Nurses’ Overtime Hours, Medical Errors Linked, Report Indicates

Nurses who work shifts longer than 12 hours or who work unplanned overtime at the end of a shift are as much as three times more likely to make errors, such as giving patients incorrect medications or dosages, according to a study published Wednesday in the journal Health Affairs, the Boston Globe reports. In the study, researchers from the University of Pennsylvania School of Nursing surveyed 393 registered nurses in hospitals nationwide. During one month in 2002, the nurses kept a daily log of their shift lengths, overtime, break schedules, coffee intake, weariness driving home and number of errors or near-errors they committed. Nurses who worked at least 12.5 hours committed errors on 103 of 2,057 shifts, or 5%, and reported near-errors -- defined as mistakes nurses caught before they affected patients -- on 97 shifts, the study found. Nurses working an average shift of between eight and 12 hours made errors on 12 out of 771 shifts, or 1.6%, and committed near-errors on 20 shifts, according to the study. The study found that 14% of nurses worked at least 16 continuous hours one or more times during the month, with the longest shift lasting 23 hours, 40 minutes.

Additional Findings
Researchers were "puzzle[ed]" to find that nurses who planned to work longer shifts and overtime reported fewer errors than those who worked unexpected overtime and those who worked an average length shift, the Globe reports. Ann Rogers, the study's lead author, suggested that nurses who planned to work longer shifts purposely could get more sleep and go about their tasks in a calmer manner (Kowalczyk, Boston Globe, 7/7). About half of the nurses' errors involved medication; other errors included procedural mistakes (Heldt Powell, Boston Herald, 7/7). According to Rogers, nurses in the study commonly said, "'I am trying to do too much. I triple-checked myself three times because I knew I was tired,' or 'it was 4 a.m. and I wasn't concentrating.'" Rogers added, "That's a bad time for any human being to be awake."

'Epidemic' of Errors
There is a "growing concern" that the national shortage of nurses is leading to an overstressed workload that can jeopardize patient care, the Globe reports. Some hospitals are "bending to nurses' demands" on limiting longer shifts as the "epidemic of medical errors" becomes more apparent, the Globe reports (Boston Globe, 7/7). For example, Massachusetts and some other states are considering rules that would limit working hours for nurses. Julie Pinkham, executive director of the Massachusetts Nurses Association, said of the study, "When the data shows you're out there injuring patients, I don't think we can just let it go." However, some hospital administrators have said facilities should establish their own standards, rather than adopt state requirements (Boston Herald, 7/7). Researchers in the fall plan to release more reports from the study, including papers on nurses' caffeine consumption and whether nurses fall asleep while driving home from work (Boston Globe, 7/7).

An abstract of the study is available online.