Introduction
The issue of mandatory overtime has evoked divergent reactions from key stakeholders in the nursing fraternity. Mandatory overtime for nurses has been one of the factors attributed to the heightened exit of nurses in the healthcare sector. The concept of overtime implies that nurses in their line of work exceed the hours agreed upon to complete certain tasks. Therefore, mandatory overtime in nursing indicates that the predetermined and regularly instituted work schedule, policies, contract provisions, and policies and procedures are altered (American Nurses Association, 2015). A section of nurses perceives the mandatory impositions as inhibitors to their efficiency and satisfaction in the workplace. Other nurses view it as a means of improving their earnings from the overtime rates provided for by the law. Additionally, other issues like family and work balance, compensation, quality of service, and patient safety have triggered new developments regarding mandatory overtime in nursing. This paper will focus on mandatory overtime as a current issue in nursing. The paper reflects on the effects of overtime on healthcare policy, its influence on the nursing practice and clients’ satisfaction, related policies in healthcare, and its impact on future nursing practices.
Purpose of the paper
This paper is geared towards understanding the underlying issue of mandatory overtime in the nursing profession. Therefore, the triggering factors for the development of the problem would be assessed. This aspect infers to issues like adequacy of nurses, increased rates of patients, emergencies, and scheduled practices. Moreover, the relation of the policy in nursing and its implications for both the needs of the clients and the providers would also be essential for the paper. This part would focus on the efficiency of the nurses and the delivery of quality services to patients regardless of the overtime pressure. Furthermore, the compatibility of the organizational policy regarding other related policies in the nursing industry would be covered to elucidate the elements of legislation on the matter. In this respect, the laws in various states in the US since 2001 would be considered. Therefore, the basis of the paper would be on the key underlying issues for the trend concerning the policies that ensure quality service provision in the nursing profession.
The development of the paper would consider the background elements of the issue of mandatory overtime as experienced in healthcare organizations. The contextual aspects of the current issue depict that nurses and patient outcomes have been undermined due to the understaffing inefficiencies that trigger mandatory overtime in the nursing practice. The American Nursing Association (2015) holds that mandatory overtime has resulted in inefficiencies in the nursing practice over the past decade. Therefore, mandatory overtime is regarded as an unsustainable solution to the problem of understaffing in nursing organizations.
The implications of mandatory overtime on nursing policy
Policies regarding staffing and client satisfaction in the nursing sector are directly or indirectly subject to the rising cases of mandatory overtime in various organizations. For this reason, the issue has been an increasing challenge for nurses in hospitals due to the direct and indirect implications of patient care standards and nursing job satisfaction. The US laws recognize 12-hour working shifts between 0900 hours and 1700 hours. In the case that the nursing staff members are engaged in more than 12 hours of work in a day they experience inadequate rest and sleep. Sleep deprivation due to overtime work schedules evokes fatigue, which leads to difficulties in neurobehavioral operations such as impaired attentiveness and vigilance, decision-making ability, and reduced reaction time. Lengthy working schedules without adequate rest have subjected both patients and nurses to incompatible implications and practices with the nursing policy provisions (American Association of Critical Care Nurses, 2015).
The issue of overtime infringes the stipulations established by the American Nursing Association Policy and Provisions of Health Reform Law. The American Nurses Association (2010) requires all patients to be provided with standard packages of essential health services. Poor quality parent care undermines the efficiency of this provision, thus affecting the policy directly. Besides, the body requires effective, patient-centered, timely, and efficient nursing services to all patients with an equal approach. The mandatory overtime impositions by various hospitals compromise the provisions of the American Nurses Association thus affecting the nursing profession.
Relationship between mandatory overtime and nursing
In almost all the sectors of a particular economy, issues of overtime have been a common trend whereby employees are required to extend their services past the regular working hours. In the recent past, the field of nursing has witnessed concerns over the implications of mandatory overtime resulting in proposals for banning the practice in hospitals. However, the issues of understaffing and the continued patients’ needs that transcend the average working hours have led to increased cases of mandatory overtime among nurses (Bae, 2013).
The American Nursing Association (2015) position statement on the overtime issue requires nurses to work past the regular working hours. In times of disasters, nurses are allowed to be released as sections of organized medical teams that endeavor in healthcare services in such cases. However, the autonomy of the nurses should be considered in response to such calls for duty during disasters.
Nursing professionals are required to consider their level of fatigue before accepting to work overtime. Mandatory overtime from the management violates the professionals’ rights, thus leading to the tendency of erratic procedures (Huston, 2013). Therefore, the issue of mandatory overtime violates the rights of nurses since they usually get the notice an hour before the extension of the working schedule after 12 hours of working.
Literature Review
The subject of overtime in nursing has been researched and the results published in journal articles, books, and online platforms to address the issue. Nelson and Kennedy (2008) regard mandatory overtime in the nursing sector as a management tactic of maintaining profitability. Usually, nurses are required to work past the 12 hours when understaffing occurs. However, some managers opt to “flex down” the workforce with the idea that hospitals are overstaffed when the patients record a low census. The routine cancelation of scheduled shifts implies that nurses do not receive the payment unless they decide to use their vocational time to recover the unpaid wages. Therefore, the issue of mandatory overtime should also be viewed from the management’s perspective of ensuring financial sustainability at the expense of the satisfaction of the nurses. The issue of understaffing and overstaffing due to varying patients’ census can be regarded as the little secret behind mandatory overtime and “flexing down” as a means of maximizing their benefits. Therefore, the implication is that nurses are denied their rights for working in fair conditions that consider their schedules and remuneration.
