It’s no surprise that working long hours can take a toll on employees, especially healthcare employees. A Health Affairs study found that nurses who work more than 12 hours in a shift and 40 hours in a week are more prone to increased turnover and job dissatisfaction. The same study concluded that nurses who work shifts longer than 12 hours are 1.45 times more likely to leave their job position within a year.1 When left unmanaged, overtime can create a deeply embedded problem that can have a rippling effect on other aspects of your hospital, including patient satisfaction.
Patients reported lower satisfaction levels when higher proportions of nurses worked shifts longer than thirteen hours. These patients were more likely to rate the hospital 6 or lower on their HCAHPS survey. Scoring a 7 or lower on HCAHPS results in a 37% chance of that same patient seeking voluntary return to that hospital in the future.2 Additionally, nurse dissatisfaction caused by long hours also impacts the likelihood that patients will recommend the hospital to friends and family. For every 10 percent of nurses reporting job dissatisfaction, the likelihood of patient recommendations decreases by 2 percent.3 With the average lifetime value of a typical household totaling $405,000, creating better patient experiences should be a priority.4
Reducing staff overtime is easier said than done. However, hospitals can make this happen by driving a fundamental culture change from overtime being the “rule” to overtime being the exception. If hospitals implement measures to reduce shift and workweek length, and set guidelines for what is an acceptable amount of overtime, nurses might not feel obligated to work extra hours.
There is a correlation between overtime and increased likelihood for staff turnover, staff injuries on the job, medical errors that harm patients, and lower patient satisfaction scores. Effective workforce management strategies, supported by innovative technology can address each of these challenges by effectively managing overtime while freeing up nurse manager hours that can be refocused on more critical needs, like caring for and treating patients.
Nurses are not only the backbone of the healthcare workforce, they are the closest point of interaction with the patient. Their satisfaction is directly tied to the overall patient experience and as such, hospitals must focus greater attention on initiatives that promote their wellness and satisfaction. Better management of overtime is a good place to start.
1Stimpfel, Amy, et al. The Longer The Shifts For Hospital Nurses, The Higher The Levels Of Burnout And Patient Dissatisfaction. Health Affairs, 31, no.11 (2012):2501-2509.
2J.D. Power and Associates National Hospital Service Performance Study: (2005)
3Health Affairs “Nurses’ Widespread Job Dissatisfaction, Burnout, & Frustration with Health Benefits Signal Problems for Patient Care.”
4How to Maximize Lifetime Value of the Patient Relationship, Presented at The Beryl Institute Patient Experience Conference 2011, Accessed on February 20, 2015. https://c.ymcdn.com/sites/theberylinstitute.site-ym.com/resource/resmgr/conference_2011_pdf/morgan_-_revenue_cycle_impac.pdf?hhSearchTer ms=%22lifetime+and+value+and+patient%22
Together with API Healthcare, my company and I have taken a deep dive into the issue of nurse overtime. During our research, we found information about the impact of overtime that wasn’t too surprising – overtime inflates labor costs. However, we also found information that was more startling – overtime can be a root cause of turnover, patient dissatisfaction, medical errors and nurse injuries. I was able to present these research findings during a recent webinar called “How Overtime May Be Harming Your Business and Patients.”
After hearing about the impact of overtime beyond the overtime costs, the webinar attendees asked some very salient questions. One question came up over and over: At what point is it less expensive to use overtime rather than recruit another FTE?
The very first question that needs to be answered in order to address this issue is:
Is the overtime being used as a short-term solution or a long-term strategy?
Overtime can be a reasonable solution to a short-term staffing issue. For example, during short periods of high census, putting nurses into overtime can help ensure that patients get the care they require.
However, pervasive and prevalent overtime for long periods of time is not only costly; it can also put patients and staff at increased risk.
Consider the following research findings:
The risk for making an error more than doubles when nurses work 12.5+ consecutive hours.i
Nurses working shifts of 13+ are 2.57 times more likely to intend to leave their job in the next year than nurses who work 8-9 hours.ii
As nurses work more hours, patients are more likely to rank hospitals 6 out of 10 or below in HCAHPS.iii
Working in jobs with overtime schedules is associated with a 61% higher injury hazard rate compared to jobs without overtime.iv
With those statistics in mind, it’s easy to see that if overtime is being used as a long-term strategy, it’s time to carefully evaluate if there’s a need to hire more staff.
For more information about the potential costs and risks associated with overtime, I invite you to take a look at a white paper that addresses this topic in more detail.
iRogers, Ann, et al. The Working Hours Of Hospital Staff Nurses And Patient Safety. Health Affairs, 23, no.4 (2004):202-212.
iiStimpfel, Amy, et al. The Longer The Shifts For Hospital Nurses, The Higher The Levels Of Burnout And Patient Dissatisfaction. Health Affairs, 31, no. 11 (2012): 2501-2509.
ivOccup Environ Med. “The Impact of overtime and long work hours on occupational injuries and illnesses: new evidence from the United States. 2005;62:588-597” Accessed July 10, 2014.