Scheduling should be a dream… For nurses, it's a nightmare.
With over two and a half million in the United States, nurses are one of the nation's largest workforce segments. Their average salary of around $65,000 makes them fairly well compensated too. However, the physical and emotional stress that the job imparts can sometimes make it feel like a minimum wage. Hospitals squeeze their nurses for maximum productivity while their patients often do the same. Extra hours get tacked on to the ends of shifts and open slots are desperately filled by the hospital's staffing department. Studies show that these extra hours lead to more errors for the patients, poorer health for the nurses, and lost money for the hospital. A lot of this could be fixed through proper management of the nurse's schedule. Reducing overtime hours, maintaining proper ratios, and fulfilling schedule requests can all help alleviate the aforementioned issues hospitals face today.
Medical errors within a hospital are now the third leading cause of death in the US. When nurses end up working longer than their scheduled shift, medical errors become up to three times more likely. There are various reasons for a nurse having to work longer than their scheduled shift; heavy workload, short staffing, poor nurse-to-patient ratio, a late co-worker, among others. Hospitals often have numerous security measures in place the help prevent medical errors. Nurses follow their 5 Rights of Medication Administration (Right Patient, Right Drug, Right Dose, Right Route, Right Time) that they were taught in nursing school and electronic charting now requires you scan the drug and patient before giving a med. Yet the errors persist, in part because the root of the problem has not been solved. When nurses are fatigued or distracted they are more likely to overlook that one important piece of information that may have prevented the error. Fatigue and distraction can be directly related to scheduling and staffing issues, and so scheduling and staffing issues can be directly related to medical errors.
Working overtime has run rampant in hospitals too. Approximately 40% of nurses in one survey reported working longer than their scheduled 12-hour shift. 14% of respondents reported working at least one 16 hour shift within the last month. Overall, the participants worked on average 55 minutes longer than each scheduled shift. Despite some states attempts, there are still no federal or state regulations that prohibit the number of hours a nurse can voluntarily work in a 24-hour period or 7-day week.
While working longer than expected is an obvious contributor to nurse fatigue, there is another factor that often gets overlooked by non-nurses. The dreaded Island Shift. Many nurses only work 3 or 4 days a week and are required to work every other weekend. If you do the math, this leads to a pretty erratic and inconsistent schedule. So erratic, in fact, that it is not uncommon to see a nurse scheduled to work one shift in between days off. This is rarely ideal. These Island Shifts are particularly bad for night shift nurses, who have to switch their sleeping schedules back and forth. When their shifts are clustered their days off are clustered. This means more continuity with patients, less stress (usually) for nurses, and better outcomes for the hospital. Island Shifts are a product of improper scheduling, and improper scheduling is a product of hospitals not adopting the necessary technologies. Fortunately, these technologies are now working their way into the hands of nurses, who demand better scheduling.
A good nurse schedule and a properly managed workforce are more than just perks. Having nurses work their desired shifts without overtime will lead to a number of better outcomes:
- Nurses—the hospital's largest employee group—will be more satisfied with less turnover.
- Patients—the hospital's reason for business—will experience less medical errors.
- Hospitals—these billion dollar businesses—will save money.