News & Events

Mandated Overtime and Patient Safety: Three Articles

The Working Hours of Hospital Staff Nurses and Patient Safety
Ann E. Rogers, et al., Health Affairs, 23(4): 202-212, July/Aug. 2004

  • Nurses working mandatory overtime are three times more likely to make a medical error. "Overtime, especially that associated with 12-hour shifts, should be eliminated."

Keeping Patients Safe: Transforming the Work Environment of Nurses (Executive Summary)
Institute of Medicine, National Academy of Sciences, Nov. 2003

  • Following up on the 1999 report on patient safety, To Err is Human, the Institute for Medicine calls for improved nurse-to-patient ratios, limits on mandatory overtime, and nurse involvement on every level to protect patients. The study recommends a 1:2 ratio in ICUs, and for all nurses to have the ability to stop admissions to their unit if they feel they cannot provide safe care. It calls for a 12-hour limit on nurses’ hours, and because forced overtime is so dangerous, it says patients and their families should be notified when they are being cared for by a nurse who is working beyond 12 hours so they can seek alternative care.

Nurse Working Conditions and Patient Safety Outcomes
Patricia W. Stone, Ph.D., et al., Medical Care, 45(6): 571-578, June. 2007

  • A review of outcomes data for more than 15,000 patients in 51 U.S. hospital ICUs showed that those with higher nurse staffing levels had a lower incidence of infections, such as central line associated bloodstream infections (CLSBI), a common cause of mortality in intensive care settings. The study also found that overtime for nurses was associated with an increased risk of catheter-related urinary tract infections and bedsores. The study found that patients cared for in hospitals with higher staffing levels were 68 percent less likely to acquire an infection. Other measures such as ventilator-associated pneumonia and skin ulcers were also reduced in units with high staffing levels. Patients were also less likely to die within 30 days in these higher-staffed units. Increasing RN staffing could reduce costs and improve patient care by reducing unnecessary deaths and reducing days in the hospital.