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Nurses’ Response to Mandatory Overtime

While no statistical studies to date directly measure the impact of mandatory overtime on recruitment and retention,234 the evidence concludes that this practice has a negative effect on hospital vacancy and turnover rates. Nurse newsletters across the country have recorded complaints about mandatory overtime.235 Furthermore, forced overtime appears to heighten health risks for nurses. While little scientific research directly focuses on mandatory overtime, substantial literature exists on the harmful effects of nurses working rotating night shifts, conditions generally similar to those of mandatory overtime. A study by the National Institute of Occupational Safety and Health found that when compared to regular-shift nurses, those working rotating night shifts consistently showed worse physical and psychological health, lower job satisfaction, and worse (self-rated) job performance.236 Other studies have shown that workers rotating night shifts experience higher rates of cardiovascular and gastrointestinal disorders, as well as higher work-related injuries.237 One analysis found that nurses working rotating night shifts had twice as many errors and accidents at work or while driving home as did nurses working regular shifts. These nurses also suffered from poorer quality of sleep and were more likely to nod off while driving to or from work. More than one-third of nurses working rotating night shifts reported that they nodded off at least once a week while on the night shift, as did 32.4 percent of permanent night shift nurses; by contrast, only 2.8 percent of regular day- or evening-shift nurses suffered from this problem.238 In addition, one expert argues that mandatory overtime increases nurses' risk of prolonged exposure to chemical hazards, exposure to infectious agents, and ergonomic stresses.239

In addition to these safety concerns, regular overtime work has been shown to lead to the types of stress and burnout that so many nurses already experience.240 Frequent mandatory overtime is one of the top five factors leading to increased stress, and 62 percent of employees who regularly work overtime shifts find their jobs highly stressful, compared with only 34 percent of employees working regular hours.241 Nurses in jobs with high demand, low control and poor institutional support have been shown to suffer declines in health status as significant as those associated with smoking or sedentary lifestyles.242 One study tracked 79,000 nurses for more than four years and found a significantly higher risk of coronary heart disease for women doing shift work.243

Beyond the simple negative effects of overtime work in general, additional problems mount when overtime is imposed against employees' will. One recent study examined the impact of employees' lack of control over work schedules on a range of personal and psychological health measures. In general, working longer hours added to problems both at work and at home — and these problems were worse for women and for single parents. Independent of one's work schedule, however, "lack of schedule control significantly increases the lack of work-home balance, burnout, distress, dissatisfaction, poor general health, and minor physical problems."244 "Control over scheduling matters a great deal," researchers concluded. "Of the eight family and health outcomes examined ... control over scheduling had highly significant positive effects on six."245

The severity of the burdens imposed by mandatory overtime is reflected in the growing incidence of strikes related to this practice. In recent years, nurses in Michigan, Ohio and Pennsylvania (all represented by AFSCME) have been out on strike over the issue of mandatory overtime.246

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