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Too Tired to Care: Research focuses on overtime policies for overworked nurses

Posted: July 30, 2014

As politicians and policymakers wrangle over the Affordable Care Act, and health care providers brace for an expected influx of previously uninsured individuals demanding access to medical services, one issue gets lost in all the noise: how will already overworked, overtired nurses handle the increasing patient load?

In 1999, the Institute of Medicine published “To Err Is Human,” a report stating that up to 98,000 people a year die because of mistakes in hospitals. A report in the September 2013 issue of Journal of Patient Safety said that number may be much higher, with between 210,000 and 440,000 hospitalized patients each year suffering some type of preventable harm that contributes to their death.

That would make medical errors one of the leading causes of death in the United States.

Recent surveys of nurses have found a link between heavy workloads — coupled with insufficient staff — and adverse patient outcomes. Nurses working long hours often experience fatigue, poor sleep quality, impaired vigilance and lack of alertness. As a result, the chance of medication errors increased. Click here to view the recent surveys on "Nurses in the Workplace: Expectations and Needs" posted on International Council of Nurses (ICN) webpage.

Dr. Sung-Heui Bae

Sung-Heui Bae, PhD, assistant professor

In the past, mandatory overtime for registered nurses was a practice used by many hospitals and other clinical settings to maintain adequate numbers of staff nurses. Under forced overtime, nurses were unable to refuse required extra hours due to fatigue or feeling that they would be unable to deliver adequate, safe patient care.

Responding to the growing safety concerns, several states recently passed legislation placing a cap on overtime hours and established a consecutive work hour policy, by which nurses may not work more than 12 hours during a 24-hour period.

But is legislation enough to ensure improved safety and patient outcomes?

A recent study on the impact of overtime practices and work hours on registered nurses found that the policy of banning mandatory overtime does in fact lead to a reduction in the likelihood of nurses working more than 40 hours per week.

“This suggests that such policies can be successful in preventing nurses from working extended hours and thereby promote safer conditions for both patients and health care staff,” said Dr. Sung-Heui Bae, co-author of “Impact of States’ Nurse Work Hour Regulations on Overtime Practices and Work Hours among Registered Nurses.”

However, there are concerns, Bae said. In order to maintain their income, some nurses are volunteering for overtime or working additional jobs, and hospital administrators are allowing this practice despite the safety issues.

“In spite of the success of caps placed on consecutive hours worked and mandatory overtime, hospital administrators and nurse managers are failing to address the impact that long hours make on nurses and, ultimately, patient well-being,” Dr. Bae said. “What is needed is a change in the culture, in which administrators closely monitor how many hours they themselves work and how many hours they allow their staff to work.”

The article “Impact of States’ Nurse Work Hour Regulations on Overtime Practices and Work Hours among Registered Nurses” (PDF) was recently published in the journal Health Services Research. Authors are Sung-Heui Bae, PhD, assistant professor, University of Texas at Austin School of Nursing; and Jangho Yoon, PhD, assistant professor, Oregon State University College of Public Health and Human Sciences.