Nursing Overtime: The Good, The Bad, The OMG!

Nursing Overtime

According to our 2018 Nursing Salary Guide, overtime hours can be a welcome salary boost or a dreaded energy drain for nurses. But whether nurses love overtime or hate it, nearly half will work more hours per week than they sign up to work.

Of the 22,017 nursing professionals surveyed, 50.07% reported working overtime, many working more than nine hours a week, says Rob Senior, editor of Advance Healthcare Network who interpreted the survey numbers. “And they’re required to do it.”

Overtime realities

Nationwide nursing shortages mean hospitals and clinics must do more with what they’ve got, which translates to routinely asking or requiring staff to work overtime.

Nursing overtime falls into two categories:

Voluntary overtime: Paid overtime a nurse willing accepts or seeks to boost salary or gain more on-the-job experience.

Mandatory overtime: Hours nurses are required to work beyond their contracted shifts. Typically, mandatory overtime kicks in after a nurse works 36 to 40 hours per week. This type of overtime can be as little as the hour a nurse waits for a shift replacement to fight traffic and arrive at work, or it an amount to one or more additional shifts, the result of chronic nursing shortages.

Sometimes the line between voluntary and mandatory overtime is blurred for nurses who have dedicated their lives and careers to healing and helping others.

“When the phone rings and a supervisor asks you to come in for a shift, there’s an overwhelming sense that I have to do this,” says Julianne E. van Kalken, who is board certified in nursing professional development and works at Elliot Hospital in Manchester, N.H. “You think, ‘My unit needs me. My patients need me.’”

Our 2018 Nursing Salary Guide found that mandatory overtime is more common in some geographic areas, job titles, and work settings.

Here’s a quick look at some of the stats from the survey:

  • Statistically, you’re more likely to be forced to work overtime in the Midwest (14.68%) and least likely in the Northwest (10.65%).
  • Of all specialties, military nurses are most likely to have mandated overtimes hours (47%), while school nurses are least likely (5.07%).
  • Surgery centers are, by far, the most likely to mandate overtime, compared to for-profit and non-profit hospitals.

Download the 2018 Nursing Salary Guide

The problem with mandated overtime

First, no one wants to be forced to work longer than anticipated; it upsets the work/life balance that everyone is trying so hard to achieve.

Mandatory overtime, however, has more serious consequences. A 2012 study by the University of Pennsylvania, School of Nursing, looked at the relationship between shifts, nurse burnout, and patient dissatisfaction.

The study showed that as nursing overtime increased, so did patient dissatisfaction with care. What’s more, burnout, job dissatisfaction, and an intention to leave the job were more than twice as likely among nurses who worked shifts of 10 hours or longer than nurses who worked shorter shifts.

New and young nurses are particularly eager to work overtime, then particularly vulnerable to the negative consequences of working too many hours, says van Kalken.

“As you gain experience, you know when it’s advantageous to pick up overtime, and when it’s not; brand new nurses don’t have that perspective,” she says. “A new nurse may not have any concept where their limit is and find themselves working 60 hours a week. I tell them they need to find balance. You can’t kill yourself working the first year to pay off student loans. You have to have time to decompress.”

The University of Pennsylvania nursing shift study also found greater patient dissatisfaction in hospitals with more nurses working the longest shifts. Patients reported:

  • Nurses sometimes or never communicated well.
  • Pain was sometimes or never controlled well.
  • Patients sometimes or never received help as soon as they wanted.

“Our results suggest that patients perceive worse care (overall and in nursing-specific domains) in hospitals that have high proportions of nurses working shifts of more than 13 hours,” the study concluded.

Overtime advantages

Of course, there’s always the money.

Overtime, be it voluntary or mandatory, pays a premium that begins at time-and-a-half. Nurses who work “premium shifts” — night and weekend shifts no one wants — can receive double time plus a bonus.

Van Kalken remembers receiving an extra $1,000 every two weeks by working overtime and premium shifts.

“It’s hard to turn down that kind of cash,” Val Kalken says. “Opportunities like that don’t come along every day.”

It’s all about balance

Nurses, like every other professional, seek a life/work balance. Sometimes, the “life” part is more important; sometimes, the work (money) is a priority.

In a perfect world, nurses could decide when and how much overtime to work. Many states are considering or have enacted laws prohibiting mandatory overtime.

Hoping to help create that overtime utopia, The Academy of Medical-Surgical Nurses drafted a mandatory overtime position paper that includes:

  • Overtime should be offered on a voluntary basis and after all other attempts to provide adequate staffing has failed.
  • The medical-surgical nurse should not be required to work beyond the individual nurse’s physical and mental capacity.
  • Healthcare facilities should have a system in place to assess patient care needs and assign staff without the use of mandatory overtime. Mandatory overtime should not be used to provide adequate staffing as a solution to chronic understaffing.

Jeff Solheim, an emergency nurse and president of the Emergency Nurse Association, says overtime can put nurse and patient safety at risk.

“When we have lives we’re responsible for, is working overtime truly putting patient safety first?” Solheim says. “Nursing is a very emotional job. If you’re not taking care of yourself, you won’t last as a nurse.”

Article by Lisa Kaplan Gordon. Lisa is an award-winning writer who’s covered stories for Yahoo, AOL, and many others. She lives in McLean, Virginia.

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