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Mandatory overtime caps for nurses having effect

Monday January 30, 2012
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State-mandated caps on nurses' mandatory overtime hours have been effective in reducing overtime hours for new RNs, according to a study.

The study is part of the RN Work Project, a 10-year longitudinal study of newly licensed RNs (NLRNs) that began in 2006 and is funded by the Robert Wood Johnson Foundation. The overtime study drew on data from nurses in 34 states, covering 51 metropolitan areas and nine rural areas.

Past research has demonstrated that fatigue caused by long hours without sufficient rest between shifts can lead to mistakes that imperil both patients and nurses.

"The purpose of capping mandatory overtime is to make hospitals safer for patients and nurses," study investigator Carol Brewer, RN, PhD, FAAN, professor at the University of Buffalo School of Nursing, said in a news release. "Nurses routinely work long shifts, often as long as 12 hours straight. These laws were intended to prevent hospitals from piling mandatory overtime on top of such shifts, a practice that research shows can increase the likelihood of mistakes. The laws seem to be accomplishing their objective."

According to the study, in 2010, 16 states had rules restricting mandatory overtime hours for nurses: Arkansas, California, Connecticut, Illinois, Maryland, Minnesota, Missouri, New Jersey, New Hampshire, New York, Oregon, Pennsylvania, Rhode Island, Texas, Washington and West Virginia. At issue in the study was the extent to which those laws or regulations had actually affected the workplace. Researchers examined NLRNs' self-reported mandatory and voluntary overtime hours, as well as their total work hours.

They found that in the states with rules governing mandatory overtime, NLRNs were 59% less likely to work mandatory overtime than their colleagues in unregulated states. (Not all states with overtime rules prohibit mandatory overtime, with some simply limiting total work hours.) Overall, 11.6% of nurses said they worked mandatory overtime in a typical work week, averaging 6.1 hours.

In the states regulating overtime, NLRNs worked an average of 50 fewer minutes per week than their colleagues in states without overtime regulations.

Researchers anticipated that caps on mandatory overtime might lead to increased voluntary overtime, thus defeating the purpose of the restrictions to some degree. But the data demonstrated no relationship between mandatory and voluntary overtime hours. Nevertheless, more than 50% of NLRNs reported working voluntary overtime in a typical workweek.

"While safety is the principal objective of caps on mandatory overtime, the laws probably also have a positive effect on nurse retention," said study investigator Christine Koyner, RN, PhD, FAAN, professor at the New York University College of Nursing. "Nurses have lives and families outside the workplace just like everybody else, and they probably prefer to have a schedule they can rely on. One way to make their jobs and lives more manageable is to avoid mandatory overtime, which should lead to nurses staying in their jobs, and indeed in the profession longer."

"The states developed caps on mandatory overtime with safety issues in mind, reasoning that fewer mandatory overtime hours would translate into fewer hours," said study investigator Sung-Heui Bae, RN, PhD, MPH, assistant professor at the University of Buffalo School of Nursing. "What we learned in this study is that it's working. The tool is effective. Other states with similar objectives can follow suit and expect similar results."

RN Work Project

According to RWJF, the RN Work Project (www.rnworkproject.org) is the only multi-state, longitudinal study of new nurses' turnover rates, intentions and attitudes — including intent, satisfaction, organizational commitment and preferences about work. To date, researchers have learned that more RNs work in hospitals than any other settings early in their careers, with 88.3% working in hospitals six to 18 months after licensure and 78.8% working in hospitals 31 to 54 months after receiving their license.

The study has also revealed that 18.1% of new nurses leave their first employer within a year of starting a job, and 26.2% leave within two years. Nine in 10 of those who leave remain in nursing.

Subsequent studies will determine why nurses stay in or leave their jobs, what influences their first job choice, how the job settings they work in vary over time and whether they move in and out of nursing.

The study appears in an online edition of Nursing Outlook and is available as a PDF at http://bit.ly/xzsbQa.


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