NURSING OVERTIME WORK IN CRITICAL CARE: QUALITATIVE AND QUANTITATIVE PERSPECTIVES

Abstract

Background: Nursing overtime is being integrated into the normal landscape of practice to ensure optimal staffing levels and address variations in patient volume and acuity. This is particularly true in critical care where fluctuations in either are difficult to predict. Research exploring nurses’ perceptions of the outcomes of overtime has not been conducted, and studies exploring the relationship between nursing overtime and patient outcomes have produced conflicting results. Objectives: This study aims to explore critical care nurses’ perceptions of the outcomes of overtime, their reasons for working or not working it, and to determine the relationship between critical care nursing overtime and specific nurse (sick time) and patient (infections/mortality) outcomes. Methods: This thesis is comprised of two discrete components. Thorne’s interpretive description guided the qualitative component and multilevel regression models tested relationships in the quantitative portion. Qualitative and quantitative methods were selected because of their complementarity and ability to explore both perceptions of overtime in addition to the relationship between nursing overtime and outcomes for nursing staff and their patients. Results: Participants’ reasons for working overtime included: (a) financial gain, (b) helping and being with colleagues, (c) continuity for nurses and patients, and (d) accelerated career development. Their reasons for not working overtime were: (a) tired and tired of being there, (b) established plans, and (c) not enough notice. Major themes highlighting the perceived outcomes of overtime included: (a) physical effects, (b) impact on patient centered care, (c) the issue of respect, (d) balancing family and work, (e) the issue of guilt, (f) financial gain, and (g) safety is jeopardized. Regression analysis revealed that for every 10 hours of nursing overtime, sick time increased by 3.3 hours (p<0.0001). Overtime was not associated with patient outcomes (infections and mortality). Conclusion: There are negative and positive consequences of nursing overtime for nurses and patients. Future research needs to focus on the collection of accurate patient level data, as well as tracking and exploring the effects of unpaid overtime (missed breaks/staying late). Nurses should work to proactively lobby governments to fund adequate staffing in order to reduce the need for overtime and provide safer patient care.