New research funded by the Robert Wood Johnson Foundation (RWJF) finds that state-mandated caps on nurses’ mandatory overtime hours are having the intended effect: reducing the number of overtime hours that nurses work. Past research has shown that fatigue caused by long hours without sufficient rest between shifts can lead to mistakes that imperil both patients and nurses.
This new study is part of the RN Work Project, a 10-year longitudinal study of newly licensed registered nurses (NLRNs) that began in 2006. The RN Work Project is designed to learn more about nurses’ career patterns. The overtime study draws on data from nurses in 34 states, covering 51 metropolitan and nine rural areas. It was published in the online edition of Nursing Outlook.
“The purpose of capping mandatory overtime is to make hospitals safer for patients and nurses,” said Carol Brewer, PhD, RN, FAAN, professor at the School of Nursing, University at Buffalo. “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.” Brewer and Christine Kovner, PhD, RN, FAAN, professor at the College of Nursing, New York University, direct the RN Work Project. The two were joined in the overtime study by Brewer’s colleague at the University at Buffalo, Sung-Heui Bae, PhD, MPH, RN, an assistant professor at the School of Nursing.
Sixteen states had rules restricting mandatory overtime hours for nurses as of 2010: Arkansas, California, Connecticut, Illinois, Maryland, Minnesota, Missouri, New Jersey, New Hampshire, New York, Oregon, Pennsylvania, Rhode Island, Texas, Washington and West Virginia. Some states adopted the rule by statute; some by regulation.
The researchers focused on whether the rules had the specific intended effect of reducing nurses’ overtime hours. Toward that end, they examined data on 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 percent less likely to work mandatory overtime than their colleagues in unregulated states. (Not all states with overtime rules prohibit mandatory overtime; some simply limit total work hours.) In addition, in the states regulating overtime, NLRNs worked an average of 50 fewer minutes per week than their colleagues in states without overtime regulations.
Lawmakers are often concerned about the unintended consequences of proposed policy solutions. In this case, researchers wondered if caps on mandatory overtime hours might simply lead to increases in “voluntary” overtime hours, thus defeating to some degree the purpose of the restrictions. But the data demonstrated no relationship between mandatory and voluntary overtime hours. “It’s important to policy-makers to understand the impact of the remedies they devise for particular problems,” said Bae. “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.”
“While safety is the principal objective of caps on mandatory overtime, the laws probably also have a positive effect on nurse retention,” Kovner noted. “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. That’s particularly important in light of the looming nursing shortage. Every nurse who stays in the profession is one fewer nurse we need to recruit.”
The RN Work Project is the only multistate, longitudinal study of new nurses’ turnover rates, intentions and attitudes—including intent, satisfaction, organizational commitment and preferences about work. Future studies will examine the reasons behind nurses’ decisions to 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.