Hospitals spin the wheel with mandatory OT, no one wins.
Your in the middle of your shift, the nursing supervisor comes over to the group of nurses working and asks if anyone would like to stay and “do a double”. There is immediate silence, each nurse looks at the other and almost unanimously everyone turns back to the supervisor and signals a resounding “no”. In response the supervisor declares that someone has to be mandated.
Mandatory overtime for nursing to meet staffing needs in hospitals has become less of an occasional incident and almost a daily occurrence with many healthcare organizations across the country. Hospitals are experiencing record capacity admission rates. Emergency departments (ED) are crowded not only with an endless stream of patients coming in the front door, they are crowded with patients that have been admitted to the hospital but there are no more beds.
Healthcare facilities are unable to staff their hospitals. Phone call after phone call goes out to hospital staff at home each day to ask nurses to come in on their off duty time to fill staffing “holes”. Most nurses are exhausted with today’s work pace in the hospital. The phone rings, caller ID shows the hospital is calling, no one picks up the phone and the all to familiar message is left – “…can you work tonight we had a sick call…”. Few return the call to meet the challenge and hospital supervisors are left with no other choice but to mandate a nurse that is already on duty to continue to work. An eight or twelve hour shift suddenly becomes sixteen hours.
Mandatory overtime is now the norm for many hospitals that are unable to provide adequate staffing levels. Supervisors say they are sorry, staff members are wary of the deed; patients if they knew about it would be scared. Statistics have constantly shown that nurses who work longer hours are more likely to make errors, about three times as likely.
“It’s unequivocal from studies in other industries that when people reach that period of 12 hours, they no longer function in their usual capacity and errors go up,” said Dr. Andrew Kramer, a member of the Institute of Medicine and head of the Division of Health Care Policy and Research at the University of Colorado in Denver
In the end patient safety gets sacrificed for a warm body on the schedule. Hospitals are deliberately tossing patient safety to the wind with mandatory overtime. They are needlessly requiring nursing staff to increase their liability by working extended hours. Hospitals are purposely putting patients in harms way.
Who will speak for patients when a medical error is committed because a nurse is so tired after already working a twelve hour shift? Who will speak for the nurse who committed the error because of mental fatigue after working 14 hours straight? In today’s volatile healthcare environment with insurers refusing to pay for preventable harm to patients how do hospitals justify this action? In the face of hospital transparency why do hospital administrators knowingly invite error to occur? What other options are left to hospital administrators and supervisors who are desperate to keep up with the demands of an over capacity census?
Travel nurses are temporary employees that go from hospital to hospital to augment organic staff levels. Simply put, these folks pick up the slack. Most travel nurses have a unique ability to jump right in and start working with little orientation time. Clearly these temporary employees are one answer. However travel nurses can significantly increase hospital expenditures with regards to payroll expenses. Travel nurse companies do not provide temporary support cheaply. Many hospitals’ fiscal health can not support a large cadre of travel nurses. That being said, some are better than none.
An alternative would be to spread the mandatory overtime out over a schedule period where known vacancies exist. Nursing personnel would be required to work on their days off but not with extended hours which is the common practice now. This option provides a safer environment for patients. Last minute sick calls and the like will always pose a staffing challenge, and finding solutions to them are likely to remain difficult.
At the end of the day, hospital leaders must work with nursing personnel to solve staffing issues equitably. The additional work hours for nursing comes at great cost to nurses and their families. Healthcare leaders need to be congnicent of the continued sacrifices that nurses make and provide compensation that demonstrates the appropriate level of gratitude. Furthermore, healthcare leaders must ensure patient safety and high standards of quality.
About the Author
Mike Pringle is the author of Healthcare Today where he offers commentary and insight regarding today’s healthcare issues. Additionally he provides regular commentary for Red Scrubs and editorial content for Future Healthcare. He has over 20 years of nursing experience working both domestically and internationally. Mike has a Bachelor’s Degree in Nursing and a Masters Degree in Public Administration with a Healthcare emphasis. He specializes in both Emergency and Critical Care Nursing. He currently works at Falmouth Hospital as a Shift Manager for the emergency department.
