Nurse Overtime Harms Professional Collaboration

After one hour of overtime, nurse to nurse collaboration drops from the 50^th percentile to the 30^th percentile.

Though common, working overtime may negatively influence nurses’ collaboration with their colleagues, finds a new study by researchers at NYU Rory Meyers College of Nursing.

“Our research suggests that the more overtime hours nurses work, resulting in extended periods of wakefulness, the greater difficulty they have in collaborating effectively,” Amy Witkoski Stimpfel, PhD, RN, assistant professor at NYU Meyers and the study’s coauthor, says in a news release.

Nurses often work long, irregular hours and unexpected overtime which puts them at risk for fatigue and sleep deprivation and can lead to impaired emotional, social, and cognitive processing. This, in turn, may hurt nurses’ ability to collaborate.

The study, published in the Journal of Nursing Administration, assessed how shift length and overtime impact nurses’ perceptions of collaboration with other care providers, specifically with other nurses and physicians.

Overtime common

The researchers used 2013 survey data from the National Database of Nursing Quality Indicators, and analyzed responses from 24,013 nurses in 957 units from 168 U.S. hospitals.

Among the study’s findings:

• Across the five types of nursing units measured, the average shift length was 11.88 hours

• 12-hour shifts appear to be are the predominant shift schedule for hospital nurses

• Nurses worked, on average, 24 minutes longer than their scheduled shift.

• 33% of the nurses on a unit reported working longer than initially scheduled

• 35% percent of nurses said that the amount of overtime needed from nurses on their unit increased over the past year

“One in three nurses reported working longer than scheduled. This appears to be a chronic problem for nurses – one that extends an already long work day and appears to interfere with collaboration,” says the study’s lead author Chenjuan Ma, PhD, assistant professor at NYU Meyers.  

Interestingly, the researchers did not find a significant relationship between average shift length and collaboration meaning longer scheduled shifts did not necessarily lead to less collaboration. However, collaboration appeared to suffer in nursing units with longer overtime shifts and more nurses working overtime.

• Collaboration on a unit was measured using the nurse-nurse interaction scale (RN-RN Scale) and nurse-physician interaction scale (RN-MD Scale).

• One hour of overtime was associated with a 0.17 decrease on the RN-RN scale and was marginally associated with a 0.13 decrease on the RN-MD Scale. In other words, a 0.17 decrease from the mean score on the RN-RN scale suggests that a unit’s rank on the RN-RN score would drop from the 50^th percentile to roughly the 30^th percentile.

Advice for nurse leaders

The researchers advise that nurses, nurse managers, and hospital administrators use overtime as infrequently as possible. While they recognize longer shifts are the norm and eliminating overtime may not be possible, they do suggest offering fatigue management training and education, as well as training to help nurses and physicians communicate effectively and respectfully.

“Our findings support policies that limit the amount of overtime worked by nurses. In practice, nurse managers should monitor the amount of overtime being worked on their unit and minimize the use of overtime,” Ma said.

Collaboration among healthcare professionals is critical for quality care and patient safety.  Previous studies have shown that patients receive superior care and have better outcomes in hospitals where nurses collaborate well with other healthcare providers. In fact, a study published May 2 in the International Journal of Nursing Studies by Ma and her colleagues finds that both collaboration between nurses and physicians and collaboration among nurses are significantly associated with patient safety outcomes.