1. Kennedy, Maureen Shawn MA, RN

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Hospital nurses work long and unpredictable hours, often involuntarily. Assignments may include more patients than they believe they can care for well-or safely. Two new reports shed some much-needed light on the issues.


Overtime in general may be bad for patients, whether it's mandatory or not. While much has been written about the effects of mandatory overtime on the risk of committing errors, little information has been available on error risk in the context of voluntary overtime. In a survey study of the work patterns of hospital nurses across the country and the risk of errors, Rogers and colleagues found that more than 80% of all shifts involved some form of overtime but that in only 9.5% of cases was the overtime mandatory or "coerced." Half of the shifts were longer than 10 hours. But the risk of making an error increased as the number of hours worked per day or per week rose. RNs worked 12.5-hour shifts nearly 40% of the time, and the odds of making an error were three times higher during those shifts than during 8.5-hour shifts. The risk of making an error was highest when overtime was added to a scheduled 12-hour shift-and three-quarters of 12-hour shifts ended in overtime.


Coinvestigator Linda Scott says that the most important variable in the risk of making errors was the number of hours worked, regardless of whether a long shift was planned or compulsory. The authors concluded that the use of 12-hour shifts should be reexamined and that overtime following 12-hour shifts should be prohibited.


Spend now to save later.

The Business Case for Reducing Patient-to-Nursing Staff Ratios and Eliminating Mandatory Overtime for Nurses, a new report commissioned by the Michigan Nurses Association (MNA), shows that if the measures suggested in the title were put in place in Michigan, the costs of treatment, liability, overtime, and replacing nurses would decrease.


According to the report, reducing nurse-to-patient ratios improves the quality of care and decreases the number of adverse events and complications, which in turn decreases lengths of stay and mortality rates-and saves money. Initially, while recruiting and training additional nurses, hospitals would experience higher operating costs, but they would not experience long-term decreases in profits. Ultimately, the report says, with improvements in patient care and increases in nurses' satisfaction with their jobs, Michigan hospitals would save several hundred million dollars per year. The report can be found at Mennick, BSN, RN


Rogers AE, et al. Health Aff (Millwood) 2004;23(4):202-12.

FIGURE. Researcher L... - Click to enlarge in new windowFIGURE. Researcher Linda Scott