...How Does Mandatory or Voluntary Overtime Affect the Quality of Patient Care? Pam Glasper Beaumont Hospital Wayne How Does Mandatory or Voluntary Overtime Affect the Quality of Patient Care? Registered Nurses (RNs) constitute an integral part of the patient care and recovery process. To many patients, nurses are the health care professionals they see most often. Additionally, patients seeking care in outpatient clinics may not be aware of the number of hours nurses work. However, short stay and long stay patients see the same nurses over many shifts. What they may not realize is how many hours RNs work in a given 24-hour period to provide continuous patient care. According to Bae (2012a), a 2004 research study found that “43% of U.S. RNs worked more than 40 hours per week and about 9% worked more than 60 hours per week” (p. 205). In most instances RNs work overtime to alleviate staff shortages in their units. According to Bae (2012b), staff shortage in hospitals is not a new phenomenon and many researchers in health care system contend that such chronic shortage of nurses has a direct and negative impact on patient care (Bae, 2010; Bae, 2012b, Bae, Brewer, & Faan, 2012). For example, in several of her research articles, Bae (2010, 2012a, & 2012b) cited several research articles where researchers have found that the long hours worked by RNs are at the root of many adverse patient outcomes. Anecdotal evidence should suggest that anyone working long hours over an extended...
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...measures that has to do with patients safety and care and at same time given the facility for unremitting standards fulfillment. NCH is 100% compliance with most standards of Joint Commission in the following area; Emergency Management, Human resources, Infection Prevention and Control, Performance Improvement, Right and Responsibilities of the Individuals, Transplant Safety. During the inspection at the facility, the hospital was found to be non- compliant in this listed areas; Environment of Care, Leadership, Life Safety, universal protocol, Medication Management, Medical Staff, National Patient Safety Goals, Nursing, Record of Care, Treatment and Services, and provision of care During the PPR, the hospital was found with an increase cluster in the hallways, it is a fire hazard and a safety issue. The nurses are not familiar with verbal order procedures, using the range of orders that received and the abbreviations that are prohibited in the documents. From the trend, there are areas at which the hospital needs to implement proper education and audit. An action plan needs to be implemented by the administration to address the fallout to enable the hospital be in full compliance with Joint Commission standard. There are some discrepancies that has to be looked into and resolve to enable NCH maintain the standard compliance with the Joint Commission. Instead of looking into problems found in each unit, there are trends affecting the hospital's patient care standard of complying...
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...Political Action Awareness in Nursing Soul Mckenna NUR/587 September 14, 2010 Political Action Awareness in Nursing Nursing professionals have many industry organizations to choose from that can help the nurse stay aware of political actions related to nursing. Nursing organizations can be general or specialized, but with both, members will support a stated mission. The professional organizations have large memberships and will maintain state and national links to monitor ongoing political developments. This paper will review how nurse leaders from across the nation use the American Nurses Association (ANA) to stay current on relevant political actions and why it is so important. The Professional Organization for Political Awareness The ANA is the only complete professional organization representing more than three million registered nurses across the nation (Annual Report, 2010). The integrity of the organization along with its massive membership gives power to their causes. They lobby for their causes and keep their members informed on current political health care developments. The ANA has multiple resources available for nurse leaders. The website is a very valuable resource. The website is easy to access and contains vast amounts of information relating to state and national health care laws and policy, research, and higher education resources (ANA, 2011). Additionally links to health care policy and legislative urgencies...
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...A concept analysis of nursing overtime In this research article, Lobo et al. use the Walker and Avant’s methodology to complete a concept analysis on nursing overtime in previous literature. Unfortunately, researchers discovered numerous problems related to the consistency of how the term overtime is used as it relates to nursing. Walker and Avant’s method uses an eight step process including concept selection, determination of aims, identifications of concept use, determination of defining attributes, model case construction, construction of borderline, related, contrary, invented and illegitimate cases, antecedent and consequence identification, and definition of empirical referents to produce a consistent definition of the term overtime as it relates to nursing. The goal of this study is to produce a middle-range theory to guide further research in the measurement and studies of nursing overtime. Researchers explain that the term “overtime” is widely used in previous literature to describe any unexpected hours that nurses work in acute care settings. Furthermore, the authors explain the reasons that organizations may use overtime as a way of reducing cost during challenging economic periods. For example, they mention the idea of hiring more PRN and part-time staff to save hospitals the cost of benefit packages that fulltime employees receive. Although this approach may seem economically responsible, it seems that this simple fix does not adequately solve the issue. Researchers...
