Use, trends, and impacts of nurse overtime in New York hospitals, 1995--2000

Over the last several years, nurses and their advocates have expressed concern about heavy use of overtime (OT) in hospitals and claimed that it undermines the quality of nursing care. Some hospital managers view OT as an important staffing and scheduling tool. This study examines trends in the use of nurse overtime and its effects on several nurse-sensitive patient outcomes.; Previous studies have demonstrated a relationship between several patient outcomes and nurse staffing levels, but little is known about the impact of nurse overtime on patient outcomes. Using staffing and discharge data covering 1995 to 2000 from 160 acute general hospitals in New York State, this study examines hospital characteristics that are associated with the use of OT. These characteristics include size, location, RN unionization, hospital ownership and teaching status. The study examines trends in the use of OT. Finally, it uses multivariate regression to analyze the relationship between OT and the rates of six nurse-sensitive patient outcomes and mortality.; Significant differences were observed in the use of OT by hospital ownership and by union status. Government hospitals used less OT than non-government hospitals. Non-union hospitals used slightly less OT than hospitals with unionized nurses. As total RN hours and straight (non-OT) hours per acute inpatient day increased, OT decreased.; OT use as a percent of total inpatient RN hours increased significantly over the study period from 3.9% to 5.5%. Trends varied by hospital characteristic.; This dissertation finds little evidence for an association between nurse OT and patient outcomes. One reason may be that the administrative data used track OT use and adverse events for whole years. Since OT use is episodic, data that examine the occurrence of adverse events during periods of heavy nurse overtime may be more sensitive to the impact of OT. That hospitals vary dramatically in their OT use and that some categories of hospitals (e.g. government-owned) use very little OT—without apparent effect on patient outcomes—suggests that hospital management can find substitutes for OT to meet fluctuating staffing needs.