Overtime in particular has been negatively associated with patient care, and a good proportion of nurses are required to work extra hours.
New nurses are predominantly working 12-hour shifts and nearly half work overtime, trends that have remained relatively stable over the past decade, finds a new study by researchers at NYU Rory Meyers College of Nursing. And 13 percent hold a second job.
Changes in health policy in recent years — from the passage of the Affordable Care Act and increased access to healthcare, to the recession — which delayed some nurses’ retirements — have had implications for nurses and the hours they work, while overtime has been linked to patient safety and nurse well-being.
The research team analyzed surveys from more than 4,500 newly licensed nurses in 13 states and Washington D.C., collecting information on nurse demographics, education, work attributes and attitudes. Specifically, nurses were asked about their work schedule, daily shift length, weekly work hours, overtime, and whether they worked a second job.
In addition to the 12-hour shifts and second jobs, it was found that new nurses prefer working the day shift and 12 hours is the preferred shift length.
Twelve percent of nurses report working mandatory overtime (an average of less than an hour in a typical week), and nearly half, 45.6 percent, work voluntary overtime (an average of three hours in a typical week).
There were nuanced changes in overtime hours during the decade studied: There was a decline in both mandatory and voluntary overtime during the economic recession by about an hour per week, but overtime hours rose in the most recent cohort.
There’s good news and bad news in the results. The good news is that new nurses seem to be working a similar proportion of 12-hour shifts as more experienced nurses, and most are working the shift and schedule they prefer. There also weren’t statistically significant increases in weekly work hours or overtime hours.
But the findings on overtime were troubling given that previous research has established associations between working overtime and patient outcomes (such as medication errors), occupational injury among nurses, and factors like burnout and job dissatisfaction.
While voluntarily working overtime can be a welcome source of income for some nurses, mandatory overtime — which is restricted by law in 18 states — was found to be a practice norm, occurring for 12 percent of new nurses.
Nurses operate within a highly competitive job market, and as is the case in other high-stress fields, there’s a fatigue starting to set in. Burnout is a very real danger, and much like physicians, nurses are prone to leaving when they’ve finally had enough — and that turnover can have detrimental effects on everything from a hospital’s financial strength to the quality of patient care.