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...American Nursing Association American Nursing Association Registered nurses join professional nursing organizations for many reasons. For example, some join to learn what's going on and stay current in their field or specialty. Others want to network or enjoy the peer recognition that comes from being an active member of a major organization. These are just a few of the benefits of being a part of a professional organization. Nurses may join a general organization, such as the American Nurses Association to stay current on the latest technology and advancement of nurses. “The ANA advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public” (ANA, America Nursing Association, 2011). In addition the ANA helps establish regulations for appropriate staffing and mandatory overtime are some of the aims and activities of the ANA. Mandatory Overtime An article within Health Affair magazine states, “Research indicates that risks of making an error are significantly increased when work shifts are longer than 12 hours, when nurses worked overtime, or when they worked more than 40 hours per week” (Rogers, 2004). Mandatory overtime is one of the many workplace issues that may be contributing to nurses leaving the workforce. The American Nurses Association...
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...on Nurses The Impact of Shift Work on Nurses The purpose of this paper is to discuss nursing shift work and its impact on nursing staff health and family life. The position of the International Council of Nurses is quoted below. It is their position that shift work is detrimental. Position Statement: “The International Council of Nurses (ICN) recognizes that many nursing services must be accessible on a twenty-four basis, making shift work a necessity. At the same time ICN is very concerned that shift work may have a negative impact on an individual’s health, ability to function, immediate support group and the continuity of care, thus affecting the services provided” (ICN, 2007). The impact of shift work on nurses affects productivity at work. Nursing leaders should also encourage work place cultures that respect nurses’ days off and vacation time, promote nurses’ prompt departure and allow nurses to refuse to work overtime without retribution. Traditional eight hour shifts are becoming a thing of the past, twelve hours days and night shift are the norm providing flexibility and a balance family life. Because of unforeseen circumstances such as nurses calling out, change in patients’ condition, short staff on the schedule which was posted two weeks ago, hence the reason twelve hour shift becomes an unplanned longer shift. According to the article in the Journal of Nursing Law, “Compounding the situation nurses work long shifts and often have multiple outside responsibilities...
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...Its Impact on Patient Safety Georgetown University Foundations of Health Systems and Policy NURO-624 September 12, 2013 Nurse Burnout and Its Impact on Patient Safety Patient safety encompasses the application of best practices that are geared towards achieving positive outcomes and promoting safety, and can serve as an indicator of quality in healthcare institutions; sustainable nursing workloads improve the quality of health care by reducing unsafe conditions, as well as reducing mortality and morbidity. Several literature reviews have clearly identified the consequences for patients when nurses are overtaxed or over utilized to bridge the gap of nursing shortages. According to Mckee et al, each patient added to nurses’ workloads (beyond four patients) is associated with a seven percent increase in mortality following common surgical procedures (McKee, M. 1999). Recent health reform legislation has further stimulated increased awareness and focuses on patient centered care, and emphasizes on the importance of the patients’ experience. Moreover, patients’ expectations of their caregivers to be positively engaged in their work and performing efficiently and effectively in a supportive environment are prudent. However, several challenges are being encountered by nurses, as they strive to meet the mandates of the aforementioned health care reform. Challenges resulting from unfavorable working conditions that are not conducive to the provision of patient centered care...
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...1999, California began the process of mandating minimum nurse to patient ratios. It wasn’t until 2004 that the minimum staffing ratios were implemented. The law was established in an effort to improve patient care and retain nursing staff. Since implementation of this law, California has been able to report improved quality measures along with improved nurse retention rates (Dorning). California has documented improvement in patient outcomes and quality measures since the staffing law went into effect. Assuring a safe environment for patients assures full reimbursement to the organization for their services. California’s report showed significant improvement in the reduction of pressure ulcers, falls, and medication errors to hospitalized...
