Many healthcare institutions in the country require the nurses and other medical staff to work for longer hours each week. The underlying reason for this requirement is always very clear;the healthcare profession has been for a long time stand out as the most understaffed sector in the country. To provide care for the increasing number of patients; therefore, nurses can be required to work extra hours to cover for the understaffing problem in the sector. According to the Academy of Medical-Surgical Nurses, mandatory overtime is when nurses are forced to work beyond the hours agreed in their contract. In mostprofessions, working overtime usually means exceeding 40 hours of work per week. While overtime has been in existence in many professions over a long time, it has mainly been left a matter of choice and not mandatory. According to the American Nursing Association, improving the quality and safety of the care requires the elimination of mandatory overtime for nurses. Forcing nurses to work for longer hours has not only proved to be expensive but also impacts the quality and safety of the care as well as job satisfaction.
Background of the Mandatory Overtime
The limits of long working hours have long been studied in many professions such as aviation and marine industries. The previous research on this area has found the risks it has on the occupational settings such as the trucking and aviation industries. With a key focus on aviation and marine sector, long working hours has long been associated with increased risks on the safety and performance as well as in the job satisfaction in trying to create a healthy work-life balance. The first regulations that limit the pilots for flying overtime were first introduced in the 1940s, according to the reports by the Federal Aviation Administration. Also, the federal hours of service rules had been introduced limiting drivers from operating commercial vehicles overtime ( Bae et al., 2014 ). These regulations were meant to increase safety and enhance job satisfaction.
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The application of the mandatory working hours in the health care sector had been lower in the past decades and has only attracted controversy recently. The significant attention has been paid to the long working hours that has been experienced in some hospitals within the country. The introduction of mandatory working hours has been initiated by the increasing number of patients in the hospitals amid a shortage of nurses. The implementers see this as the only option to solve the issue of nurse shortages in hospitals. The current research in the health care sector shows that despite the current pitfalls of discontinuity that may arise in the care, having regulated work hours tend to improve job satisfaction and promote the safety of the patients ( Bae et al., 2014 ). Considerably, the mandatory overtime for nurses may not be opted out, and while some nurses may not have a problem working for longer hours, to other it can be an intrusion into the free time which prevents them from having a healthy work-life balance.
Significance in the Health Care Sector
The issue of mandatory working hours for the nurses has been found to have a significance in the health care sector. The country is currently concerned with the need to lower the ever-rising health care costs and improve quality. It is the nurses who are responsible for the provision of the care,and the quality cannot be addressed without putting them into the question.
Decreased Safety and Quality
A key problem that is associated with mandatory overtime is increased burnout and fatigue. Nurses handle a lot of patients during their shift,and at the end of the day, they get very tired and a feeling of burnout. With the understaffed sector where there is a big patients-nurse ratio, nurses are already overworked within their normal shifts. After the work, nurses are required to have a day off the work to refresh themselves and get energy for the next day. According to the reports by the American Nursing Association, working overtime increases the burnout and fatigue among the nurses making them unable to fully concentrate on their job ( Stimpfel, Brewer & Kovner , 2015). Improving the quality of the care, therefore, require that the nurses work normal hours and have sufficient time to rest and energize.
Recent studies have also shown that working for more than 40 hours a week can lead to serious cognitive impairment as a result of the fatigue. The cognitive impairment has always been associated with increased adverse events and medical errors that can harm not only the patients but also the nurses themselves. When a nurse works for long hours, their concentration levels reduce,and this increases the chances of minor medical errors such as needlestick injuries ( Stimpfel, Brewer & Kovner , 2015). Such errors decrease the quality of the care and impact the health outcome of the patients. According to the HCAHPS survey, patients tend to feel less satisfied with the kind of care they receive when a nurse works more than 13 hours in a day. According to the study conducted by the Interdisciplinary Nursing Quality Research Initiative, reducing the number of hours that nurses’ work can help improve the patients’ satisfaction, quality of care and reduced readmissions ( Stimpfel, Brewer & Kovner , 2015). The study further shows recommends that increasing the number of registered nurses working in a hospital rather than having a small number working for longer hours tend to increase the safety and quality while also promoting the satisfaction of the patients. Mandatory working hours is, therefore, a significant area of concern within the health care sector because it directly affects the quality of the care.
