports and enhances flexibility, which is a favorable characteristic of any nurse scheduling model (Clark and Walker, 2011). However, a successful and flexible model for nurse scheduling must prohibit preferential treatment in scheduling and treat all nurses on an equal playing field so that they have a chance to obtain a schedule that is desirable for their needs (Clark and Walker, 2011). These contributions are essential to the success of a nurse scheduling model that emphasizes the importance of different factors in enabling nurses to have choices in the schedules that they receive and their understanding of the issues that are most relevant to nurses with respect to scheduling and potential conflicts (Clark and Walker, 2011).

In an effort to develop strategies that are likely to be effective in addressing nursing work hours and overtime and their relationship to patient risk, it is necessary to evaluate how nurses contribute to patient risk and errors through their activities (Lawton et.al, 2012). An evidence-based framework is likely to demonstrate the severity of this problem and its short and long-term impact on patient wellbeing through an evaluation of existing evidence that associates nursing work hours and overtime with patient-related risk (Lawton et.al, 2012). There are two schools of thought related to evidence-based scenarios, including individual evaluations and systems-based issues (Lawton et.al, 2012). These factors ultimately contribute to the identification of problems and the nature of new strategies to reduce patient risk as related to nursing performance and work hours (Lawton et.al, 2012). One strategy to consider is reactive, whereby past experiences dictate the types of issues and solutions that are addressed in the present and the future, and is primarily focused on individual actions rather than the system as a whole (Lawton et.al, 2012). The second approach is proactive in nature, whereby concerns are addressed on a system-wide basis that reflect the importance of reporting errors and recognizing patterns in errors that occur throughout the organization, rather than focusing on individual events (Lawton et.al, 2012). From this perspective, it is likely that organizations will detect patterns in behavior and the root causes of said behaviors in an effort to develop viable solutions that will have a positive impact on nurse performance and patient outcomes (Lawton et.al, 2012). When records are maintained and specific incidents are recorded, there is a greater likelihood that behavioral patterns will be addressed that will lead to gradual change within an organization and the potential for improved outcomes (Lawton et.al, 2012). These changes may include adjustments to scheduling that will have a positive impact on nurses so that they are not required to commit to frequent and lengthy overtime shifts, in addition to the development of flexible scheduling mechanisms for nurses that will enable them to improve their level of preparedness for their required shifts (Lawton et.al, 2012). These factors are important because they contribute to the development of strategies that are likely to improve outcomes for nurses and for patients over time (Lawton et.al, 2012). When errors are detected and recorded on a consistent basis, it is highly likely that there will be significant patterns of growth and development that will capture the attention of nurse managers and others responsible for scheduling so that nurses are provided with the tools to maximize their performance and minimize any possible risks to patients (Lawton et.al, 2012). The concept of incident reporting continues to growth and thrive in modern healthcare systems, and it reflects many years of research and support for the expansion of knowledge to recognize errors and why they occur (Lawton et.al, 2012). This process appears to remove some of the blame from individuals for any errors that are made and instead focuses on the bigger picture and the need for systematic change (Lawton et.al, 2012). These contributions are significant because they capture the essence of nursing practice more closely by attempting to develop new approaches to recognize potentially serious problems and focus on probable solutions (Lawton et.al, 2012). There are a number of factors to consider in the development of a specific framework to record incidents and manage outcomes more effectively, and these evolve using industry knowledge and examples of successful practice methods that have taken place in the past (Lawton et.al, 2012). These factors contribute to the ability of organizations to use real-time and prior data in order to identify issues related to nursing practice that may compromise patient care and impact wellbeing in different ways (Lawton et.al, 2012). These contributions are essential to the growth and development of nursing practice and the phenomenon of scheduling and long work hours as part of the larger picture that contributes to medical errors that directly involve patients (Lawton et.al, 2012).

