00:00:01
[Music]
00:00:08
[Music]
00:00:20
so Amy thank you so much for joining us
00:00:22
today thank you for having me it's love
00:00:25
to talk to you about the study that you
00:00:27
and your colleagues have done uh about
00:00:30
uh the working conditions of nurses now
00:00:33
uh what's interesting to me in reading
00:00:35
your paper is that uh the US uh labor
00:00:38
history has had such a long tradition of
00:00:41
of trade unions fighting for the 8-hour
00:00:44
workday but in your study you found that
00:00:47
nurses actually are not part of that
00:00:49
they they many of them work 12 or 13
00:00:52
hours uh uh 13-hour shifts why why does
00:00:56
this situation exist and how how has it
00:00:59
come about so nurses traditionally
00:01:01
worked 8 hour days and then in the 1980s
00:01:04
and 1990s when there were some um
00:01:06
structural changes in healthc care and
00:01:08
there's Cost Containment measures put in
00:01:10
it was actually less expensive to have
00:01:12
nurses work 12-hour shifts because that
00:01:14
was only two nurses per day instead of
00:01:16
three and so nurses began working these
00:01:19
12-hour shifts and in fact they just
00:01:21
decided they really liked it because it
00:01:23
offered better work work life work life
00:01:26
balance so nurses could work three days
00:01:28
instead of five so they had more time
00:01:30
off for their family and friends and me
00:01:32
fewer commutes and they had more time to
00:01:34
go back to school so it's really become
00:01:37
very prevalent most hospitals either
00:01:40
offer 12-hour shifts and 8 hour shifts
00:01:42
and some hospitals only offer 12-hour
00:01:44
shifts so it's very very common now so
00:01:46
do nurses have a choice they can choose
00:01:48
whether to is it voluntary or is it it
00:01:51
depends on the hospital and sometimes it
00:01:52
depends on the unit in which they work
00:01:54
so some hospitals may give the option
00:01:57
when a nurse is hired if they're going
00:01:58
to be hired into a unit that only Works
00:02:00
schedules 12 hour shifts or it may do a
00:02:03
mix of 12 hours and 8 hours so from your
00:02:06
research it uh from your paper it seems
00:02:08
like nurses don't have uh uh work
00:02:11
workout policies there are no workout
00:02:13
policies for nurses are there other
00:02:15
professions where such policies exist
00:02:18
and why is there a difference there are
00:02:20
so other safety sensitive Industries
00:02:23
like Physicians um Pilots longdistance
00:02:26
truck drivers they all have workout
00:02:28
restrictions and there aren't any
00:02:29
National workour restrictions for nurses
00:02:32
um and in certain states there are
00:02:34
mandatory overtime prohibition but
00:02:37
nurses can work as much voluntary over
00:02:38
time as they want and when this issue
00:02:41
was looked into and um for example in
00:02:43
the state of Texas a few years ago the
00:02:45
State Board of Nursing was considering
00:02:47
doing some work hour restrictions and
00:02:49
when they put it to a vote over 90% of
00:02:52
the nurses said that they do not want
00:02:54
any restrictions on their work hours so
00:02:56
it's a very um complex uh situation
00:03:01
uh it certainly seems like it because I
00:03:03
mean uh looking at your study you looked
00:03:06
at the impact of long shifts on things
00:03:08
like burnout and job satisfaction and
00:03:10
other factors among nurses uh what were
00:03:13
some of your major findings so our main
00:03:15
findings we found that when nurses
00:03:17
worked above the standard 8 hour shift
00:03:20
um that they were at increased odds of
00:03:22
being burned out and dissatisfied and
00:03:24
also intending to leave their employer
00:03:25
in the next year and this was worse for
00:03:28
the nurses that work the longest shifts
00:03:29
so if they worked over 13 hours they had
00:03:32
um a twofold increase in the odds of
00:03:34
being burned out and dissatisfied and
00:03:36
intending to leave their employer so
00:03:38
their overall well-being was definitely
00:03:40
being impacted by these long shifts and
00:03:42
yours was not a national study you
00:03:44
covered four states right correct which
00:03:46
were the in which states was the
00:03:49
condition the worst um it it was very
00:03:52
similar actually across the states um so
00:03:55
we found that this wasn't a phenomenon
00:03:57
found only in California but maybe not
00:03:59
New Jersey it was found in all the
00:04:01
states where um nurses were working
00:04:03
these extended
00:04:05
shifts when the nurses are overworked of
00:04:07
course you know as you pointed out it
00:04:10
the they get more frustrated and the
00:04:11
chances of burnout are much higher but
00:04:14
