The Dangers of Mandated Overtime for Nurses

mandatory overtime for nursesby Sarah Stasik

It's simply not an option for healthcare organizations to leave patients without care, but nursing staff shortages can make coverage difficult.  

Leadership might turn to mandatory overtime for nurses to fill in the gaps, but that comes with its own set of dangers and challenges. 

Learn about the dangers associated with mandated overtime and what healthcare organizations are doing to address the concerns.

Mandatory Overtime for Nurses can be Dangerous for Patients 

Left unaddressed, a nursing staff shortage can be dangerous for patients, especially in critical care areas or hospitals.  

There's a reason federal law requires hospitals participating in Medicare to keep "adequate numbers" of nurses available to treat patients. While federal law doesn't dictate that number, many states have laws that do. 

But many experts feel that mandating overtime to ensure enough coverage at all times comes with its own set of dangers to patients.  

When nurses are short staffed, they may be rushing from task to task, which can lead to mistakes or overlooking important details. When nurses are forced to work overtime they aren't personally equipped for, the same thing can happen. 

Lack of sleep can cause declines in cognitive functioning, including concentration, reaction times, memory and motor skills. In short, a tired nurse may be unable to remember all the details required for the patient's chart, experience a lack of focus when instructing or treating patients or be unable to react in a timely manner in a triage situation. 

The Ohio Nursing Association notes that nurses understand these risks, but they may be afraid to speak up against mandated overtime requirements.  

ONA surveyed 170,000 nurses belonging to the organization, and 35 percent said they didn't feel comfortable voicing their issues with overtime because of fears they might lose their jobs.

Working Longer Hours Can Lead to Nurse Safety Issues 

Patients aren't the only ones at risk when mandatory overtime for nurses is put into action.  

Writing for the American Journal of Nursing, senior occupational health and safety specialist Karen Worthington lists three main health issues that arise when nurses work mandatory overtime, particularly for long periods of time.

  • Worthington notes that abnormally extended periods working in a healthcare environment may cause nurses to exceed the safe limits for exposure to a variety of things, including ergonomic stressors and chemical agents.
  • She also writes that the same nurse fatigue that endangers patients causes nurse safety issues, pointing out that it might not be safe to drive after a mandated 16-hour shift.
  • Finally, Worthington calls out workplace stress, which she says has been shown to increase risks for both mental and physical health conditions as a danger to nurses.

Research findings published by the National Institutes of Health also indicate that shift work and long hours increases the risk for injuries and obesity.

What are Organizations Doing to Address Concerns 

Marcia Faller, AMN Healthcare CNO and Executive VP of Operations, provides two potential recommendations for avoiding the cycle of mandatory overtime for nurses in an article written for American Nurse Today. 

  • Voluntary overtime may be a better option than mandating it, as every nurse is different. If nurses are allowed to evaluate how tired they are before accepting overtime hours, shifts may be more likely to be covered by RNs who work well with longer hours or on less sleep.
  • Healthcare organizations must invest in strategic planning to build future resources, understand staffing needs and have plans in place to cover shifts without requiring overtime.

It's not just a question of whether healthcare organizations should stop mandatory overtime as an SOP. In some states, the law doesn't allow it — and nursing organizations in other areas are pushing for those changes too.

If you're looking for travel nursing opportunities in states that have elected to protect patient and nurse safety by making mandatory overtime illegal, a summary is provided below.

  • Washington, Texas and New Jersey made mandatory overtime for nurses illegal.
  • Nurses in Connecticut can only be required to work overtime in emergencies or if they are in the middle of a procedure and need to complete it.
  • In Maryland, mandated overtime is illegal except when a nurse has a specific critical skill required during an emergency.
  • Rhode Island and Pennsylvania make required overtime illegal except during a declared state of emergency.
  • West Virginia law prohibits more than 16 hours of nursing work in one day.
  • In Oregon and Illinois, it's illegal except in unforeseeable emergencies, when nurses can be required to work up to four hours past their regular shift.
  • California employers can only mandate nurse overtime in emergencies and can't mandate shifts that cause nursing staff to work more than 12 hours in each 24-hour period.
  • In Alaska, even voluntary overtime is limited to 14 hours per shift.
  • Minnesota only allows mandated overtime in emergency situations.
  • Missouri employers can require overtime when short staffing causes patient safety issues, but the law requires hospitals to make what it calls a reasonable effort to avoid this.
  • New York allows required overtime only in emergencies or when a patient needs an emergency procedure.
  • In Maine, there's an exception for emergencies, but nurses have to have at least 10 hours off between shifts after working overtime.
  • Massachusetts makes an exception only when patient safety is in jeopardy and a reasonable alternative to mandating overtime to protect the patient can't be found.

No matter what shift you work as a nurse — or how many hours you put in — make sure to follow tips for keeping yourself healthy so you can best serve your patients.

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