After 1 hour of overtime, nurse-to-nurse collaboration drops significantly
Though it is common, working overtime may negatively influence nurses’ collaboration with their colleagues, according to a study by researchers at New York University’s Rory Meyers College of Nursing.
Nurses often work long, irregular hours and have unexpected overtime, which puts them at risk for fatigue and sleep deprivation and can lead to impaired emotional, social, and cognitive processing. This, in turn, may hurt nurses’ ability to collaborate, the researchers said.
The study, published in the Journal of Nursing Administration, assessed how shift length and overtime impact nurses’ perceptions of collaboration with other care providers — specifically with other nurses and physicians.
Overtime Common
The researchers used 2013 survey data from the National Database of Nursing Quality Indicators, and analyzed responses from 24,013 nurses in 957 units from 168 U.S. hospitals.
Among the study’s findings:
- Across the five types of nursing units measured, the average shift length was 11.88 hours
- 12-hour shifts appear to be the predominant shift schedule for hospital nurses
- Nurses worked, on average, 24 minutes longer than their scheduled shift
- 33% of the nurses on a unit reported working longer than initially scheduled
- 35% of nurses said that the amount of overtime needed from nurses on their unit increased over the past year
Interestingly, the researchers did not find a significant relationship between average shift length and collaboration — meaning that longer-scheduled shifts did not necessarily lead to less collaboration. However, collaboration appeared to suffer in nursing units with longer overtime shifts and more nurses working overtime.
Collaboration on a unit was measured using the nurse-nurse interaction scale (RN-RN Scale) and nurse-physician interaction scale (RN-MD Scale). In addition, 1 hour of overtime was associated with a 0.17 decrease on the RN-RN scale and was marginally associated with a 0.13 decrease on the RN-MD Scale — in other words, a 0.17 decrease from the mean score on the RN-RN scale suggests that a unit’s rank on the RN-RN score would drop from the 50th percentile to roughly the 30th percentile, the team explained.
Advice for Nurse Leaders
The researchers advised that nurses, nurse managers, and hospital administrators should use overtime as infrequently as possible. Stimpfel and May said that while they recognize that longer shifts are the norm and that eliminating overtime may not be possible, offering fatigue management training and education would be helpful, as well as training to help nurses and physicians communicate effectively and respectfully.
Collaboration among healthcare professionals is critical for quality care and patient safety, the team emphasized. Previous studies have shown that patients receive superior care and have better outcomes in hospitals where nurses collaborate well with other healthcare providers. In fact, a study by Ma and two other co-authors published May 2 in the International Journal of Nursing Studies found that both collaboration between nurses and physicians and collaboration among nurses are significantly associated with patient safety outcomes.
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