Publications

Worst Practices: Mandatory Overtime

The single most troubling development in nurse workloads is the prevalence of hospitals that use mandatory overtime as a staffing solution. As of 2001, 75 percent of nurses regularly worked overtime, and nearly half of those hours were mandatory.18

The vehemence of nurses' dissatisfaction with this practice is evident in the growing incidence of nurses' strikes that have been prompted by the issue of mandatory overtime.19

Both nurses and hospital administrators point to mandatory overtime as a leading cause of turnover among nurses. Joint Commission on the Accreditation of Healthcare Organizations President Dennis O'Leary notes that 22 percent of nurses who leave direct care work do so in search of "more regular hours."20

Further, forced overtime increases health risks for nurses on the job. Finally, mandatory overtime work leads to the types of stress and burnout that so many nurses already complain of.21 O'Leary thus warns: "Health care organizations face competition from employers who offer nurses the chance to work a regular business week. No nights. No weekends. No mandatory overtime."22

Mandatory Overtime: The Threat to Patient Care

Beyond its impact on nurses, mandatory overtime also poses increased risk for the quality of patient care. The Institute of Medicine's landmark To Err Is Human study estimated that at least 44,000 Americans — and possibly as many as 98,000 — die each year as a result of hospital medical errors.23

Recently, the Chicago Tribune published the results of an investigation into the relationship between short-staffing of hospitals — including the use of mandatory overtime — and medical errors leading to patient deaths. The newspaper's staff found,


Since 1995, at least 1,720 patients have been accidentally killed and 9,584 others injured from actions or inaction of registered nurses across the country, who have seen their daily routine radically altered by cuts in staff. ... deteriorating, oppressive workplace conditions — from mandatory overtime to stagnant pay — have made hospital jobs less appealing ... nurses sometimes [are] too overworked to adequately care for patients.24

Thus, evidence from nurses, administrators and academics alike all points to the dangers of this practice for nurse satisfaction, hospital management, and patient safety.

Print Version