The Problem of Nursing Overtime - Case Study Example

OVERTIME Introduction The background of this problem is extensive and involves process and change in the healthcare environment in general and the nursing workplace in particular for many years. The changes that occurred to make hospitals and other healthcare facilities such as clinics more competitive with each other has resulted in a situation where in some places the consumer is getting served better and the client treated better, and in some other situations where the nursing professional is served better. This balance has changed with time, as there was not always a nursing shortage, and in fact in historical occurrences when nursing was a very popular profession, such as during the early years of the second World War, there was a surplus of nurses and trained professionals were being turned down for jobs. National and statewide assessments of hospital nurse staffing frequently utilize a measure that averages counts of “the number of nurses or hours of nursing care given the number of patients or patient days of care per hospital (Aiken, Sochalski, and Anderson 1996; Anderson and Kohn 1996; Spetz 1998; Buerhaus and Staiger 1999; Kovner, Jones, and Gergen 2000; Unruh 2002). These calculations provide a rough measure of nursing staff resources given patient volume, but they do not consider the intensity of nursing care” (Unruh and Fottler, 2006). Assessment has various parameters in delivery. The basic assumption of the current research is that mandatory overtime may compromise the quality of the care the client receives from the healthcare professional, because if someone has been made to work 12-hour shifts, they may be more likely to make mistakes with clients. Therefore, the basic issues are of safety in the healthcare delivery environment, in terms of the quality of care that is received at the bottom line of the client. Issue—description and history Management has to take steps to solve the problem of nursing overtime in the light of its background that combine theory with reality in the effective application of a solution that is both lasting and cumulative, and can be generalized across different healthcare environments, and this is another reason why the general definition of the problem is appropriate. Mandatory overtime can also lead nurses into a downward spiral of personal problems. . Nonetheless, studies like Day’s feature advocacy of the 12-hour shifts of the flex time schedule in terms of support of both patients and nurses. “12-hour shifts would have positive effects for patients and staff in a ward environment. The results showed that the new shift pattern offered benefits for patients through improved communication, increased continuity of care and more content staff. The study illustrated the potential a new nursing shift pattern involving 12-hour shifts has for patient care, we well as for staff job satisfaction (sic)” (Day, 2004). In terms of advocacy, Day points out that flex time schedules may be a positive devleopment. But the contrary view is also included in Day’s article as a counter-point. “The report revealed that the 12-hour shifts are being introduced by an increasing number of managements, a practice which has raised concerns since there is some evidence that 12-hour shifts affect the amount of care patients receive, and the impact these might have on the quality of care” (Day, 2004). However, Day has found these concerns unfounded. Mandatory overtime is both a singular problem and a contributing factor to the larger problem of nursing shortages as the definition of the nursing shortage ebbs and flows in history. In history the idea of healthcare in the US has swung from socially responsible ideas of equality. The background of this problem is extensive and involves process and change in the healthcare environment in general and the nursing workplace in particular for many years. The changes that occurred to make hospitals and other healthcare facilities such as clinics more competitive with each other has resulted in a situation where in some places the consumer is getting served better and the client treated better, and in some other situations where the nursing professional is served better. This balance has changed with time, as there was not always a nursing shortage, and in fact in historical occurrences when nursing was a very popular profession, such as during the early years of the second World War, there was a surplus of nurses and trained professionals were being turned down for jobs. It is a different story when one considers staffing problems and national shortages. Rogers et al.’s study looks at the effects of hosptial staff nurses’ hours on patient safety and quality of care. One main point in the article, therefore, is the relationship that exists between errors and hours worked. The authors found that nurses tended to have more errors and near-errors if they were working on a system of extended hours that the hospital was using to counter RN shortages. In other words, if the basic assumption of the current report is that there is value to a schedule that requires a nurse to work a 12-hour shift, this is yet another study that counters that assumption and basically proves it wrong from a patient safety perspective. “The well documented hazards associated with sleep deprived resident physicians have influenced changes in hospital staff rotation policies… shift-working nurses have been the focus of a number of studies” (Rogers et al., 2004). These authors for their study did not just present a subjective view of their own thoughts or common sense reactions to nurses working long shifts and its effect on patient safety; they made an empirical experiment involving taking responses from over three hundred working nurses. The authors then took these responses and presented them in terms of statistically significant suggestions that nurses working long hours are more likely to make errors on the job; these errors, in turn, have a serious effect on patient safety and quality of care. “The long and unpredictable hours documented here suggest a link between poor working conditions and threats to patient safety… hospital staff nurses’ working long hours may have adverse effects on the safety of patients” (Rogers et al., 2004). This evidence, like the evidence of most other studies that were done seriously and empirically rather than based on selfish agendas like a nurse wanting to spend more time at home and avoid doing work to support their practice, suggests that nurse working shifts of twelve hours or more are more likely to compromise patient safety. It is important to consider client quality of care and safety to be the least common denominators. Personal position It seems to make sense to me that a nurse who has been being forced to work multiple overtime shifts would be more burnt out in their profession. I have had one job so far in m y life that required me to put in more than sixty hours a week, and it was very rough on me socially and on my peer relationships as well. I tried to balance it out, but it was difficult for me. So I can understand the problem of mandatory overtime from this perspective. It also phases me out as a perspective patient, to think that my care should be going thus. I personally believe that it is up to upper management eventually to solve the problem. Administrators must deal with the mandatory overtime issue effectively so that issues like workload and access are not affected. They must also be willing to implement new technological devices when it means saving labor. The factors that are having the greatest impact on nursing practice