The Issue of Long Working Hours Among Nurses

The primary objective of the medical and nursing profession is to provide quality healthcare services to all patients to achieve positive patient outcomes. The high quality of healthcare depends on the efficiency of the healthcare system and the impact of nursing practices on the general health conditions of the patients. There are various determinants of healthcare quality, most of which are nurse-centered. The nurse-centered factors are the issues the nurses experience daily and hinder them from providing the expected care. This report will address the issue of the long working hours.

Definition of the Issue/Problem

The problem of the long working hours is common and long-standing. Traditionally, the nurses worked on shifts for eight hours per day. That was the globally recommended time shift until recently, when the nurses had to work twelve hours. The change in shift time among the nurses provoked a heated debate on its efficiency and impact on the quality of healthcare service delivery. Research conducted in the School of Nursing at the University of Pennsylvania revealed that among 23,000 participants, who were both nursing students and practitioners, almost 70% worked on shifts for an average of 12.5 hours. In addition, research by Townsend and Anderson reveals that more than 75% of the healthcare facilities in the US have either adopted or are in the process of adopting the 12-hour shifts. The long working hours have a significant impact on both the nurses and the patients. It has been reported that long working hours increase the rate of nurses’ burnout and fatigue, which reduces their productivity. On the other hand, patients receive lower-quality services from nurses working twelve hours, which means they experience reduced health outcomes. The main causes of the long working hours include:

• The staff shortage.
• The need to cut expenditures of healthcare facilities.
• The personal decisions of a nurse to work overtime to increase their income.

The effects of the long working hours include:

• Growing nurse fatigue.
• Little rest during the working days.
• Increasing chances of patient dissatisfaction.
• Reduced nurse productivity.

In addition, long working hours harm the quality of nursing practices. The main purpose of this paper is to address the issue of long working hours among nurses and to find possible solutions to this problem.

The Significance of the Issue

The Manifestation of the Issue

The disadvantages of the long working hours outweigh the benefits. Several studies investigated the impact of long shifts on the performance of the nurses. The findings of these research works show clearly that they cause a problem. The first indicator is that the quality of the nurses’ health services suffers. It was identified that since the twelve-hour shift was introduced two decades ago, the quality of health services in the hospitals that accepted that proposal has reduced by 15%. In addition, the health outcomes of the patients treated by nurses who continuously work for more than eight hours are 10% lower than those who work less than eight-hour shifts. Therefore, long working hours have influenced the healthcare profession profoundly for the past two decades.

Factors that Led to the Development of the Issue

Several factors led to the adoption long working hours within the healthcare system. First, there needs to be more staff in the healthcare facilities. The population of the US is more than 320 million people, but only 3.8 million registered nurses are available. This number of nurses cannot cater to the rising healthcare needs when each nurse works eight hours. Consequently, the only solution is to increase the shift time so that one nurse might stay longer and provide healthcare services to more patients. Secondly, many hospitals face a financial crisis due to underfunding. As a result, they need to receive the necessary funds to employ the required number of nurses and to meet patients’ demands. These hospitals end up overworking the nurses by increasing their shift time. Lastly, some nurses decide to work overtime to earn extra money. This usually emerges since nurses spend more than they earn. Therefore, the nurses work longer, sometimes fifteen hours in one day. Therefore, this issue can be solved if these factors are addressed.

Impact of the Issue

The long working hours impact the patients, the nurses, the quality of nursing care, and its costs. First, the long working hours might increase the chance of injury in both the patient and the nurse. According to Dall’Ora, Griffiths, Ball, Simon, and Aiken, patient and nurse injuries grow exponentially if a nurse works more than nine hours. In addition, injuries are more common during the night shifts than during the day shifts. Secondly, the quality of nursing care among the nurses who work for more than eight hours is lower than the performance of the nurses working on 8-hour shifts. This is evident from the fact that the health outcomes of patients treated by nurses on long working shifts are usually less promising than those provided by nurses on shorter shifts. In addition, the nursing practice suffers from the negative influence of long working hours because nurses working more than eight hours tend to create health problems and medical errors often related to hospital-acquired infections. Berkman et al. suggests nurses suffer from cardiovascular and metabolic disorders when facing a work-family conflict due to long working hours. The nurses working long hours also experience fatigue which may result in fatigue-related accidents. These failures and medical errors increase medical costs because higher expenditure arises from correcting the incurred mistakes. The medical expenditure resulting from these errors has grown in the US over the past few decades.

