Mandatory Overtime in Nursing: What You Need to Know

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Given that there continues to be a nationwide shortage of nurses, it is common practice for hospitals and clinics to request that their nursing staff work overtime. While working overtime can be an effective solution to a nursing shortage, it also can present a number of problems — nurses run the risk of becoming burned out, tired and/or stressed if they take on too much overtime.

Although nurses are protected in a handful of states from being forced by their employer to complete over time, this situation is not the case in a majority of states. This article will look at areas of the country where overtime regulations are in place, as well as some of the reasons why excessive overtime should be avoided, if possible.

A closer look at the issue of mandatory overtime

According to a position statement from the Academy of Medical-Surgical Nurses (AMSN), when nurses are forced to work beyond the hours of their agreed contract, that time is known as mandatory overtime. For most nursing professionals, overtime usually means exceeding 40 hours of work per week. Mandatory overtime cannot be opted out of, and while some nurses may not mind working longer hours and even relish the challenge, for others, it can be an unwelcome intrusion into their free time, inhibiting the chance of establishing a healthy work-life balance.

Given the problems that mandatory overtime can cause for hardworking nurses, the AMSN, among other groups, has adopted the position that overtime should be voluntary only, never mandatory. The organization also asserts that mandatory overtime should not be used by medical facilities as a permanent solution to any staffing shortages. Rather, staffing issues should be addressed directly by clinic committees, with other strategies implemented to address any shortages.

The guidelines proffered here have yet to be adopted at the federal level. Consequently, nurses still can be compelled to work mandatory overtime in a majority of states. A notable minority of states, however, have addressed the issue with legislation. As explained by legal representatives Wage/Advocates, the laws range from tight regulations in some states to outright bans in others. States with overtime legislation for nursing professionals include Massachusetts, California, Texas and Oregon. In many of the states with overtime regulations, exceptions can be made during emergencies. For example, a major accident or storm that leads to multiple casualties arriving at a hospital or clinic at any one time could result in necessary overtime.

According to a fact sheet on state approaches to mandatory overtime published by the American Nurses Association, Alaska was the most recent state to pass overtime regulations in nursing. This restriction occurred in 2010, with Texas introducing regulations a year earlier.

Even in states where such regulations do not exist, many leading medical facilities are working to eliminate the need for mandatory overtime.

Mandatory overtime can lead to an increased risk of error.

Why is mandatory overtime a potential problem?

Although many nurses enjoy the challenge and compensation associated with overtime, researchers have indicated that the practice can be problematic in some cases, especially when nurses engage in overtime on a routine basis. Some of the most common adverse consequences include the following:

  1. Reduced staff morale and burnout
    As detailed by Marcia Faller, RN, MSN, in American Nurse Today, a journal of the American Nurses Association, when nurses work long hours beyond their choosing, they are at a heightened risk of becoming tired, stressed and even resentful, leading to reduced morale and greater job dissatisfaction. Faller explained this outcome in terms of a negative cycle: Nurses are stressed and resentful of the forced overtime, increasing the risk that they will leave to work elsewhere. Retention rates drop as a consequence, and clinical staff administrators are faced with a labor shortage, leading them to assign overtime to fill in for the absences — and so the cycle is repeated.
  2. Higher risk of medical error
    According to the position statement from the AMSN, which cited research from the Institute of Medicine, the risk of error increases after a medical professional works for more than 12 hours at a time. Faller elaborated on these findings by reporting that, during any shifts that exceed 12.5 hours, the risk of mistakes can increase by three times. Even simple errors can have profoundly negative consequences for patients.

Solutions to the issue

The issue of mandatory overtime needs not cast a shadow over the nursing profession as a whole. In a notable minority of states, there are strict state regulations in place that help regulate the practice. Even in states where such regulations do not exist, many leading medical facilities are working to eliminate the need for mandatory overtime.

In fact, in addition to government regulations, health care facilities can implement a number of strategies to curtail the need for mandatory overtime, including the following:

  1. Strategic planning
    Faller argued that the need for mandatory overtime can be mitigated if clinic and hospital managers plan for their staffing needs strategically, by understanding the kinds of problems that lead to low retention rates and addressing them. Strategic planning, according to Faller, also can involve searching for pools of talent from which qualified nursing staff can be found. She offered the examples of establishing a special training program within institutions or sourcing qualified talent in the form of recent graduates from advanced degree nursing programs.
  2. Improving working conditions
    As Faller argued, mandatory overtime is often a consequence of a vicious circle, whereby stress and burnout among nursing professionals culminates in low retention rates. One way to address the issue, therefore, is to offer overtime only on a voluntary basis and to improve overall working conditions for nursing staff, whether through offering extra assistance via managers, increasing pay or shortening hours. With improved working conditions, retention rates likely will increase, reducing the need for mandatory overtime in the process.
  3. Using travel nurses
    As explained by journalist J.E. Cornett in the Houston Chronicle, hiring travel nurses for temporary contracts is an effective way to address pressing staff shortages that would otherwise lead to mandatory overtime. When nurses take temporary leaves of absence throughout the year employers are tasked with finding ways to keep staffing at adequate levels. Travel nurses can fill openings and ensure the quality of patient care remains high but remove the need to require mandatory overtime for regular nursing staff.

Consider Bradley University

One path to working more reasonable hours, at a time of your choosing, is to study to become a nurse manager. Bradley University offers its MSN program online, meaning that you will be able to study at a time that best suits your busy professional schedule.


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