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Mandatory Overtime - Bad for Nurses, Worse for Patients

Mandatory Overtime

Bad for Nurses--Worse for Patients

Mandatory overtime affects both healthcare workers and healthcare consumers. In the past, mandatory overtime in healthcare was used only in response to unforeseen emergencies in acute care hospitals. Since the mid-1990's, hospitals have used mandatory overtime as standard practice in an attempt to cut costs by not hiring additional nurses. Nurses and other direct care staff are being required to work double shifts, often without any advance notice, which can also put a severe strain on their family obligations.

Nurses and other healthcare workers are vital to the delivery of healthcare in our hospitals and nursing homes. The abuse of mandatory overtime by healthcare employers is forcing many nurses to work when they are seriously fatigued. Fatigue from overwork can lead to medical errors in administering medications and an impaired ability to observe important changes in a patient's condition. This situation is neither fair to nurses nor safe for patients.

Mandatory overtime puts patients at risk:
The highly-regarded Institute of Medicine has reported that as many as 98,000 patients die from medical errors in hospitals every year. This indicates that the problem is not with individual decision-making or carelessness by doctors and other direct care workers, but it is a systematic failure in the delivery of care. It is clear that exhausted workers will be more prone to errors in judgment or lack of attention to detail. This is especially serious when the wrong decision can be life-threatening to a patient.

Mandatory overtime forces nurses out of the profession:
Wisconsin, like other states, is facing a worsening nursing shortage. The U.S. Department of Workforce Development projects a shortage of 10,000 healthcare workers in Wisconsin by 2012.

Nurses and healthcare workers are routinely forced to work beyond the end of their shift, sometimes up to 16 hours. These unpredictable schedules negatively impact healthcare workers' ability to manage their obligations at home, such as taking care of their children or aging parents. Furthermore, nurses leave the professional because they believe quality of care suffers when they are forced to care for critically ill patients when they are fatigued.

Hospitals respond to economic hard times:
As hospitals lose revenue, they may respond by reducing RN's and healthcare staff, and increase the use of mandatory overtime. Mark Honoski, owner of Premier Medical Staffing Services, a service that provides nurses and healthcare staff to hospitals and other healthcare facilities on a day-to-day basis, predicts an increase in mandatory overtime. "With the pinch of economic times, many facilities have decided to do more with who they have and have even been forced to mandate overtime." stated Honoski.
(BizTimes, January 23, 2009)

Other professions have limits on work hours:
There are limits on the work hours of truckers, airline pilots, flight attendants and rail workers becaue it is assumed that alertness is critical to the safe performance of their jobs, and many other lives are at risk.

15 other states have passed mandatory overtime legislation:
Since 2000, 15 states have either banned mandatory overtime or have passed laws restricting its use in healthcare facilities. (The 15 states include: California, Connecticut, Illinois, Maryland, Minnesota, New Hampshire, New Jersey, New York, Oregon, Pennsylvania, Rhode Island, Texas, Washington and West Virginia.)

In 2008, WFNHP's survey of 1,500 Milwaukee-area nurses found that mandatory overtime is widespread, and is a major contributor to errors in patient care: 

  • 42% of the nurses have been forced to work overtime at least once a month, with 12% mandated at least once a week.
  • 82% of the nurses believe that mandatory overtime is an important contributor to nurse turnover, with 54% saying it is a very important contributor.
  • 73% of the nurses believe a ban on mandatory overtime would significantly improve the ability to recruit new nurses into the profession.
  • When asked to what extent quality of care suffered when nurses are required to work forced overtime, 96% said quality suffers, with 56% saying it suffers a great deal.
  • Evidence of care suffering was born out with 43% of the nurses reporting they were aware of errors in care that have occurred as a result of nurse fatigue. Over 500 nurses listed examples of errors. The overwhelming number of examples centered on medication errors. The errors reported by the nurses included giving the wrong medication, the wrong dosages, administering drugs at the wrong time and to the wrong patients. The other concerns cited were examples of nurses falling asleep at work or while driving home. 
    (The Wisconsin Federation of Nurses & Health Professionals, "RN Opinion Survey," May, 2008)

For more information, contact the Wisconsin Federation of Nurses and Health Professionals locally at 414-475-6065, or toll-free at 1-800-828-2256, or via email at


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