Social Justice Considerations

Health and social justice mean that every patient can receive quality healthcare services, irrespective of their social or financial background. As aforementioned, financial constraints are considered to be one of the contributing factors to the long working hours. The most affected healthcare facilities are local public hospitals. People with low incomes tend to attend these hospitals, assuming they are at a higher chance of receiving low-quality services from the nurses working long shifts. This challenge does not face the rich because they can afford healthcare services from elite and well-funded hospitals. Therefore, it is evident that the long working hours create a social injustice among poor and low-income people.

Review of the Literature/Discussion

Issue/Problem

The problem of long working hours has been described as when nurses willingly or unwillingly work for shifts that exceed eight hours. Sometimes, the nurses work up to eighteen hours during one shift. This problem has a significant negative impact on both the nurses and the patients. In addition, the nursing profession is adversely affected because the quality of nursing care is compromised. Therefore, the impact of the long working hours has interested various nursing researchers.

Causes and Effects

The causes and effects of long working hours have been extensively researched. For instance, Dall’Ora et al. argue that the most common cause is that the hospitals adopt the long shifts strategy due to the nursing shortage. According to this paper, more than 65% of the hospitals in the US, especially the ones in rural areas, need to be more staffed. It forces them to overwork the available nurses by increasing their shift time to twelve hours so that they can meet the healthcare demand. In addition, the need for overtime among nurses has been a major cause. Some nurses willingly work overtime so that they can earn extra money. There are several effects of long working hours, most of which are negative. A survey conducted by Lo et al. shows that long working hours significantly increase the likelihood of needlestick injuries by 45% and the likelihood of the nurse experiencing sharps injuries by 56%. In addition, the twelve-hour shifts have been profoundly influencing the sleeping patterns of the nurses. This problem has become the most common among nurses with young children. Long working hours have also negatively affected patient outcomes. In this regard, the healthcare conditions among the patients treated by nurses working on a twelve-hour shift were worse than those treated on an eight-hour shift. Unfortunately, no research investigates the impact of long working hours on the cost of nursing services.

Possible Solutions/Recommendations

One of the solutions to this problem is the adoption of the state’s nurse work-hour regulations. The state’s regulations on the mandatory reduction of overtime and long shifts have reduced the problem of long working hours. Another recommendation is that hospital management adopts flexible working hours. In this regard, the management can consider giving a day’s leave to the nurses who work long hours or allowing the nurses to work shorter shifts after a long shift. These strategies help reduce the effects and consequences of long working hours and overtime.

Positives and Negatives of the Solutions/Recommendations

The positive impact of the first recommendation concerning the state’s regulations on the mandatory reduction of overtime and long shifts is that the healthcare providers will follow the strategy because there are legal implications for individuals and organizations that will violate it. The disadvantage of this solution is that it can result in numerous court cases, especially from private hospital owners who object to the regulations. This would delay its implementation. The positive impact of the second recommendation on flexible working hours is that it will improve patients’ and nurses’ outcomes because fatigue-related errors will be reduced. The nurses who take a day off or work shorter shifts do not suffer from fatigue caused by long working hours; thus, they are more productive. The drawback of this solution is that it might be misused by some nurses and hospital management that might not be willing to implement it because it needs to be legally supported.

Intended and Unintended Consequences of the Solutions/Recommendations

The intended consequence of the first solution is that it will be successful due to its legal foundation. However, the unintended consequence is that it might reduce the delivery of healthcare services in short-staffed hospitals. These hospitals could not provide healthcare services when required because the number of nurses would be limited. The intended consequence of the flexible working hours solution is that it would improve the productivity of nurses due to reduced fatigue, but its unintended consequence is that some nurses might be willing to overwork to be able to take more days off. In conclusion, the literature review shows that the issue of long working hours is a serious problem that needs to be addressed and solved. The identified causes of the long working hours include the nurse shortage and the need for nurses to work overtime to provide for their families. However, the long working hours negatively impact the patients and the nurses. The likelihood of the nurses experiencing needlestick and sharps injuries increases with the long working shifts. In addition, the long working hours interrupt the sleeping patterns of the nurses and aggravate the patients’ outcomes. The recommended solutions include the state’s regulations on the mandatory reduction of overtime and long shifts and the hospital management adopting flexible working hours. The government should increase the number of registered nurses in hospitals by providing funding and promoting education and research in nursing. The intended positive consequence of this recommendation is that it will solve the overtime issue, while the positive unintended consequence is that the private hospitals might not have the resources to match the public hospitals, thus forcing them out of the market. The only limitation might be that there would need to be more funds to implement this solution fully. ? References: 1. American Sentimental University. (2014). 12-hour nursing shifts vs. 8-hour nursing shifts: Which is best? 2. Bae, S. H., & Fabry, D. (2014). Assessing the relationships between nurse work hours/overtime and nurse and patient outcomes: Systematic literature review. Nursing Outlook, 62(2), 138-156.

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