Overtime in Nursing Leads To Adverse Patient Outcomes: Research Paper

Introduction

The mandatory overtime and or voluntary overtime is frequently used to cover staff vacancies which can result in fatal medication errors, nonfatal medical errors, fatigue, and nurse burnout (Garrett, 2008). Mandatory overtime or voluntary overtime is used in many hospitals around the United States. Nursing vacancies are expected to increase by 29% by the year 2020 (Garrett, 2008). This literature review aims at demonstrating how mandatory and voluntary overtime can lead to adverse patient and nurse outcomes.

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Overtime in Nursing Leads to Adverse Patient Outcomes

The methods for this literature review were directed by searching the databases CINAHL, PubMed, and Health Reference Center Academic. Keywords that were used during this search included Mandatory overtime in Nursing, Effects of overtime in nursing, and patient outcomes. The search included articles written between 2008 and 2012. All the articles were research-based. A total of five articles were critically reviewed, and final total three articles were used for this review. After a critical analysis of these journal articles was completed, a categorized table was created to summarize the findings. The table was organized to show the similarities and differences between sources.

Table 1: Sources and themes

This literature review seeks to evaluate the effects of nursing overtime and long work hours on nurse and patient outcomes. It also outlines the relationship between nurses extended work duration and adverse patient outcomes. The themes of these articles included mandatory or voluntary overtime in nursing leads to errors in patient care, and nurse burnout, fatigue, and job dissatisfaction. Many hospitals use mandatory and voluntary overtime to deal with nursing staffing problems and fluctuating patient census, however, the articles reviewed show the adverse effects of overtime can lead to errors in patient care. In the study by Garrett (2008), a nurse worked two eight-hour shifts administered the wrong medication to the patient, which resulted in a fatal medication error.

Adverse Events and Errors Affecting Patients

In this research, adverse events were injuries resulting from medical management rather than the underlying disease. Adverse events in these articles included need stick, sharps injuries, work-related employee injuries, patients fall with injuries and nosocomial infections. A patient getting the wrong medication or dose was considered an error without reference to whether or harm was experienced.

In a study performed by Bae and Fabry (2014), the authors try to find out the impact of nurse overtime and the long hours on the patient and nurse outcomes. The reason is that over time and long hours affect the two parties in different ways. The authors hypothesized that when regulation ban overtime, hospitals may respond by giving nurses incentives such as a bonus payment to encourage the use of voluntary overtime to control for nurse staffing shortfalls. This will act as a form of motivation which makes them provide their best to the patients. The results from the 21 nurses and 19 patients who were examined indicated that there is a relationship which exists between work and overtime. Also, 67 relationships of the nurse outcomes and 41 relationships of the outcomes of the patients were examined. Therefore, the findings confirmed that there is a positive relationship between working for long hours and adversative outcome on the nurses is strong. However, this only happens when the nurses are motivated.

According to Garrett (2008), working voluntary or mandatory overtime leads to increased errors such as medication errors, increased falls. These issues increase patient adverse impacts and lower the morale of the nurses. The author analyzed data from 26 studies on nurse staffing levels and patient safety measures. The author found out that it is inadequate nurse staffing which results in the adverse outcomes of the patient and even increases the nurse's burnout. Most of the healthcare centers usually rely on voluntary or mandatory overtime in covering the staff nurse vacancies. Rogers (2004) also confirmed this issue in the study which included 393 registered nurses most of whom were women who worked full-time. Most hospitals use overtime and extended work shifts in coping with the shortage of registered nurses. In the findings out of 393 registered nurses 199 errors and 213 near errors were reported. The errors also increased when the nurses were in longer shifts or worked more than 40 hours in a week as the author found out that 40% of 5317 work shifts exceeded twelve hours.

In another study by Olds & Clarke (2010), the authors compared the relationship between registered nurses extended work duration with adverse events and errors, including need sticks injuries, patient falls with injuries, work-related injuries, nonsocial infections, and medication errors. The study included 11,516 registered nurses examined work hours, adverse events, nurse characteristics, and errors, using questionnaires over a year. The results indicated that all the adverse events and error variables were significantly related to working more than 40 hours a week. Of the 11,516 nurses, 5,532 reported working voluntary overtime, and 1,487 reported working mandatory overtime. Of all the nurses working overtime, 9.6% indicated that they had sustained needle stick injury in the last year. 15.1% of the nurses reported wrong medication or dose, and 19.8% for patient falls with injury related to nursing fatigue. Therefore, over time, whether it is mandatory or voluntary, affects both the patients and nurses.

