Medical errors are more likely to occur when nurses work more than 40 hours per week or long, 12-hour hospital shifts, during which errors can triple, according to a University of Pennsylvania study published in July. Meanwhile, nursing organizations are aggressively lobbying to eliminate a new Department of Labor (DOL) regulation that would make it easier for employers to deny overtime pay to nurses.
The Penn study, published in the journal Health Affairs, surveyed 393 RNs across the country during a 4-week period. It found that more than half of the mistakes involved the administering of medication. Drugs were given to the wrong patient, at the wrong time or in the wrong dosage. Other errors included deviation from standard nursing practices, charting mistakes and errors in transcribing information. Working overtime increased the odds of making a mistake regardless of how long the shift. The study did not track the impact of the mistakes on patients.
All totaled, the study found 199 errors and 213 near-errors. Thirty percent of the nurses reported making a mistake. Nurses in the study reported that they were able to leave at the end of their scheduled shift less than 20 percent of the time. Two-thirds worked overtime 10 times or more during the month. A quarter worked more than 50 hours a week for two or more weeks during the month. On average, each participant worked an additional 55 minutes beyond the end of his or her shift.
No Easy Fix
Some experts consider medical errors to be one of the largest problems in healthcare. In 1999, a report by the Institute of Medicine estimated that 44,000 to 98,000 Americans died annually from preventable errors in hospitals. Medication errors were the most common mistakes cited in the report.
Yet, no state or federal regulations restrict the number of hours that a nurse may voluntarily work in a 24-hour period or in a seven-day period. Mandatory overtime has been a contentious issue across the nation, and has been banned in California, New Jersey, Maine and Oregon. But the issue is not as neat as something that hospitals demand and nurses resist.
Many full-time nurses with small children, for instance, prefer to work 12-hour shifts because it results in a three-day workweek. However, the Penn study found that even nurses who worked the longest shifts were asked to work additional overtime. Still, nurses who welcomed the overtime for the extra pay also logged a significant number of errors after 12 straight hours on the job, the study found.
A second phase of the Penn study will look at ways to combat nurse fatigue.
At issue regarding overtime pay is which employees are classified as hourly employees - and therefore eligible for time-and-a-half pay after 40 hours worked in a week - and which are deemed salaried employees and thus disqualified from receiving overtime pay. Under the proposed new federal guidelines, white-collar workers earning $23,660 to $100,000 will continue to collect overtime, unless they are on a list of exempted professions.
Employers must pay overtime to hourly workers under the new DOL regulation, but have the option to pay overtime to salaried employees to retain personnel. Technically, nurses are exempt from overtime, but hospitals continue to pay it because of the nationwide staffing shortage.
Supporters of the DOL change insist it expands the overall number of workers entitled to overtime and does not alter the "salaried" status of nurses. Opponents like the American Nurses Association (ANA) counter that most RNs are paid on an hourly basis, putting them in an ambiguous position that employers could exploit.
In a statement, ANA also said that it was concerned that "if the economic disincentive of paying time-and-a-half is removed, employers are even more likely to rely on mandatory overtime as a regular nurse-staffing tool."
Mark Dixon is a frequent contributor to ADVANCE.