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...away from overtime shifts is that many nurses like and expect this schedule, as it is the norm in many institutions (Geiger-Brown & Trinkoff, 2010). No hospital want their nurses to work exhausted, sick and give low quality of care. However, even the hospital that no mandatory overtime they will allow nurses to “self- schedule” in a way that substantially increase fatigue risk or may ask nurses to accept “on call” or mandate overtime to cover open shifts so as not to use expensive supplemental staffing (Geiger-Brown & Trinkoff, 2010). Eventhough, some states regulate the use of mandatory overtime. Some nurses is not aware of it or use the voluntary overtime the same as mandatory overtime. The willingness of nurses to work longer hours is one main concern on how hospital nurse administrators and executives will maintain nurses satisfaction retention and recruitment and patient outcomes while preventing the use of mandatory overtime. Some nurses have misconception that if they refuse to work they are scared to loss the job In united states, not every states have restriction to mandatory overtime because it is a complex issue to be solved. Or we can say the failure of government to pass a law that will help healthcare providers to address the issues of mandatory overtime. According to experts at the National Institute on Occupational Safety and Health, there has been little research into the ways in which overtime by health care providers compromises patient and staff...
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...Traditional Taped Report Methods Community Health Nursing Lewis Clark State College The change from taped report to a bedside report is essential to increasing patient safety and satisfaction, nursing satisfaction, physician satisfaction, and a savings to the health-care facility. The Joint Commission found that the breakdown in communication during the shift report is a leading cause of sentinel events in the United States (Laws & Amato, 2010). We will explore benefits to the patient, nurse, facility and physician. The patient and family benefit by becoming a part of their own treatment. They will participate in decisions and know at all times the plan for their care. This autonomy helps the patient to have a confidence in the health-care facility and staff. They provide essential information that is not available otherwise to assist in providing the best care possible for the patient. With the family and patient being informed about the plan of care, they are less anxious. This promotes more compliance with care and willingness to start treatments earlier. These patients have a higher level of satisfaction and are less likely to litigate (Anderson & Mangino, 2006). In a study at Sharp Grossmont Hospital in San Diego County, a 481-bed community hospital, the patient benefits included a reduction of unanswered call lights and a reduction in patient falls. With the bedside report, patients are able to have needs met when bedside reporting is...
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...October 19, 2012 Nursing Statistics, Shortage, and Burnt Out According to The Department for Professional Employees, AFL-CIO (DPE), Nursing has been among the fastest growing occupational fields, and the demand for nurses is expected to continue as baby boomers retire, creating a need to replace retiring nurses and care for the aging population. Nurses are integral to our health care system; however, their profession is made more difficult by unsafe working conditions, causes of burnout, and being an underpaid profession. Ultimately, these difficulties not only affect nurses, but jeopardize safe and efficient patient care. According to the DPE 2012 fact sheet, there are an estimated 500,000 RNs in the U.S. who are not practicing their profession, in part because of difficult working conditions of nurses that are exacerbated by limited staffing and long working hours. Additionally, with managed care restructuring the health care industry in the 1990s, hospitals reduced staffing levels to lower costs. Nurses now care for more patients during a shift, which has led to a number of problems for both nurses and patients. Overworking results in injury: 39% percent of RN injuries resulting in missing work were attributed to overexertion. Many hospitals routinely require nurses to work unplanned or mandatory overtime and to “float” to departments outside their expertise. Over 60% percent of RNs report being forced to work voluntary overtime, which leads to Nurses’ cardiovascular...