are those concerning the utilization and development of new technology in the workplace as well as human resources initiatives in the nation regarding the shortage of nursing personnel. Both of these issues affect nursing practice on a daily basis and give new challenges because they represent change and dynamism that is going on both within the profession and outside of it. Therefore there are more players than just nurses involved in the process and it is a more complicated problem. It would be easier to cope with these issues if the nurse-patient ratio was decreased so that nurses do not have such a heavy workload. Agency nurses should be cut back to allow more time for full-time nurses. Various nursing organizations across the country have implemented changes that address this very serious problem. Technological and ergonomic developments of the future and present in the workplace are also issues affecting my practice, and therefore should also be discussed in terms of solutions. I don’t think healthcare should be about making money as much as helping people. Looking at the future of nursing practice in an active notice of precognition in implementation that will be affecting many healthcare facilities in the near future. This development works as a time-saving method that allows nurses to have an expanded area of information access. Training is available on the new systems of computer integration: all of the computers are on a networked database so that nurses can do things like receive charts and access patient information easily and quickly. Training is a very important part of instituting these new programs which involve technological development in the workplace. “the dedication and care nurses provide to patients and nurses continuing desire to make a difference in patients lives. Now, when it seems that inpatients are sicker and nurses are needed more than ever, there are fewer of them. Now, when the mean age of inpatients is older, there are fewer resources at nurses disposal to assist in the care of those patients” (Miller, 2004) There are many reasons that nurses can find themselves in the workplace feeling like a fraud who isn’t really able to help patients. One of these reasons is that they are being asked to work too much overtime and are not being given the choice about overtime. Hopefully in the future, with the development of time saving technology, combined with a decrease in nurse-patient ratio, mandatory overtime will become a thing of the past. But it is a problematic issue, because not many intelligent free thinkers are really going into nursing these days, and it’s really a constant problem. I think that the community should become empowered and involved in its healthcare needs. Shared views and implications for practice One goal to correct the problem would be to approach it from a legislative point of view, introducing bills to limit mandatory overtime being imposed on nurses. We need to get focused on ways to address and face the problem of nurses being made to work overtime, and another goal associated with this is to also find ways in which to attract new nurses to the profession so that it can grow (so that nurses won’t need to work so much overtime). But the solution to the problem is not just that there need to be more nurses, but that there needs to be better education nurses from an administrative point of view. This is because the solution to the problem is not just to hire a bunch of new nurses on the spur of the moment who might not have the full training potential they could have, just because there is a nursing shortage. From an administrative perspective and a management perspective, the problem is a lot more complicated than this and therefore requires more complicated solutions. “Data from the 2000 survey indicate that 43.3 was the average age of an RN in the United States. According to Dr Geolot, in 1980, the average annual salary of full-time RNs was $17,398. The 2000 average was $46,782, but that was only $23,369 in real dollars” (Beu, 2004). Hospitals need to be making their revenues more competitive, as well as improving technology in the workplace itself. In terms of organizational structure and dynamics in the workplace, the administrative staff still has a lot of power over policy in terms of setting goals for the facility in terms of profits and this is not always associated with giving nurses more opportunities for choosing their overtime and getting better pay. This is because the facility must cope on a daily basis with budget and profit issues which do not allow all of the factors to be met all of the time. Goal development in the workplace is a more positive issue because it is more often implemented directly, in terms of comparison with solutions to mandatory overtime in terms of increased pay and benefits. Most of the time, I am an advocate for greater overtime and pay, but if it means the expense of a type of job where safety is paramount, I have second considerations. Conclusion The problem looked at by this report is that of flex time, or the trend of healthcare facilities hiring nurses to work 12-hour shifts for three days, freeing up time for the nurses over the other four days of the week, but also demanding a lot out of them in terms of long shifts. The problem with this practice can be seen from two perspectives, that of the hospital and that of the average nurse. From the hospital’s perspective, the practice of flex time is not valued highly in most cases, because it affects staffing time and budget allocations, and there is also the worry that nurses who have worked three twelve hour shifts may become exhausted and compromise patient safety. From the perspective of many nurses, however, flex time has many benefits, since it frees up substantial time for other responsibilities such as school and family. The background of this problem is extensive and involves process and change in the healthcare environment in general and the nursing workplace in particular for many years. The changes that occurred to make hospitals and other healthcare facilities such as clinics more competitive with each other has resulted in a situation where in some places the patient is getting served better and the client treated better, and in some other situations where the nursing professional is served better, perhaps at the expense of the patient. “A study published on-line by the journal Health Affairs indicates that hospital nurses working shifts of 12.5 hours or more are three times more likely to make an error than nurses working shorter shifts. The study is based on data from 393 members of the American Nurses Association who kept a log of their hours worked, overtime, days off, and sleeping patterns for 28 days” (Miller, 2004). This balance has changed with time, as there was not always a nursing shortage, and in fact in historical occurrences when nursing was a very popular profession, such as during the early years of the second World War, there was a surplus of nurses and trained professionals were being turned down for jobs. Now, the opposite is often the case. REFERENCE Beu, B. (2004). The nursing shortage and the Nurse Reinvestment Act. AORN Journal. Day, G. (2004). Is There A Relationship Between 12-Hour Shifts and Job Satisfaction in Nurses? Alabama Nurse. Miller, D. (2004). Where Have All the Nurses Gone? The Impact of the Nursing Shortage on American Healthcare. AORN Journal. Rogers, A, W. Hwang, et al. (2004). The working hours of hospital staff nurses and patient safety. Health Affairs. Unruh, L. and M. Fottler (2006). Patient turnover and nursing staff adequacy. Health Services Research. Read More