NURS 625 Week 2 Blog 1 on Overtime as a Staffing Resource Example

Blog 1: Legal, Ethical and Safety Limits on Overtime as a Staffing Resource

NURS 625 Nursing Administration III: Management of Resources, Blog 1

Thread by [Student Name]

The hospital, the unit and the classmates replied to are composites written for a model blog.

On the medical unit where I am completing my practicum hours, the manager posts incentive shifts every Thursday for the following week. In the six weeks I have watched, every schedule has needed at least nine of them, and the same five nurses pick up most. One of them told me she has not had two days off in a row since spring. Overtime was meant to cover gaps; on this unit it has become the staffing plan. When I asked the manager why, she said the position control showed only two open lines, so the director had never approved a recruitment push. On paper the unit looked staffed; on the schedule, five nurses were quietly carrying two empty positions. In practice, the hours of those two vacancies, plus sick calls and a leave of absence, were being absorbed by the same small group of nurses week after week.

Our reading frames staffing as a resource that the administrator must manage within legal, regulatory and ethical boundaries (Roussel et al., 2020). Overtime fits that frame, because it has three kinds of limits. The first is legal: several states restrict mandatory overtime for nurses outside declared emergencies, and federal wage law sets how overtime must be paid. The second is ethical: a nurse who is asked to work a fourth twelve-hour shift is being asked to give up rest she needs to practice safely. The third is safety, and here recent evidence is sobering. Pittman et al. (2025) analyzed four years of staffing and safety data from 70 US hospitals and found that the average use of overtime hours exceeded the safe threshold the authors identified for pressure ulcers by 63.6%, while agency hours exceeded it by 140%. Data of this kind show association rather than cause, but it suggests that hospitals are routinely using more overtime than their own outcomes support.

As a future administrator, I would treat overtime as a budget line with a ceiling, not an open tap. That means tracking overtime hours per nurse each pay period, flagging anyone above a set limit, and reporting the unit's total to the director alongside agency spending. When the ceiling is hit, the answer should be a staffing plan, not another incentive. On my practicum unit, the overtime report alone would have shown within a month that two vacancies were really closer to four, which is the kind of evidence a director needs before approving new positions or a float pool.

God built rest into creation and commanded it for every worker in Israel, including servants and strangers (English Standard Version Bible, 2001/2016, Exodus 20:8-10). An administrator who lets five nurses carry the gaps of a whole unit is spending something that does not belong to the budget. Stewardship of a nurse's hours is part of stewardship of the organization's resources. Jesus also invited his tired disciples to come away to a quiet place and rest a while (English Standard Version Bible, 2001/2016, Mark 6:31), which tells me that protecting rest is not a lack of commitment to the work but a condition for doing it well over a whole career.

Reply to Kendra

Kendra, you argued that voluntary overtime is harmless because nurses choose it. A 2026 systematic review complicates that view. Braiki et al. (2026) synthesized 71 observational studies and found that mandatory overtime was linked to eight adverse nurse outcomes, voluntary overtime to three, and no study reported a benefit for patients from either kind. Choice reduces the harm but does not remove it. Most of the included studies were cross-sectional, and the authors called the overall evidence inconsistent, yet the direction of the findings was the same across almost every outcome they examined. The authors also found no study that compared mandatory and voluntary overtime on patient outcomes, so we cannot assume voluntary hours are safe for patients. I would still offer incentive shifts, because they give willing nurses extra income and keep units open, but I would cap them per nurse each pay period and review anyone who reaches the cap twice in a row. A cap protects the nurses who find it hardest to say no.

Reply to Owen

Owen, I liked your idea of screening for fatigue before approving extra shifts. Kang et al. (2026) surveyed 213 perianesthesia nurses in South Korea and found that clinically significant insomnia affected about a quarter and fatigue about two-thirds. Insomnia and fatigue, but not overtime itself, were associated with more self-reported medication error types. About four in five of the nurses had worked overtime recently, so overtime may simply have been too common in the sample to show an effect. That suggests the hours matter through what they do to sleep and fatigue, so a brief fatigue check might predict risk better than counting hours alone. The design was cross-sectional and the errors were self-reported, but the finding supports your idea of asking how rested a nurse is before approving another shift. A two-question check at the time of the request would cost the manager a minute and could catch the nurse who is exhausted but too loyal to refuse.

Reply to Priya

Priya, you said that adding staff is the only real alternative to overtime, and one Australian study supports the link between workload and harm. Al-Ghraiybah et al. (2025) linked a survey of 361 nurses to 71,257 patient episodes and found that each additional patient per nurse raised the odds of a hospital-acquired infection by 42%, while a better practice environment and hand hygiene lowered them. If a short-staffed shift covered by a tired nurse still runs at higher ratios, overtime may not fully protect patients either. Your budget argument for a float pool is stronger with numbers like these. A float pool costs money every pay period, while infections, extra days and readmissions cost money later and in another department's budget, which is why administrators often fail to compare them. The study was set in one hospital, but its patient sample was large enough to make the comparison worth raising with your director.

References

Al-Ghraiybah, T., Lago, L., Fernandez, R., Molloy, L., & Sim, J. (2025). Effect of nursing practice environment, nurse staffing, overtime and hand hygiene on hospital-acquired infections in a tertiary teaching hospital. Journal of Clinical Nursing, 34(10), 4142-4154. https://doi.org/10.1111/jocn.17618

Braiki, R., Provost, J., & Rochefort, C. M. (2026). The characteristics of working overtime and their associations with nurse and patient outcomes: A systematic review of observational studies. Canadian Journal of Nursing Research. Advance online publication. https://doi.org/10.1177/08445621261463879

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Kang, Y., Choi, E. Y., Baek, W., Park, C., & Min, A. (2026). Associations of insomnia, fatigue, and overtime work with self-reported medication errors among perianesthesia nurses: A cross-sectional study. International Nursing Review, 73(3), Article e70233. https://doi.org/10.1111/inr.70233

Pittman, P., Tiunn, H. L., Luo, Q., Herron, M., Tatum, D., & Martin, J. (2025). Increased utilization of overtime and agency nurses and patient safety. JAMA Network Open, 8(4), Article e252875. https://doi.org/10.1001/jamanetworkopen.2025.2875

Roussel, L. A., Thomas, P. L., & Harris, J. L. (2020). Management and leadership for nurse administrators (8th ed.). Jones & Bartlett Learning.