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Worst Practices: Mandatory Overtime

Unfortunately, although some hospitals have moved to adopt best practices for improving recruitment and retention, too many others have moved in the opposite direction. Perhaps the most troubling development is the increasing prevalence of hospitals that use mandatory overtime as a staffing solution. Presumably, hospital administrators believe that the imposition of mandatory overtime will save money by limiting recruitment and benefit expenses. However, multiple studies have shown mandatory overtime to be perhaps the single worst practice to emerge from the era of downsizing and managed care. Mandatory overtime is almost universally banned by magnet hospitals. The imposition of mandatory overtime is a factor that discourages nurses from accepting employment and encourages existing nurses to think about leaving. In addition, the evidence suggests that mandatory overtime is likely linked to a host of patient problems. Finally, while mandatory overtime may be thought of as a cost-saving measure, it often generates very large costs, even if sometimes unaccounted for, in the form of increased turnover, lower productivity, longer patient stays, and higher rates of treatment errors that in turn necessitate more extended and costly solutions. 


The increased imposition of mandatory overtime is one of the most common developments nurses reported in the ANA national survey, with one-third of nurses stating that they have personally been forced to work involuntary overtime during the past two years.230 Participants in AFSCME's 2001 Nurse Congress cited the routine use of mandatory overtime as one of their highest priority concerns.231 Similarly, when the AFT conducted a survey on mandatory overtime in 2001, researchers found that 75 percent of nurses regularly worked overtime. Nearly half of that number were required to work at least part of their hours, and another 32 percent felt that they "had to stay" whether or not they were officially required to do so.232 Most nurses, in fact, do not have a choice but to stay even when they are exhausted because employers threaten discipline, termination or even loss of licensure when an employee refuses to work overtime. One source advises nurses to just "say no" when they are too tired to work safely, but to be prepared to be terminated from their job for refusing mandatory overtime.233

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