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Voluntary overtime can promote continuity of care while giving nurses the option of working longer hours and earning more money.But because longer shifts from any cause can contribute to burnout, voluntary overtime should be limited.Under pressure from chronic staffing shortages, hospital administrators may implement a policy of mandatory overtime.

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Some hospitals go so far as to terminate nurses who refuse overtime work; others report them to the state licensing board for patient abandonment.Instigating the cycle Chronic overtime can lead to a vicious cycle: Excessive work hours reduce staff morale, which in turn contributes to job burnout.They can do this only through strategic staffing planning based on a thorough understanding of their goals and objectives—in conjunction with dedicating resources to long-term solutions, such as new nurse graduate programs, internal training programs for specialty units, foreign nurse recruitment, and appropriate use of temporary staff.Strategic planning doesn’t necessarily mean eliminating all overtime.Forcing a nurse who may already be fatigued to work beyond her scheduled shift increases the likelihood of patient harm.

A fatigued nurse is more apt to make errors; the risk of errors triples when nurses work more than 12½ consecutive hours.It’s the first step toward creating a better environment for both nurses and patients. Menu Categories/ANAPolitical Power/State/State Legislative Agenda/Mandatory Rogers AE, Hwang WT, Scott LD, Aiken LH, Dinges DF. Trinkoff A, Geiger-Brown J, Brady B, Lipscomb J, Muntaner C. Selected references American Nurses Association (2007). The working hours of hospital staff nurses and patient safety. Overtime isn’t the only issue that can influence the quality of the work environment and patient care.To improve the work environment and promote better recruitment, retention, and patient care, hospitals should determine the root cause of each factor that affects nursing staff levels. American Nurse Today.com/journal for a complete list of selected references.All hospitals have occasional nursing shortages stemming from unexpected census peaks, unfilled nursing vacancies, personal time off, or leaves of absence.