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Use of Overtime for Nurses Continues to Rise

In spite of the recognition that long hours of nurse overtime can jeopardize patient care, cause burnout and increase turnover, many hospitals still force nurses to work beyond their scheduled hours as a way to fill staffing shortages. Although some states have enacted laws that prohibit the use of mandatory overtime (see related article on Illinois), it is routine in others. To look at how pervasive the problem is, the Agency for Healthcare Research and Quality funded a study to analyze the use of overtime. The study used data from 1995 to 2002 from non-federal acute care hospitals in New York to analyze trends in overtime for RNs and to examine the association of those trends with other variables, including base staffing, RN wages and hospital characteristics. The results were published in August in the journal Policy, Politics and Nursing Practice.

From 1995 to 2002, overtime increased from an average of 3.9 percent of total hours to 5.9 percent, but there were variations according to the locations and types of hospitals:

  • Urban hospitals increased their use of overtime more than rural hospitals.
  • Overtime grew much more rapidly in non-teaching hospitals than in major teaching hospitals.
  • Government hospitals had the lowest use of overtime of any ownership category and continued to use little overtime during the study period.
  • Nonprofit hospitals increased use of overtime from 4.0 percent in 1995 to 6.1 percent in 2002.

Both union and nonunion hospitals showed an increase in the use of overtime. Nonunion hospitals increased use of overtime from 3.5 percent in 1995 to 4.7 percent in 2002, while union hospitals increased their use of overtime from 4.2 percent to 6.0 percent during the same period. Interestingly, the study authors concede that these numbers may not accurately reflect the overtime in these hospital categories. Because the study measured only paid overtime hours rather than all hours worked beyond the standard work week, there could be systematic bias in the reporting of overtime hours. "Union contracts are likely to have strict definitions of overtime and unionized nurses would be encouraged to report and get paid for all overtime while nurses in nonunion hospitals may work extra time without reporting it."

The authors expressed concern about the significant growth in overtime use, particularly since 12-hour shifts have become more widespread. Overtime combined with 12-hour shifts puts nurses over the limits that the Institute of Medicine has suggested may affect performance and threaten patient safety.

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