Nursing and Mandatory Overtime, Essay Example

Introduction

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 their resources, skills, and expert knowledge. Nurses play an essential 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 due to 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 following discussion will emphasize the significance of mandatory overtime and its impact on nursing quality and direct patient care and also consider the reasons behind mandatory overtime, which include high turnover rates and limited staffing to fill available shifts.

Why this Topic was Chosen

The topic of mandatory nurse overtime was chosen because it represents a challenge for many healthcare organizations who struggle with nurse staffing issues on a regular basis. When nursing units are understaffed, current nurses are required to work mandatory overtime shifts, which place a significant strain on their mental and physical health and wellbeing. Mandatory overtime for nurses represents many limitations for nurses in their provision of high quality care for patients. 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. Mandatory overtime is a quality issue because it impacts the ability of nurses to provide high quality patient care, and also a cost issue that impacts nursing unit budgets when overtime costs are excessive due to limited staffing.

Background of the Issue

Nurses obtain training in many areas in order to perform their required duties; however, the nature of nursing practice requires multitasking and decision-making so that patient lives do not hang in the balance. Organizations struggle with the reality of budgetary constraints that often limit the number of employees that are hired and employees must often extend their reach in order to accommodate the needs of an organization, contributing to 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 work.

To date, 16 states have established regulations to limit overtime, even though some organizations are not likely to comply with these regulations (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). 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).

How this Problem Impacts Nursing Care

With mandatory overtime, there is an increased risk to patients under the supervision of nurses working long shifts (Trinkoff et.al, 2011). 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). 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).   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). 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). There is a correlation between overtime and its impact of needle-related injuries to patients (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).

Prior research indicates that many nurses do not take breaks throughout the day, in spite of having them available (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). Nurses working with critically ill patients are required to work longer shifts, and this places a burden on their ability to provide expert quality care on a consistent basis (Stimpfel and Aiken, 2012).

Excessive work hours and lengthy shifts play a significant role in increasing the risks associated with patient safety (Olds and Clarke, 2010). 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 (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).

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).
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 and 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). 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 (Niu et.al, 2011).

Mandatory nurse overtime demonstrates a lack of understanding and focus regarding the levels of stress and fatigue for nurses (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). 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).

Healthcare organizations place significant demands on practicing nurses in the form of long shifts and overtime hours (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). 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 the nursing work environment, safety is particularly critical because unsafe conditions pose a serious risk to patient health and 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). 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). 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). 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). 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 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 must be evaluated in order to identify the cause of these errors (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 all 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). 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 requires a lengthy period of time for acceptance and execution throughout the institution (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). 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). An organization should recognize that system-wide changes may be effective indicators of collaboration and growth throughout the organization (van Beuzekom et.al, 2010).

Possible Solutions to the Problem

One of the critical areas of nursing overtime 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 (Clark and Walker, 2011). Nurses 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). 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 enables nurses to have choices in the schedules that they receive (Clark and Walker, 2011).

In an effort to develop strategies that address 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). 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, 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 (Lawton et.al, 2012). When errors are detected and recorded, 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 (Lawton et.al, 2012). The concept of incident reporting continues to grow and thrive in modern healthcare systems, and it reflects many years of research and support 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). 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 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. 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 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.

References

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