Bae (2013) validates the existence of mandatory overtime in healthcare organizations and its implications for both nurses and patients. Bae (2013) sought to examine the relationship of the aspects of mandatory overtime regulations in nursing, the nurses’ injuries, and adverse patient effects. Secondly, the study majored on the impact of mediating the nurse overtime issues concerning the correlation between the regulations and outcomes after controlling other attributes of the nursing practice. The results found that 15.6% of RNs that engaged in mandatory overtime were either paid or unpaid (Bae, 2013). Thirty-four percent (34%) voluntarily offered their services in overtime shifts that were either paid or unpaid, while 32% of the nurses experienced on-call hours. Therefore, 60.1% of all nurses engaged in overtime either on-call, voluntarily, or mandatory at a given time. Bae (2013) postulates that the two commonly experienced nurse injuries due to mandatory overtime are bruises at 49.7% and verbal abuses at 56.6 %. Around 79.2% of all nurses experienced one of the injuries. On the issue of adverse implications of mandatory overtime, the attributed medical errors were at 44.5% while 38.2 % accounted for patient falls (Bae, 2013). Indeed, the results depict that mandatory overtime is imposed as one of the hospital regulations that have adverse implications for both patients and nurses.
According to Olds and Clarke (2010), it is evident that nearly all the adverse effects and errors in medication administration are related to working for a period exceeding 40 hours in a week. Olds and Clarke (2010) observe that needle-stick injuries and medication errors are related to the working duration and overtime variables. Additionally, nosocomial infections and patients’ falls with injury are due to mandatory overtime regulations.
The influence of mandatory overtime on clients’ healthcare needs and nursing practice
Mandatory overtime influences the way the healthcare needs of clients are addressed coupled with how nurses offer their services. Therefore, the clients’ healthcare needs, reduced satisfaction, heightened adverse events, and patient mortality among others affect the quality of care (Huston, 2013). As illustrated earlier, the influence is due to the nurses’ fatigue and impatience with hospital management due to the imposition of mandatory overtime regulations.
Mandatory overtime provisions also influence the practice of nursing in various ways that portray adverse implications. The issue induces nurse fatigue, decreased job satisfaction, poor performance, reduced absorption and retention, and increased nurses’ litigation concerning working conditions. Additionally, job-related injuries (sleep disturbances, needle-stick injuries, and musculoskeletal problems), and chronic illnesses (diabetes, hypertension, and heart complications) are common (Nelson & Kennedy, 2008). Therefore, the trending issue in nursing evokes adversities to the nursing practice thereby influencing proposals to mitigate the issues.
The implication of future nursing practice
The implications of mandatory overtime in the nursing profession are both short and long-term. This assertion holds due to the policymakers’ move to encourage voluntary overtime, which is either paid or unpaid to curb the adverse effects of both the nurse and the patient (Olds & Clarke, 2010). Legislation against exploitative overtime regulations is on the verge of being increased despite the understaffing cases in various hospitals.
Halting the vicious cycle of mandatory overtime is also essential for securing the future of nursing. Burnout induced by chronic overtime needs to be stifled to break the savage cycle that would render the nursing practice ineffective in the future (Huston, 2013). Therefore, breaking the harmful cycle of mandatory overtime in nursing should enact laws to curb the problem and plan strategically to ensure adequate nurses.
Policies closely related to mandatory overtime
The Joint Committee on Administrative Rules provides a policy that seeks to prohibit mandatory overtime in the nursing field. The policy requires nurses to avoid working overtime unless in cases of unforeseen circumstances. Additionally, the American Nursing Association (2015) developed a policy to protect the nursing fraternity from mandatory overtime events and enhance efficiency. The policy aims at safeguarding the interests of the clients and nurses by discouraging the imposition of mandatory overtime.
Conclusion
Current issues such as mandatory overtime have been trending due to the increased cases that portray detrimental results to both the client and the nurse. Thus, the issue affects the practice of nursing and client satisfaction directly. Nurses are subjected to long working hours that induce fatigue, injuries, patient falls, and other hazardous events in hospitals. Since 2001, the federal government in the US has put policies forward to prohibit mandatory overtime in the nursing field. The implications of the issue influence the current satisfaction of clients and the quality of care. This aspect implies that the future of nursing has to end the trend to promote quality healthcare provision. The issue is related to healthcare policies such as the Nurses Practice Act and the ANA provisions. In conclusion, the prevalence of mandatory leave has been attributed to the varying patients’ numbers that cause understaffing and overstaffing. Ensuring the adequacy of nurses is essential to alleviate the increasing mandatory overtime cases in hospitals.
References
American Association of Critical Care Nurses: Mandatory Overtime. (2015). Web.
American Nurses Association: ANA Policy & Provisions of Health Reform Law. (2010). Web.
American Nurses Association: Overtime Issues. (2015). Web.
Bae, S. (2013). Presence of Nurse Mandatory Overtime Regulations and Nurse and Patient Outcomes. Nursing Economics, 31(2), 59-68.
Huston, C. (2013). Professional Issues in Nursing: Challenges and Opportunities. Philadelphia, PA: Lippincott Williams & Wilkins.
Nelson, R., & Kennedy, M. (2008). The Other Side of Mandatory Overtime. American Journal of Nursing, 108(4), 23-24.
Olds, D., & Clarke, S. (2010). The Effect of Work Hours on Adverse Events and Errors in Health Care. Journal of Safety Research, 41(2), 153–162.