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Stop Requiring Nurses to Work Overtime

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

Nurse managers should also use in-services and other forms of education to raise awareness of the effects of fatigue on their health and job performance to be sure that nurses who do volunteer for overtime aren't overdoing it.

But Brewer also cautions against "voluntary" overtime that's really more of a requirement. If a nurse manager begs and pleads with a nurse to "do her a favor" and pick up an extra shift, or threatens to make her work on a weekend when she doesn't want to, then the overtime isn't really voluntary at all.

"I think that has more to do with the organizational culture and the relationship of the supervisors to the nurses," Brewer says. "My guess is that anybody who has kind of that relationship with their nurses is not going to have a very happy unit."

The real test for the effectiveness of these mandatory overtime laws will come during the next acute nursing shortage, Brewer says. But in the meantime, nurse managers always need to be thinking about what's important to their nurses, and ways to increase satisfaction and reduce turnover.

"I think what leaders have to think about always is the long term. Whether we're in a shortage or not, the factors that create satisfaction and longitudinal loyalty from your employees tend to stay the same," Brewer says. "Just because your staffing issues aren't as acute doesn't mean you shouldn't be paying attention to them."

Moreover, high use of mandatory overtime is likely a symptom of bigger problems.

"If you've got high use of mandatory overtime you've got other organizational issues that are also impacting the nurses' satisfaction and organizational commitment," Brewer says.


Alexandra Wilson Pecci is a managing editor for HealthLeaders Media.

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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.