System restricts nurses' overtime
Additional pilot program targets the ED
Citing anticipated benefits for patient care, for caregiver health, and for the bottom line, Emory Healthcare in Atlanta has put a limit on overtime hours for its nurses, including those in its two EDs. Under the new policy, overtime is limited to less than 3% of its schedule, and it does not allow nurses who wish to work overtime to put in more than 60 hours a week.
"We found that when nurses worked 12.5 hours or longer, their risk of making an error tripled," says Ann E. Rogers, PhD, RN, FAAN, a professor at Emory University's Nell Hodgson Woodruff School of Nursing. Rogers has conducted research on the association between overtime and errors. "It's hard to maintain concentration that long," says Rogers, noting that the errors her research found included procedural errors, medication administration errors, and transcription errors.
ED nurses face unique challenges, Rogers notes. "Some of the shifts start at three in the morning and go to 3 p.m., or vice versa," she says. "While I understand why they do it in terms of staffing, you have people coming into work at the absolute sleepiest time in terms of circadian rhythms." Thus, these nurses are on the road coming home or going to work under less than optimal conditions, Rogers says.
While the new policy does not specifically address timing of shifts, Emory has established a Central Staffing Resource Center (CSRC) with nurses who are willing to travel to any of Emory's five hospitals to work in any unit. Marilyn Margolis, MN, RN, director of nursing operations at Emory University Hospital and a former ED director, says, "We don't want to jeopardize patient care, but we want to be sure we're providing nurses who are well-equipped to take care of patients."
The CSRC nurses are trained to work in all five of the Emory system's hospitals, she explains.
"If I'm a critical care nurse in CSRC, I can go to any of these hospitals for a premium in pay," explains Margolis, adding that there are nurses in CSRC that are trained ED nurses and are used to fill needs in both Emory EDs.
"The important thing is these nurses have to be trained specifically for EDs. They can't just be ICU nurses," says Margolis. They are given ED orientation "for as long as it takes," she adds. If they don't already have ED experience, they come down to an ED and are assigned a preceptor, who will work with them as many weeks as it takes for them to get comfortable.
The use of these CSRC nurses enables Emory to enforce its limits on overtime hours, Margolis says. "After your staff signs up on the schedule, when you have needs posted they go to CRSC," she explains.
In addition to limiting overtime, Rogers says it's important for nurses to get their full 30 minutes for lunch and 15 minutes for breaks. "The ability to take a 15-minute nap during your break will get you fired in most places, but it has been demonstrated to be one of the most effective things you can do to help people," she says.
Margolis says, "We have a policy that nurses get a 30-minute lunch break and a 15-minute break. The ability to do that is very important. We make provisions for staff to be relieved for lunch, and we have break areas on the ED units. It's a really important part of keeping the staff satisfied and engaged, productive, and safe." (In conjunction with this new policy, Emory has added a pilot program that specifically targets EDs. See the story below.)
Sources
For more information on nursing overtime policies, contact:
- Marilyn Margolis, MN, RN, FAAN, Director of Nursing Operations, Emory University Hospital, Atlanta. Phone: (404) 712-0681. E-mail: [email protected].
- Ann E. Rogers, PhD, RN, FAAN, Professor, Emory University's Nell Hodgson Woodruff School of Nursing, Atlanta. Phone: (404) 727-5122. Fax: (404) 727-8514. E-mail: [email protected].
New program helps the EDs Emory Healthcare, which recently introduced a new policy to limit overtime hours for its nurses, including those in its two EDs, has just launched a companion pilot program that specifically targets the ED. "We're now putting a premium on critical staffing needs," says Marilyn Margolis, MN, RN, FAAN, director of nursing operations at Emory University Hospital and herself a former ED director. Margolis explains that "critical" staffing needs are defined as anything greater than two needs on one shift. "If today we had two 'holes' or needs for nurses, we have a process in pilot for EDs where we can offer premium pay to have our own staff fill these needs," she says. The reason this pilot program was instituted in the ED is because "it's very important to have nurses who are ED-trained," she says. The ED staff prefers this arrangement because they can work in their own department, Margolis says. Their peers prefer it because these nurses are known entities, she says. Patients receive consistent care. However, "those nurses who fill in can't go over the overtime limit," says Margolis, who say that nurses are restricted to 60 hours a week. |
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