When overtime hours, particularly mandatory overtime, are required by organizations to provide adequate registered nurse staffing, nurses can be pushed beyond their capacity to work safely and to provide appropriate, quality care to patients. Extended work hours contribute to nurses’ job dissatisfaction (Institute of Medicine, 2004; United States General Accounting Office, 2001). Additional shifts and hours are also reported to cause work-related illness and injuries (Christo & Pienaar, 2006; Cohen & Single, 2001) as well as health care errors (Institute of Medicine, 2004). The Center recommends that nurses develop workplace policies in collaboration with employers requiring no employee be forced to work overtime. In 2006, The Center adopted a position statement opposing mandatory overtime and outlining recommendations to decrease the physical and mental burdens such practices place on health care professionals (CENTER for American Nurses, 2006).

It has been noted that fatigue impairs nurses’ performance and increases the chance of making errors that affect health outcomes. It is not uncommon for nurses to work past the end of a scheduled shift. Those who work shifts lasting 12.5 hours or more have a 3 times greater risk for making errors (Rogers, Hwang, Scott, Aiken, & Dinges, 2004). To improve the work environment, the Center agrees with the recommendation made by the Institute of Medicine to prohibit mandatory or voluntary overtime in excess of 12 hours per 24-hour period and in excess of 60 hours per 7-day period (Institute of Medicine, 2004). Nurse fatigue is a controversial issue. Some support imposed limitations on work hours and shifts; others, particularly those who work overtime or have more than one job, believe they can self-regulate their work behaviors. The Center has provided a number of publications on shifts, work hours, and nurse fatigue to inform nurses about personal safety and quality care. Examples include Nurses and Fatigue fact sheets and articles focusing on shifts and work hours posted on the Web and provided directly to state nurses association members for reprinting in their statewide publications. Future nurse fatigue workplace policies will need to balance the work interests of nurses and employers with the safety interests of patients.

Musculoskeletal injuries are common because of the need to lift, turn, and assist patients. Back, neck, and shoulder pain are the most common type and cost the industry an estimated 6 absentee days per nurse per year (Trinkoff, Lipscomb, Geiger-Brown, & Brady, 2002). The Center supports the American Nurses Association’s (ANA) “Safe Patient Handling” campaign to encourage hospitals to provide lifting devices and lifting teams when transporting, lifting, and repositioning clients.

The current nurse shortage is compounded by the large number of aging nurses. The average age of a nurse in the U.S. is estimated to be 47 years (HRSA Health Professions, 2010). Mature nurses work in environments that are often stressful, demanding, and lack retention incentives devised especially for older nurses. They are expected to mentor novice nurses and build healthy intergenerational collaborative work relationships. In addition, a majority lack the financial skills necessary to plan for retirement. The Center highlights workplace strategies designed to retain mature nurses, increase nurses’ financial planning skills, and explore flexible staffing strategies that support the mature nurse.

Workplace design profoundly affects nurses and patients in the health care environment. A well-planned facility design can improve the quality of care for patients, promote recruiting and retention of staff, and enhance operational efficiency and productivity (CENTER for American Nurses, 2007). The Center provides education about ergonomics, technology, and workplace design to promote the well-being and safety of health care workers and patients. Nurses are encouraged to participate as full partners in workplace design and redesign decisions (CENTER for American Nurses, 2007).

Evidence validates that disruptive behaviors such as lateral violence and bullying negatively impact the health care work environment, the recruitment and retention of nurses, and the quality and safety of patient care (see Chapter 56). The Center has worked with other organizations to decrease such behavior.