According to Trinkoff (2007), mandatory overtime has long term negative effects on the health of the nurse as well, who usually does not have the option simply to decline these extra hours. The nurse who is mandated for overtime often faces termination if she fails to comply, and according to the American Nurses Association (ANA Board of Directors, 2009), may face the additional threat of being reported to the state nursing board for abandoning their patients, which also carries with it the implied threat of suspension or loss of their state nursing license.
In the past twenty five years the nation has faced a severe shortage of available nurses in the workforce, and “… (b)y 2005, roughly half a million U. S. registered nurses (about one fifth of the national total) had chosen not to work in nursing. ” (The Truth About Nursing, 2007) However, with the recent recession of 2008, nursing as a profession is beginning to look more attractive to a younger generation, and according to the Robert Wood Johnson Foundation (2012), nursing school enrollment is at an eight year high as of 2011, and many schools now have waiting lists to get into a nursing program (Rampell, C. 2012). There are several political stakeholders in this issue who are directly involved in seeing nurses’ overtime hours brought down to a reasonable level. Nurse and patient advocate groups and nurses’ unions are obviously concerned in the issue of mandatory overtime and in several states have brought the issue to their legislatures and helped to pass bills ending the practice; these include New York (Webber, N. , 2008), Texas (Texas Nurse Association, 2009) and Massachusetts (Massachusetts Nurses Association, 008). One of these advocacy groups is the above mentioned Robert Wood Johnson Foundation, the largest private health care advocacy foundation in the Unites States, research done on behalf of which finds that caps on nursing overtime directly benefit the patient (Robert Wood Johnson Foundation, 2012). Nursing unions generally would be expected to be vocal advocates for limiting overtime hours, and one study finds that overtime hours in nursing does in fact vary according to union membership (Berney, B. Needleman, J. , Kovner, C. , 2005). As early as 2000 the ANA House of Delegates has adopted an action “Opposing the Use of Mandatory Overtime as a Staffing Solution” (ANA Board of Directors, 2006), and supports the Safe Nursing and Patient Care Act, legislation at the federal level which would limit the number of overtime hours a nurse may be required to work. Policy Goals and Options The policy goal at hand is to decrease the use of mandatory overtime by hospitals to cover staffing shortfalls.
According to Fitzgerald (2012), although nurses nationwide have attempted to work with management to utilize new ideas for avoiding the use of mandatory overtime, over the years no solution has been found that is equitable to both parties. Failing in this, the nurses and their advocacy groups have applied to their state legislatures, with the American Nurses Association (2012) helping to introduce bills in 22 states limiting the use of mandatory overtime as a staffing tool, or for reasons other than certain specific and unforeseeable emergency conditions.
The goal of this new policy is to aid both nurse and patient, and the policy is demonstrably effective toward that end: according to the Robert Wood Johnson Foundation (2012), any documented decrease in mandatory overtime has led to a decrease in errors, in nurse injuries, and in the rate of burnout caused by mandatory overtime which, according to Garret (2008), is the number one reason why nurses have left the profession.
With both the reduction in burnout and the increase in nursing school applicants, healthcare institutions will have a larger pool of applicants to fill openings in their workforce, decreasing the shortage in general, and making the use of mandatory overtime as a staffing tool even less tenable. In spite of these advances, hospital administrations often work with staffing shortfalls due to budgetary constraints, leaving nurses overwhelmed by patient load and leading again to errors and burnout.
Another policy option that has helped in this regard has been the drive to enact laws which specify maximum nurse to patient ratios; California is the first state in the nation to enact such legislation, according to Kasprak (2004). One study by Aiken et. al. , (2010) has shown that a decreased nurse to patient ration leads to better outcomes for the patient in terms of decreased mortality, decreased infection rates, and increased patient satisfaction.
Garret (2008) notes that nurses with better patient ratios have fewer injuries, call out sick less, and are more likely to remain in the workforce, all of which tends to alleviate short staffing issues. This also benefits the hospital because staff turnover is an avoidable expense, and the Robert Wood Johnson Foundation (2009) estimates a cost to train each nurse of $32,000. 00 on average, a considerable expense to incur with any frequency. Evaluation of Options Nurses may be encouraged to work with employers to eliminate mandatory overtime through such options as flex staffing.
In the event of staffing shortfalls, agency or contract nurse staffing may be considered. According to Mongiello (2007) the cost to hire an agency or contract staffer is equivalent to hiring a new employee, and the employer retains the option of terminating the work relationship at any time. Nurse administrators should evaluate the cost of hiring additional employees against the expenses of mandatory overtime – including hidden costs. As noted, the estimated cost of training each nurse is an average of $32,000. 0, which figure does not include benefits. This may be set against not only direct payroll costs of overtime, but also costs of lost productivity from burnout which leads to high turnover. Finally, Pappas (2008) finds that, on average, a single nurse error costs $903. 00 per incident. Employers should be encouraged periodically to evaluate nurse job satisfaction, especially as related to overtime and its effects on employee retention, since it has been listed as a factor in their choice by nurses who leave the field (Tawoda, T. , 2012).
Job satisfaction among existing staff is a clear and direct path to avoiding high rates of turnover, and the subsequent costs of new hiring as detailed above. This would also give the employer the means by which to build a more experienced nursing staff, and to develop an ongoing employer/employee relationship, leading again to better staff retention and lower training costs. Recommended Solution The easiest and most viable option is for the employer to hire additional nurses, or to otherwise increase staffing levels through agency or contract staffing.
They will be aided in this by the growth of a new pool of graduate nurses subsequent to increased rates of attendance in nursing schools as noted above (Robert Wood Johnson Foundation, 2012). If employers fail to recognize the benefits in the reduced turnover, lower error rates, and higher patient and nurse satisfaction inherent in lower nurse to patient staffing ratios and lower incidences of mandated overtime hours, then in their own and their patients’ best interests, nurses should become active in the political process so that their concerns may be addressed at the legislative level as a regulatory issue.