Policy Statement on Mandatory Overtime (Approved by the AONE Board of Directors, December 2003) Statement of the Issue Overtime has been defined as the hours In its groundbreaking publication, worked in excess of an agreed-upon, Perspectives on the Nursing Shortage: A predetermined, regularly scheduled full- Blueprint for Action (AONE, 2000), the time or part-time work schedule, as American Organization of Nurse Executives determined by contract, established work (AONE) recognized early on the potential scheduling practices, policies or impacts of the nursing shortage. In the procedures. The Institute of Medicine last three years, the nursing shortage has report, Keeping Patients Safe: become more acute. Shortages have been Transforming the Work Environment of documented in countless studies and have Nurses (IOM, 2003), cautioned that long become a critical factor in the access to work hours of some nurses represented and the provision of timely patient care one of the most serious threats to patient services. The Division of Nursing at the safety. The Fair Labor Standards Act Health Resources and Services (FLSA) has defined mandatory overtime as Administration projects the need for one hours worked over 40 per week or over 80 million nurses by 2010. Barring aggressive for a two-week period. Mandatory intervention, the supply of nurses will fall overtime does not include those overtime by 29 percent below what is required by hours for which workers have volunteered, the year 2020. but the nurse manager must consider the total number of hours a nurse has worked A majority of the states have reported and the effects of fatigue on human professional nurse vacancy rates from 12 performance when making assignments. to over 20 percent. To deal with the professional nurse shortages, health care In the view of AONE, declining a patient institutions have closed beds, reduced the assignment after completion of a regularly volume of elective surgeries, and placed scheduled shift will not be deemed as emergency rooms on diversion to attempt patient abandonment, be grounds for to deal with rising nurse vacancies. In disciplinary action, or result in actions many cases, institutions have initiated against the nurse. AONE does not consider mandatory overtime or asked staff to mandatory overtime to include “staffing remain voluntarily on patient care units up” for unseen emergencies, such as mass after the completion of a scheduled tour of causalities or snowstorms, or scheduled duty. Surveys have indicated that the “on call” time when a nurse may be paged practice of using mandatory overtime is to come into work as defined in his or her widespread; however, at times, the stories job description. have been overblown. The use of mandatory overtime has contributed to a negative image of the nursing profession Policy Position and the characterization of the hospital It is the view of AONE that mandatory work environment as overly stressful and overtime is the staffing vehicle of last unsafe for patients. resort, limited to crisis situations that would put patients in danger of not receiving the basic requirements of the physical, mental and emotional state, to safe care that they require. either accept or decline extra hours as a competent and safe care provider at the AONE believes that all health care delivery patient side. organizations, working in conjunction with the nurse executive and his or her nurse AONE is opposed to legislation prohibiting managers, are responsible for the the use of mandatory overtime at both the monitoring of staffing as it relates to state and federal level with regard to the patient safety, actual or potential patient registered professional nurse. It is the outcomes, and the quality of the work view of AONE that the issue is best environment. Every effort must be made addressed within the institutional setting. on the part of these organizations and the Mandatory overtime is but one aspect of nurse management team to develop the nursing shortage and its usage should staffing plans based on the consideration be monitored and tracked. of such factors as patient acuity and volume, the experience level of the nursing staff, the layout of the unit, the References relationships and availability of physician staff and the needs of the patients and the American Organization of Nurse nursing staff. Executives. 2000. Perspectives on the Nursing Shortage: A Blueprint for Action. Ultimately, it is the individual nurse who Chicago, IL: AONE. must be accountable to assess his or her ability, within the parameters of one’s Institute of Medicine. 2003. Keeping Patients Safe: Transforming the Work Environment of Nurses. Washington, DC: National Academies Press.
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