Nurse Burnout, Fatigue, and Job Dissatisfaction

According to Stimpfel et al., (2012), nurses reported job dissatisfaction, fatigue, and burnout related to both mandatory overtime and voluntary overtime. Methods used a sample of 22,275 registered nurses from 577 hospitals in California, New Jersey, Pennsylvania, and Florida. Of the sample, those who worked more than 40 hours a week were 28% more likely to report an injury due to fatigue. 32.8% of nurses reported work-related injuries, and 19.8% of patients fall with injuries. Job dissatisfaction for nurses is four times higher than the average rate for all U.S workers (Garrett, 2008). Most nurses are dissatisfied with their jobs since they work for longer hours as compared to the individuals in the other occupations. One in five nurses has reported that they intend to leave their current jobs within a year. Nurses working shifts of ten hours or longer were up to two and a half times more likely than nurses working shorter shifts to experience burnout and job dissatisfaction. Burnout was measured using a nine-item emotional exhaustion subscale of the Maslach a reliable and valid instrument for assessing burn out in a human professional, a score of 27 or more are considered an indication of high emotional exhaustion, which half of the sample scores were over 27. Of the sample nurse 10,000 reported burnout relatedly to nurse shortage, which resulted in mandatory or voluntary overtime. The percentages of nurses reported burnout and an intention to leave increased as the shift length increased more than regularly scheduled shift.

The effects of mandatory or voluntary overtime on both adverse nurse outcomes include fatigue, burnout, job dissatisfaction, and poor sleep quality and patient adverse effects Garrett, 2008). The research that was conducted by Garrett (2008) analyzed information from 26 studies on nurse staffing levels, patient, and nurse outcomes. The result of the data shows fatigue is a leading contributing factor for nurse absenteeism, burnout, and job dissatisfaction. Research also shows that after 17 hours without sleep can be the equivalent of having a blood alcohol level of 0.05%. Fatigue has been shown to comprise problem solving, attention to details, and errors in patient care.

Olds and Clarke's (2010) article seek to find the relationship between registered nurses' extended work duration and nurse burnout, fatigue, and job dissatisfaction as well as the patient adverse outcome of overtime. The researchers used a sample of 11,516 Pennsylvania Registered Nurse were analyzed, and the results were overtime is an essential issue because it has implications for the safety of both patients and healthcare workers. More than half of the sample of nurses reported working overtime, have fatigue and job dissatisfaction. Furthermore, 1,900 of the nurses reported burnout and reported not turning down voluntary overtime because of guilt or coercion from managers and peers. This article has limited data results of how fatigue and burnout were measured. Data, however, suggest a relationship between overtime hours worked and errors. However, more research is required to show the effects of fatigue and how it can be measured.

Discussion

After critically reviewing the literature on the topic of Overtime in Nursing leads to adverse patient outcomes. It can be said this topic is useful in today's nursing field. This literature has demonstrated how overtime, either mandatory or voluntary can result in adverse effects for patients and nurse. Nurses that work for over 40 hours a week are two and half times more likely to make an error and result in adverse effect for the patient and or nurse adverse effect. Some adverse effects for the patients include medication error (without reference to whether harm was experienced or not) transcription errors, procedural errors, nosocomial infections, and adverse nurse outcomes such as burnout, fatigue, and job dissatisfaction. The sources were found to useful and current. Also, many of the articles had similar themes and are revealed throughout the review of sources were organized in Table 1. This table allowed the sources to be organized for clear, precise information about the literature.

Recommendations

Though these sources were found to be credible, the limitation was noticed throughout the studies. Some limitations include the study conducted by Bae et al. (2014) which only included the Newly Licensed Nurses, with less than two years of nursing experience. Thus, it does not give an accurate overview of overtime for nurses in general. For the study explored by Garrett (2014), there was a lack of significance between CLIS and nurse staffing and pressure ulcers. The study does link the increase in falls, medication errors, and restraints application duration to lower nurse staff and increased adverse patient outcomes. Moreover, for the study explored by Olds and Clarke (2010), overtime was assumed to be related to fatigue in nurses, such that the more hours nurses reported working, the more fatigued they might be. This indirect way of assessing fatigue is limited because the study did not assess the amount the respondents slept or other factors that may be related to fatigue such as physical or emotional stressors. All the articles reviewed proved that nursing overtime rather mandatory or voluntary could have adverse effects on patients and nurses. Research and data collection will need to be continued further regarding this issue.

Conclusion

In summary, mandatory, and voluntary overtime is often used because of the nursing shortage, and high census of patients. Therefore, it is essential hospitals find another solution to a nursing shortage since extended nursing hours can result in errors that can cause patient and nurse adverse effects. Fur...