Reduced Job satisfaction and Retention
According to the report published in the Journal of American Nurse Association, when nurses work for longer hours against their choice, they are more likely to get tired, depressed and reduced morale as well as greater job dissatisfaction. When nurses get stressed and resentful due to forced overtime, they are more likely to seek a job somewhere else where they will work the normal hours. This has a direct impact on the retention rates amid the shortage of staff within the health care sector. According to the report published in the Health Affairs Study, nurses who are forced to work more than 40 hours a week are more likely to get dissatisfied with their job and develop the desire quite ( Cho et al., 2015 ). The same study shows that a nurse who works more than 12 hours in a shift is two times more likely to quit within the next one year after taking the job, and this causes a ripple effect due to the patients’ dissatisfaction.
Maintaining a healthy work-life balance is one of the most important things not only in the nursing profession but to all human beings. Even as people work, they also value family and needs some time to spend with their family members. Mandatory overtime intrudes into the free time the nurses can have with their families,and this affects their work-life balance. The result is increased stress, dissatisfaction and desire to quit. According to a study conducted in 2014, the healthcare institutions that have limited the working hours to 40 in a week reported increased job satisfaction and high retention rates ( Han, Trinkoff & Gurses, 2015 ). Just like any other professionals, the nurses have a life outside work and needs some free time to rest and stay with their family members.
Increased Costs
Even as the health care costs in the United States continue to rise, a report published by The New York City Health and Hospitals Corporation shows that it is expensive to pay the nurses for overtime every week as compared to hiring the more staff. In some instances, nurses make more money in overtime than they do in the annual wage. The health care institutions continue to incur more costs when paying weekly overtime for the nurses. At the same time, reduced retention means these institutions must constantly seek to replace the nurses who have left, another area which adds costs.A study conducted in 2015 shows that health care institutions can save up to 30% on funds if they limit the number of working hours to 40 a week and then hire more staff to fill the understaffed sector (Cho et al., 2015). As a result, mandatory overtime adds costs to already the most expensive healthcare sector in the world.
Conclusion
Many studies have found the issue of mandatory overtime on the nurses to have effects on the overall quality of the care and satisfaction of the patients as well as reduced retention. The key focus on the health care system should be to deliver quality and not quantity. Forced overtime ensures that a single nurse attends to a large number of patients, but with reduced quality and increased chances of readmission. It is undoubtedly true that the health care system is understaffed, but the solution is not to force nurses to work for longer hours because evidence has shown that it decreases efficiency and effectiveness. Instead, the health care institutions should properly plan for their staffing needs and strike a balance that will ensure there is enough staff.
References
Bae, S. H., Kelly, M., Brewer, C. S., & Spencer, A. (2014). Analysis of nurse staffing and patient outcomes using comprehensive nurse staffing characteristics in acute care nursing units. Journal of Nursing Care Quality , 29 (4), 318-326.
Cho, E., Lee, N. J., Kim, E. Y., Kim, S., Lee, K., Park, K. O., & Sung, Y. H. (2016). Nurse staffing level and overtime associated with patient safety, quality of care, and care left undone in hospitals: a cross-sectional study. International journal of nursing studies , 60 , 263-271.
Han, K., Trinkoff, A. M., & Gurses, A. P. (2015). Work‐related factors, job satisfaction and intent to leave the current job among United States nurses. Journal of clinical nursing , 24 (21-22), 3224-3232.
Stimpfel, A. W., Brewer, C. S., & Kovner, C. T. (2015). Scheduling and shift work characteristics associated with risk for occupational injury in newly licensed registered nurses: an observational study. International journal of nursing studies , 52 (11), 1686-1693.
