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Have you considered the domino effect of overtime? Click here to learn more.

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I recently presented a webinar titled, “How Overtime May Be Harming Your Business and Patients,” where I had the opportunity to share research findings that connect overtime to patient dissatisfaction. Polling during the webinar revealed that there may be a major disconnect between what the research shows and how healthcare leaders feel overtime impacts their hospital.  Let’s walk through the research and examine the disconnect.

Overtime leads to nurse dissatisfaction.

Both common sense and the research point to a simple truth: long shifts lead to nurse burnout and staff dissatisfaction. For example, nurses who work shifts of 13+ hours are 2.7 times more likely to be burnt out, 2.38 times more likely to be dissatisfied with their jobs and 2.57 times more likely to leave their job in the next year compared to nurses who work 8-9 hours.1

Overtime that leads to nurse dissatisfaction leads to patient dissatisfaction.

Research also tells us there is a direct link between OT and patient satisfaction. For example, when nurses work more than 13 hours, patients are more likely to score a hospital 6 or lower out of 10 on the HCAHPS survey.2 And, another study shows that the percentage of patients who would “definitely recommend” a hospital to their loved ones decreased 2 percent for every 10 percent of nurses who expressed dissatisfaction with their jobs.3

Not everyone has made the connection for their hospital, their employees and their patients.
Before I presented the research findings about the connection between overtime and patient dissatisfaction, we polled the webinar attendees. Here’s what those results look like:

Has overtime been identified as a root cause of patient dissatisfaction in your hospital/health system?
Screen Shot 2015-08-25 at 10.28.49 AM
Clearly, these polling results are very different from the research. So, what’s next?

While patient satisfaction has always been an important part of healthcare delivery, it’s gaining in importance. The move from fee-for-service to pay-for-performance, as well as an increased ability for patients to comparison shop, is putting patient satisfaction in the spotlight.

With patient satisfaction a top priority for the majority of health systems, it’s important to ask more questions and dig a little deeper to determine how overtime is impacting your health system. To learn more about the potential negative effects of overtime, please read the white paper, “Unveiling Overtime’s Total Costs: How OT May Be Harming Your Business and Your Patients.”


1Stimpfl, Amy, et al. The Longer the Shifts for Hospital Nurses, The Higher the Levels of Burnout and Patient Dissatisfaction. Health Affairs, 31, no.11 (2012): 2501-2509.


3McHugh, Matthew et al. “Nurses’ Widespread Job Dissatisfaction, Burnout and Frustration with Health Benefits Signal Problems for Patient Care.” Health Affairs, 30, no.2 (2011): 202-210.



It’s no surprise that working long hours can take a toll on employees, especially healthcare employees. A Health Affairs study found that nurses who work more than 12 hours in a shift and 40 hours in a week are more prone to increased turnover and job dissatisfaction. The same study concluded that nurses who work shifts longer than 12 hours are 1.45 times more likely to leave their job position within a year.1  When left unmanaged, overtime can create a deeply embedded problem that can have a rippling effect on other aspects of your hospital, including patient satisfaction.

Patients reported lower satisfaction levels when higher proportions of nurses worked shifts longer than thirteen hours. These patients were more likely to rate the hospital 6 or lower on their HCAHPS survey. Scoring a 7 or lower on HCAHPS results in a 37% chance of that same patient seeking voluntary return to that hospital in the future.2 Additionally, nurse dissatisfaction caused by long hours also impacts the likelihood that patients will recommend the hospital to friends and family. For every 10 percent of nurses reporting job dissatisfaction, the likelihood of patient recommendations decreases by 2 percent.3 With the average lifetime value of a typical household totaling $405,000, creating better patient experiences should be a priority.4

Reducing staff overtime is easier said than done. However, hospitals can make this happen by driving a fundamental culture change from overtime being the “rule” to overtime being the exception. If hospitals implement measures to reduce shift and workweek length, and set guidelines for what is an acceptable amount of overtime, nurses might not feel obligated to work extra hours.

There is a correlation between overtime and increased likelihood for staff turnover, staff injuries on the job, medical errors that harm patients, and lower patient satisfaction scores. Effective workforce management strategies, supported by innovative technology can address each of these challenges by effectively managing overtime while freeing up nurse manager hours that can be refocused on more critical needs, like caring for and treating patients.

Nurses are not only the backbone of the healthcare workforce, they are the closest point of interaction with the patient. Their satisfaction is directly tied to the overall patient experience and as such, hospitals must focus greater attention on initiatives that promote their wellness and satisfaction. Better management of overtime is a good place to start.


1Stimpfel, Amy, et al. The Longer The Shifts For Hospital Nurses, The Higher The Levels Of Burnout And Patient Dissatisfaction. Health Affairs, 31, no.11 (2012):2501-2509.

2J.D. Power and Associates National Hospital Service Performance Study: (2005)

3Health Affairs “Nurses’ Widespread Job Dissatisfaction, Burnout, & Frustration with Health Benefits Signal Problems for Patient Care.”

4How to Maximize Lifetime Value of the Patient Relationship, Presented at The Beryl Institute Patient Experience Conference 2011, Accessed on February 20, 2015. ms=%22lifetime+and+value+and+patient%22