Limiting Overtime, Overall Hours Considered Key to Patient Safety
A newly published study finds that state-mandated caps on nurses’ mandatory overtime hours are working, reducing overtime hours for newly registered nurses in the affected states. Past research has demonstrated that fatigue caused by long hours without sufficient rest between shifts can lead to mistakes that imperil both patients and nurses.
This new study is part of the RN Work Project, funded by the Robert Wood Johnson Foundation, a ten-year longitudinal study of newly licensed registered nurses (NLRNs) that began in 2006. The RN Work Project is designed to learn more about nurses’ career patterns, including turnover. The overtime study draws on data from nurses in 34 states, covering 51 metropolitan areas and nine rural areas. It is published in the online edition of Nursing Outlook.
Lead investigators for the study were Sung-Heui Bae, PhD, MPH, RN, assistant professor at the School of Nursing, University at Buffalo; Carol Brewer, PhD, RN, FAAN, professor at the School of Nursing, University at Buffalo; and Christine Kovner, PhD, RN, FAAN, professor at the College of Nursing, New York University. Kovner and Brewer direct the RN Work Project.
“The purpose of capping mandatory overtime is to make hospitals safer for patients and nurses,” said Brewer. “Nurses routinely work long shifts, often as long as 12 hours straight. These laws were intended to prevent hospitals from piling mandatory overtime on top of such shifts, a practice that research shows can increase the likelihood of mistakes. The laws seem to be accomplishing their objective.”
According to the study, 16 states had rules restricting mandatory overtime hours for nurses as of 2010—Arkansas, California, Connecticut, Illinois, Maryland, Minnesota, Missouri, New Jersey, New Hampshire, New York, Oregon, Pennsylvania, Rhode Island, Texas, Washington and West Virginia. At issue in the study was the extent to which those laws or regulations had actually affected the workplace. Researchers examined NLRNs’ self-reported mandatory and voluntary overtime hours, as well as their total work hours to find the answer.
They found that in the states with rules governing mandatory overtime, NLRNs were 59 percent less likely to work mandatory overtime than their colleagues in unregulated states. (Not all states with overtime rules prohibit mandatory overtime; some simply limit total work hours.) Overall, 11.6 percent of nurses said they worked mandatory overtime in a typical work week, averaging 6.1 hours of mandatory overtime.
In addition, in the states regulating overtime, NLRNs worked an average of 50 fewer minutes per week than their colleagues in states without overtime regulations.
Researchers anticipated that caps on mandatory overtime might lead to increased voluntary overtime, thus defeating, to at least some degree, the purpose of the restrictions. But the data demonstrated no relationship between mandatory and voluntary overtime hours. Nevertheless, more than 50 percent of NLRNs reported working voluntary overtime in a typical work week.
“While safety is the principal objective of caps on mandatory overtime, the laws probably also have a positive effect on nurse retention,” said Kovner. “Nurses have lives and families outside the workplace just like everybody else, and they probably prefer to have a schedule they can rely on. One way to make their jobs and lives more manageable is to avoid mandatory overtime, which should lead to nurses staying in their jobs, and indeed, in the profession longer. That’s particularly important in light of the looming nursing shortage. Every nurse who stays in the profession is one fewer nurse we need to recruit.”
“It’s important to policymakers to understand the impact of the remedies they devise for particular problems,” said Bae. “In this case, the states developed caps on mandatory overtime with safety issues in mind, reasoning that fewer mandatory overtime hours would translate into fewer hours overall. What we learned in this study is that it’s working. The tool is effective. Other states with similar objectives can follow suit and expect similar results.”
The RN Work Project is the only multi-state, longitudinal study of new nurses’ turnover rates, intentions and attitudes – including intent, satisfaction, organizational commitment and preferences about work. To date, researchers have learned that more RNs work in hospitals than any other settings early in their careers – nearly nine in ten (88.3 percent) work in hospitals six to 18 months after being licensed and 78.8 percent work in hospitals 31 to 54 months after licensure. The study has also revealed that nearly one in five (18.1 percent) new nurses leave their first employer within a year of starting a job and more than one in four (26.2 percent) leave within two years. Nine in ten of those who leave stay in the nursing field.
Subsequent studies will determine why nurses stay in or leave their jobs, what influences their first job choice, how the job settings they work in vary over time, and whether they move in and out of nursing.
The NYU College of Nursing is a global leader in nursing education, research, and practice. It offers a Bachelor of Science in Nursing, a Master of Arts and Post-Master’s Certificate Programs, a Doctor of Philosophy in Research Theory and Development, and a Doctor of Nursing Practice degree. For more information, visit www.nyu.edu/nursing.
The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable and timely change. For 40 years the Foundation has brought experience, commitment and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. For more information, visit www.rwjf.org.