Conclusion

In the modern era, nurses are subject to long hours and many roles and responsibilities that directly involve patient care. These factors play a critical role in the ability of nurses to provide high quality care and treatment on a continuous basis. However, under some circumstances where long shifts or mandatory overtime are required, nurses are likely to experience fatigue and other symptoms that could pose a risk to their own wellbeing, including fatigue, malaise, poor mental clarity, and subsequent poor judgment. These factors pose a threat to the integrity and delivery of patient care, thereby creating an environment that is difficult on patients. When these circumstances occur, it is important to recognize the potential causes of these events and the reasons behind poor outcomes for patients. Nurses may place their patients at unnecessary risk as a direct result of fatigue and lack of clarity associated with excessive and/or mandatory overtime shifts. As a result, it is important for nurses to be provided with the flexibility and resources that are necessary to obtain sufficient sleep and to be subject to reasonable work hours and shifts. These factors are critical because they enable nurses to be part of a larger system-wide change in strategy and practice so that patient errors are recorded and changes are made on a larger scale. These issues will enable nursing leaders to recognize that long hours and shifts pose a difficult burden for nurses because they are often unable to perform to the best of their ability. These factors must be considered in healthcare organizations and provide a basis for the exploration of new strategies that will improve patient care outcomes and nursing performance on a regular basis, and will establish a framework for a positive and meaningful work environment.

Poster Presentation

Introduction: In modern healthcare systems, nurses serve as key contributors in providing high quality patient care and treatment on a regular basis. However, it is also known that nurses are required to work long hours and additional shifts when staffing levels are low. Nurses may quickly become fatigued and find it difficult to maintain mental clarity during these shifts. As a result, nurses are more likely to commit errors that may directly impact patient care and outcomes. These factors require an examination of issues such as mandatory overtime and other factors that play a role in limiting successful performance for nurses who work long hours and extended shifts. These issues pose a serious threat to the quality and integrity of patient care.

Mandatory overtime for nurses is a likely contributor to weaknesses in nursing-related performance and the potential risk of patient-related errors. These factors are increasingly common in nursing practice environments where nurses are required to work overtime hours and lengthy shifts without adequate breaks and the ability to gain sufficient sleep. Under these conditions, the integrity and strength of professional nursing practice is called into question and may pose a risk to the overall quality of patient care that nurses provide. These factors also demonstrate a lack of focus and understanding of the reasons why these risks occur and how they might be properly managed.

Purpose: The primary purpose of this study is to evaluate the conditions under which mandatory overtime for nurses occurs and how these requirements impact quality of care and nursing performance. In many cases, nurses experience extreme fatigue and high levels of stress when they work long shifts and/or overtime hours, and these conditions may pose a risk to patients in the form of errors in medication administration or unforeseen injuries. Nurses are often required to commit to long shifts or overtime hours without sufficient sleep, and these factors contribute to limited mental clarity and the ability to care for patients without the risk of errors or other challenges.

The development of a successful strategy to minimize patient-related errors requires nurse managers to recognize the impact of work hours and shifts on these risks. There are considerable consequences associated with mandatory overtime and the requirement to work shifts that are longer than 12 hours. These factors are essential to the discovery of new techniques to improve patient outcomes and nursing performance so that nurses are effectively prepared to maximize their performance with sufficient sleep and strong mental clarity on a regular basis.

Background of Issue/Problem: Limited resources and educational opportunities limit the number of nursing graduates that are available to fill positions. This poses a serious threat to the integrity of nursing practice by limiting the number of nurses who are available to fill the required shifts. As a result, nurses often face the risk of serious consequences as a result of limited staffing, including required longer shifts and mandatory overtime. These requirements may pose a serious risk to patients in the form of medication and other types of errors that also jeopardize nursing performance.

Overtime in nursing practice poses a serious threat to the integrity of the profession. When nurses are required to work long hours, they limit their ability to think clearly and to focus properly, which plays a significant role in promoting positive nursing outcomes for patients. These factors must be considered on a widespread basis as a means of improving practice methods as a whole rather than focusing on singular events that will not provide any real benefit to nursing practice over time.

Effect of Issue on nursing care: With the emergence of mandatory overtime and longer shifts, nurses place themselves and their patients at risk over time. This leads to the identification of medical errors on an ever-increasing basis, which endangers the lives of patients and could otherwise be avoided. These factors play a role in supporting nursing outcomes and in shaping the reality of nursing practice objectives in light of mandates that impact quality of life for nurses and for patients.

