Background
Nurses report a dramatic increase in the use of mandatory overtime to solve staffing problems and fear potential consequences for safety and quality of care for their patients. Nurses are fully cognizant and concerned about inadequate staffing. In addition, they are also resentful that they bear the personal, professional and legal burden for this problem that is perceived by nurses as a violation of their human rights. This practice causes the nurse to assume accountability and liability for potentially unsafe situations and/or loss of their employment.
Little research has been done to comprehensively evaluate overtime and its relationship to productivity, quality and safety provided in hospitals or the incidence of work place accidents, injuries and stress-related illnesses among nurses. There is limited research evaluating implications of extended/overtime work on health status health care workers (Samkoff and Jacques, 1991). The available research has, however, indicated a relationship between extended shifts and fatigue and generalized performance (Galinsky, et. al., 1993; Sawin and Scerbo, 1995; Pilcher and Huffcutt, 1996; Spurgeon, Harrington and Cooper, 1997). The absence of a solid research foundation on extended hours of work on nurses makes it easier to abuse the hours of work -- especially when work revolves around the care of vulnerable human beings with needs that span the full 24 hours in a day.
Nurses believe employer dependence on the use of mandating last-minute overtime, or of using peer pressure as a negative motivator, alleviates a sense of urgency or necessity to proactively find safer and more appropriate staffing. In fact, in some areas, (mandatory) overtime is used as a component of staffing models and the phrase "mandation" has been coined to define the methodology. Many nurses contend employers insist they stay for an extra shift (or more) or face dismissal for insubordination, as well as being reported to the state board of nursing (BON) for patient abandonment.
Provision 5 of the ANA Code of Ethics for Nurses with Interpretive Statements (2001), notes that "The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth." Interpretative Statement 5.4 continues and further states that "Where patterns of institutional behavior or professional practice compromise the integrity of all its nurses, nurses should express their concern or conscientious objection collectively to the appropriate body or committee. In addition, they should express their concern, resist, and seek to bring about a change in those persistent activities or expectations in the practice setting that are morally objectionable to nurses and jeopardize either patient or nurse well-being."
Definitions
Overtime is . . .
the hours worked in excess of an agreed upon, predetermined, regularly scheduled full-time or part-time work schedule, as determined by contract, established work scheduling practices, policies or procedures.
Patient abandonment is . . .
a unilateral severance of the established nurse-patient relationship without giving reasonable notice to the appropriate person so that arrangements can be made for continuation of nursing care by others. Refusal to accept an assignment (or a nurse-patient relationship) does not constitute patient abandonment.
A number of state boards of nursing have issued advisory opinions or positions on what does, and does not, constitute abandonment. Included among them are: Alabama, California, Michigan, Ohio and Oregon. In each state's comments, abandonment is defined, and matters that are subject to discipline by the state board are differentiated from those that should be handled by the employer. In a unique approach, the South Carolina BON has issued an advisory opinion stating that 12 hours of work should be a maximum expectation when considering the nurse's ability to ensure safe patient care delivery. The Michigan BON noted that nurses who exercise critical judgement in rejecting a request to work overtime because they believe they cannot safely provide care are not abandoning their patients (The Michigan Nurse, April 2001). In addition to action taken by individual BONs, the Delegate Assembly of the National Council of State Boards of Nursing, Inc. (NCSBN) passed a resolution which "recognizes the professional responsibility of nurses to accept or decline overtime assignments based on their self assessment of ability to provide safe care."
The American Nurses Association remains very concerned about the impact of mandatory overtime on the ability of the nation's nurses to provide high quality health care services. ANA believes that the elimination of mandatory overtime for the nation's nurses is a critical success factor in efforts to improve the quality of health care and improved working conditions for nurses.