Exhausted, Overworked Caregivers Can't Give Quality Patient Care.

For years, studies have documented that long work hours in health care facilities lower the quality of care and put patients at risk of injury or death. A 1992 study in the American Journal of Public Health reported that nurses who worked variable schedules (including mandatory overtime) were twice as likely to report errors or accidents related to sleepiness.(1) In its groundbreaking report in 2000 entitled To Err is Human, the Institute of Medicine estimated that between 44,000 and 98,000 patients die in hospitals each year as a result of medical errors.(2) In a follow up study issued last year, the IOM reported that “the number of hours worked has been identified as a contributing factor to the commission of errors by nurses,” and cited one study that “found that shift durations of greater than 12 hours were significantly associated with increased errors among nurses.”(3) Two other studies have demonstrated that overtime is linked to infection outbreaks in hospitals.(4)

Long work hours and mandatory overtime for health care workers are growing problems in Pennsylvania, and legislative action in this area is overdue. According to an independent poll conducted in 2001, Pennsylvania nurses work an average of 7 and 2/3 weeks of overtime per year.

Banning mandatory overtime except in cases of real emergencies will go a long way toward eliminating deadly medical errors and eliminating the nursing shortage.

Mandatory Overtime is Overused

A recent Hospital Association of Pennsylvania study confirms that 97% of Pennsylvania hospitals use overtime to fill vacancies on a regular basis. But when caregivers are forced to work 16, even 20 hour shifts, deadly mistakes can be made.

• According to a recent report by the Pennsylvania Department of Health’s State Health Improvement Plan4, combining data from surveys taken in conjunction with RN licensure renewals in April and October of 2002 and 2003, found that41.8% of RNs in state inpatient facilities, 15% in hospitals, 12.1% in nursing homes had been forced to work overtime in the previous two weeks. The number was 12.6% for RNs overall, or 1 in 8.

• 36% of LPNs in state inpatient facilities, 11.8% in hospitals, and 11.4% in nursing homes reported mandatory overtime; 10.2% for LPNs overall

Mandatory Overtime Is Fueling the Nursing Shortage

Mandatory overtime contributes to the nursing shortage. Many nurses and other caregivers choose to leave their profession because they are unable to give patients high quality care. Family pressures are also a factor, as many health care workers are unexpectedly required to work additional hours beyond their shift, forcing them to choose between their job and their family.

Frontline health care workers today are working harder and longer, caring for patients that are sicker than ever (thanks to managed care hospital admission criteria).As working conditions have deteriorated, health care professionals have voted with their feet by leaving the bedside. Nearly 1 in 4 RNs in Pennsylvania have already left nursing, the highest dropout rate of any state in the country.(5) According to the recent Department of Health licensure renewal survey, nearly half of RNs employed in health care in Pennsylvania plan to leave nursing in the next ten years, and 21% anticipate leaving the field nursing in the next five years. In a very telling statistic, what the report describes as a “surprising portion” of young nurses are planning to leave – 27.6% of nurses under age 35 anticipate getting out of the field within the next decade.(6) The survey’s licensure renewal statistics tell a similarly striking story of young nurses burning out and leaving the profession: a higher percentage of nurses aged 25-29 and 30-34 failed to renew their licenses (16.6% and 14.3% respectively) than in any other age groups except nurses 65 and older.(7)

• 25.7% of RNs reporting mandatory overtime also said they were dissatisfied with their jobs, compared with 13.8% of RNs who didn’t report mandatory overtime who said they were dissatisfied with their jobs.
• Among LPNs these figures were 23.4% and 14.2% respectively.

(1) “Rotating shift work, sleep, and accidents related to sleepiness in hospital nurses,” DR Gold, S Rogacz, N Bock, TD Tosteson, TM Baum, FE Speizer, and CA Czeisler. American Journal of Public Health 1992 82, pp. 1011-1014.

(2) Institute of Medicine, To Err Is Human: Building a Safer Health System. Linda T. Kohn, Janet M. Corrigan, and Molla S. Donaldson, editors. Washington, 2000, p. 26.

(3) Institute of Medicine, Keeping Patients Safe: Transforming the Work Environment of Nurses, Ann Page, editor. November 2003, pp. 43-44.

(4) Studies by Arnow, et al., and Russell, cited in Economic Policy Institute, “Time after Time: Mandatory overtime in the U.S. economy,” Lonnie Golden and Helene Jorgensen, January 2002, p. 9.

(5)Health Resources and Services Administration, National Sample Survey of Registered Nurses, cited in Legislative Budget and Finance Committee, Pennsylvania’s Response, , p. 18.

(6) PA Department of Health, Special Report, p. 63.

(7) PA Department of Health, Special Report, p. 72.

Health care workers in acute care hospitals, nursing homes and state health facilities: In a Pennsylvania Department of Health survey, 42.9% of RNs in state inpatient facilities, 21% in military and federal facilities and 15.2% in hospitals reported mandatory overtime. More facts on how mandatory overtime hurts all health care workers.

The industry itself: Health care facilities spend tens of millions of dollars each year — most of which comes directly from taxpayers — on recruitment and training costs associated with high staff turnover. Long work hours and mandatory overtime are key contributing factors to job dissatisfaction and staff turnover.