Nursing care may be severely compromised by the reality of modern practice settings, given the shortage of nurses that are available to work and the increased focus on disease prevention and treatment. These factors require knowledgeable, experienced, and alert nurses who will challenge the status quo and make probable recommendations regarding the impact of nursing overtime and work hours on patient wellbeing.

Synthesis of possible solutions to the problem: In light of the issues related to patient care relative to nursing practice, it is important to identify the resources that are necessary to support flexible work shifts so that nurses possess adequate sleep to perform their duties. These factors are essential in enabling organizations to focus on their nurses and the wellbeing of patients as a collaborative approach to improve outcomes.

Recognizing the system-wide issues that exist also supports the development of new approaches to record errors as they occur and to address issues that have a much larger impact on quality of patient care. These systemic issues are likely to be effective in enhancing nursing progress in evaluating scheduling so that nurses are able to optimize the care that they provide rather than posing a risk to patients that could otherwise be avoided. The implementation of new strategies is essential to the discovery of methods to improve nursing practice and knowledge to achieve greater quality patient care.

References

Bae, S. H. (2012). Nursing overtime: why, how much, and under what working conditions?. Nursing economic$, 30(2).

Bae, S. H. (2013). Presence of nurse mandatory overtime regulations and nurse and patient outcomes. Nursing economics, 31(2), 59-68.

Bae, S. H., Brewer, C. S., & Kovner, C. T. (2012). State mandatory overtime regulations and newly licensed nurses’ mandatory and voluntary overtime and total work hours. Nursing outlook, 60(2), 60-71.

Clancy, C. M. (2011). AHRQ Commentary: Limiting Nurse Overtime, and Promoting Other Good Working Conditions, Influences Patient Safety. Heart Failure.

Clark, A. R., & Walker, H. (2011). Nurse rescheduling with shift preferences and minimal disruption. Journal of Applied Operational Research, 3(3), 148-162.

Holden, R. J., Scanlon, M. C., Patel, N. R., Kaushal, R., Escoto, K. H., Brown, R. L., … & Karsh, T. (2011). A human factors framework and study of the effect of nursing workload on patient safety and employee quality of working life. BMJ quality & safety, 20(1), 15-24.

Keepnews, D. (2011). A Systems Approach to Health Care Errors. Heart Failure.

Lawton, R., McEachan, R. R., Giles, S. J., Sirriyeh, R., Watt, I. S., & Wright, J. (2012). Development of an evidence-based framework of factors contributing to patient safety incidents in hospital settings: a systematic review. BMJ quality & safety, 21(5), 369-380.

Nahrgang, J. D., Morgeson, F. P., & Hofmann, D. A. (2011). Safety at work: a meta-analytic investigation of the link between job demands, job resources, burnout, engagement, and safety outcomes. Journal of Applied Psychology, 96(1), 71.

Niu, S. F., Chung, M. H., Chen, C. H., Hegney, D., O’Brien, A., & Chou, K. R. (2011). The effect of shift rotation on employee cortisol profile, sleep quality, fatigue, and attention level: a systematic review. Journal of Nursing Research, 19(1), 68-81.

Olds, D. M., & Clarke, S. P. (2010). The effect of work hours on adverse events and errors in health care. Journal of safety research, 41(2), 153-162.

Raso, R. (2012). The legality of mandatory vaccination and overtime. Nursing Management, 43(2), 56.

Stimpfel, A. W., & Aiken, L. H. (2013). Hospital Staff Nurses’ Shift Length Associated With Safety and Quality of Care. Journal of nursing care quality, 28(2), 122-129.

Trinkoff, A. M., Johantgen, M., Storr, C. L., Gurses, A. P., Liang, Y., & Han, K. (2011). Nurses’ work schedule characteristics, nurse staffing, and patient mortality. Nursing Research, 60(1), 1-8.

Van Beuzekom, M., Boer, F., Akerboom, S., & Hudson, P. (2010). Patient safety: latent risk factors. British journal of anaesthesia, 105(1), 52-59.

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