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...Report Miscommunication and missed information, resulting in potential errors, have been on the rise at Pelham Medical Center. In the past, the primary nursing staff was giving verbal report to oncoming nurses at the nursing stations. There are many disadvantages to this practice. Verbal report at the nursing station is distracting with so many nurses talking at the same time and is frequently interrupted by other staff, call bells, and family members. There are also potential HIPPA violations when reporting on patients within earshot of other people who are not involved in that patient’s care. The patients and their family members or care givers are not directly involved in the report and hand off process (Gregory, Tan, Tilrico, Edwardson, & Gamm, 2014). Pertinent information was being reported incorrectly or not reported at all. Physician orders were being missed and not completed. All of these events, collectively, have adversely affected patient safety and overall patient satisfaction. Patients and their families do not like to feel that the primary nurse does not know the “whole picture” or has an incorrect understanding of the plan of care. In an effort to reduce potential errors, increase communication between staff and with patients and their care givers, and increase patient and nursing satisfaction, the nursing administration of Pelham Medical Center decided to implement bedside shift report on the medical-surgical unit. This change has been implemented and...
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...presented the results of her study “The Working Hours of Hospital Staff Nurses and Patient Safety” published in Health Affairs, July/August 2004. Her study followed 393 registered nurses working over 5,317 shifts. Each nurse tracked hours worked, time of day worked, overtime, days off, sleep/wake patterns, errors and near misses. According to Dr. Rogers, fatigue results in: * Forgetfulness * Slowed reaction time * Diminished decision making * Reduced vigilance * Apathy, lethargy * Impaired communication. Delivery of health care requires higher cognitive functions – judgment, logic, complex decision-making, memory, vigilance, information management and communication skills. Fatigued workers try ineffective solutions to problems and neglect activities deemed non-essential. Sleep research indicates that most people need at 7.5-8 hour of sleep each night. Nurses in the study averaged 6.8 hours of sleep. Long hours, and the impact of competing priorities in personal lives impact getting adequate rest prior to working. In more than half the shifts, nurses were unable to take breaks due to shift demands. Findings included correlation among work duration, overtime, number of hours worked and reported errors and near errors. Regardless of the scheduled shift length, overtime increased the odds of reporting error, but the risks significantly increased when overtime followed a twelve-hour shift. On average, nurses worked about 55 minutes longer than...
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...in a hospital, there are many different reasons that the budget needs to be adjusted in order to meet the needs of the staff, patients and organization. This case study looks at the budget of a cardiac care unit with a variable budget. Several different factors have led to variances in the budget for the current fiscal year. Solutions are suggested to address the positive variances, that will fulfill the needs of staff and patients in the most beneficial and economic way possible. Due to a change in patient acuity on the unit, there has been a change in the staffing needs to adequately care for the needs of the increase in the number of very sick patients. Staff is requesting a permanent change in the staffing pattern to address these needs. There has been $275,000 expended year to date from the personnel budget. $30,000 of that was expended in the month of March. For the previous 9 months, that leaves an average of over $30,000 per month expended to the personnel budget. To address this negative variance in the budget, I would approach administration to request that the staffing grid be adjusted to allow for at least 1 extra-licensed personnel for shift, as well as 1 extra non licensed nurses aid per shift. In order to justify the need for the extra staff I would provide supporting documentation such as the average daily census and patient acuity over the past 9 months to justify the need for increased personnel. It is...
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...A bedside reporting can increase patient and family satisfaction, increase institutional value, and reduce health care costs. An actively involved patient and family are more likely to give high ratings on patient satisfaction survey with high regards to the patient care provided. Therefore, an institution’s values become standards of patient care that must be led by excellence, aim, and success in obtaining goals. On the other hand, nurse satisfaction is as much as important as the patient and family satisfaction. A highly satisfied nursing staff may not easily get burned out to high stresses and enhance nursing staff retention. A retrospective analysis before the implementation of bedside reporting showed that nurses stayed a total of 1,421 hours, or 100 hours per month (range = 67-137 hours), past their clock-out times between the months of October 2006 and April 2007 (Tidwell, Edwards, Snider, Lindsey, Reed, Scroggins, & Brigance, 2011). Tidwell et al., (2011), and colleagues concluded that nurses were less likely to work overtime once the bedside reporting was implemented and this in return, reduced an institution’s cost tremendously. After the implementation of the bedside reporting, nurses worked 923.5 hours that saved US$12000 for a year (Tidwell et al., 2011). A bed side...
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