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Stop Requiring Nurses to Work Overtime

Alexandra Wilson Pecci, for HealthLeaders Media, January 31, 2012

Brewer is the co-author of a study published in the journal Nursing Outlook that finds that state-mandated caps on nurses' mandatory overtime hours have been successful at reducing overtime hours for newly licensed registered nurses (NLRNs) in those states.

Overall, 11.6% of nurses said they worked mandatory overtime in a typical work week, averaging 6.1 hours of mandatory overtime. But in states that govern mandatory overtime, the study found that NLRNs were 59% less likely to work mandatory overtime than their colleagues in unregulated states.

"Mandatory overtime should always be the last option," Brewer says. Instead, nurse managers need to make sure they have resources available when they need extra staffing. For example, is there an adequate float pool? Is there an adequate use of agency employees?

Nurse managers might look into other options as well; Brewer says some hospitals are using a system that auctions off open hours to nurses who are willing to pick up extra shifts.

In fact, Brewer and her co-authors write that "nurse managers could use voluntary overtime as an alternative to mandatory overtime when regulations prohibit mandatory overtime."

"It's not that nurses don't want to do overtime, because they quite evidently do. But they want control over the overtime," says Brewer. "Having control over your work hours is a satisfier; it's something that nurses need to have to be satisfied in their job."

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1 comments on "Stop Requiring Nurses to Work Overtime"


Chris Fox - Avantas (2/1/2012 at 9:45 AM)
In the article, Dr. Brewer mentions the use of auction systems for staff to fill open shifts. We recently conducted a research study (which will be published shortly) that exposes some of the dangers of reactive programs such these, namely: program abuse (e.g., 11th hour bartering), inefficiency, spiraling costs, and a sense of entitlement among nursing staff. With a reactive staffing approach, don't be surprised by these outcomes because "you get what you incent." Rather, proactive incentive shift management, where shifts are posted up to a month in advance and rates drop as shifts are picked up (and the severity of the need decreases), is a much more effective way of filling open shifts. This protocol promotes scheduling further in advance of the shifts and eliminates the last minute scheduling chaos that can be common on the unit level. This proactive assessment of patient volume is generated with the use of predictive analytics, and has proven that staff are willing to schedule early in the process with more than 75% of open shifts picked up more than two weeks ahead of the shift date. That being said, in our experience there are often two main issues that contribute to the use of mandatory overtime (in addition to the lack of accurate forecasts of patient volume). - A silo approach to staffing, where resources are not shared across the enterprise - The lack of right-sized sources of core and internal contingency staffing Getting a handle on these two elements have helped our clients realize tremendous reductions in overtime and agency usage, while positively impacting continuity of care, staff morale, and quality.