does it also have an impact on patient
00:04:16
outcomes yes so this was actually the
00:04:18
first study to look at the relationship
00:04:20
between nurses shift length and how
00:04:22
patients perceive their care in the
00:04:24
hospitals and we found that when there's
00:04:26
a higher proportion of nurses working
00:04:28
those really long shifts of over 13
00:04:30
hours that patient satisfaction went
00:04:32
down and that was in things like whether
00:04:34
or not patients would recommend the
00:04:35
hospital to their family and friends
00:04:37
whether they would rate the hospital low
00:04:39
on a scale of 1 to 10 um and then also
00:04:42
things like communication with their
00:04:43
nurses and then conversely we found in
00:04:45
hospitals that had a high proportion of
00:04:46
nurses working the standard 8 hour
00:04:49
shifts patient satisfaction was improved
00:04:52
so that's very interesting because uh
00:04:55
obviously if making nurses work for very
00:04:58
long hours brings down patient
00:05:00
satisfaction then the business
00:05:02
implications for the hospital are
00:05:03
clearly very negative uh in spite of
00:05:07
that why is does this situation exist uh
00:05:10
any did your research point up uh point
00:05:13
out any reasons for that well we found
00:05:16
that um when we asked nurses questions
00:05:18
about their scheduling and their shift
00:05:20
length that overall actually they are
00:05:21
very satisfied with um having flexible
00:05:24
schedules being actively involved in
00:05:26
their scheduling so that's um something
00:05:28
that we found was really interesting
00:05:30
that although most of the nurses worked
00:05:31
these 12-hour shifts and they appeared
00:05:33
satisfied with them that there were
00:05:35
still these negative um implications for
00:05:37
their well-being and then also for the
00:05:39
patients uh now what what are some of
00:05:42
the business implications of not
00:05:43
addressing these issues in hospitals
00:05:45
sure so um typically when nurses become
00:05:47
burned out and dissatisfy those are
00:05:49
precursors to um voluntary turnover and
00:05:52
so if they leave the hospital the costs
00:05:54
for recruiting retraining rehiring and
00:05:58
um Staffing temporary nurses is very
00:06:01
costly and it can be um the annual
00:06:03
salary of a nurse which can be anywhere
00:06:04
from $50 to $80,000 or so so it's very
00:06:07
costly for hospitals if they have a a
00:06:09
high number of turnover um and it's also
00:06:12
you know bad for staff morale and it's
00:06:14
not good for the patients either so
00:06:16
there's certainly um a big cost
00:06:18
associated with having overwork
00:06:20
dissatisfied burned out nurses what
00:06:22
implications do your findings have for
00:06:26
uh on hospital reimbursements by
00:06:27
Medicare and Medicaid sure so under the
00:06:30
Affordable Care Act um there was a
00:06:32
provision put in place so that Hospitals
00:06:34
now face um reductions in their
00:06:36
reimbursement if they don't achieve
00:06:38
National um standards on their patient
00:06:41
satisfaction and we use the hospital
00:06:43
consumer assessment of healthcare
00:06:44
providers and systems that are known as
00:06:45
H caps um and that was a survey that we
00:06:48
used in our study and if they don't
00:06:50
achieve this Benchmark then they they
00:06:53
face reductions in um reimbursements so
00:06:56
one easy way to help um increase the
00:07:00
likelihood of achieving those benchmarks
00:07:02
is to have a well-rested um you know
00:07:05
adequate nursing staff and so by
00:07:07
investing in nursing hospitals have the
00:07:09
potential to reap you know more rewards
00:07:11
through reimbursement right uh now uh
00:07:15
based on your research what changes
00:07:17
would you recommend that hospitals make
00:07:19
in the way in which nurses jobs are
00:07:22
structured so we we were able to see
00:07:24
that the nurses that work the longest
00:07:26
shifts and we presume that they were
00:07:27
overtime shifts um those were the most
00:07:30
detrimental so certainly curbing
00:07:32
overtime certainly completely reducing
00:07:35
mandatory overtime and then monitoring
00:07:37
the rest of the nurses work hours would
00:07:39
be really important and then also
00:07:41
educating the nurses and the managers
00:07:43
about the effects of working these long
00:07:44
shifts so that they are aware um that it
00:07:47
can impact them the staff as well as
00:07:50
their
00:07:51
patients uh what was the most surprising
00:07:53
finding of your research project I think
00:07:56
the most interesting piece that we found
00:07:58
was um what I mentioned earlier was that
00:08:00
the most of the nurses really seemed on
00:08:02
paper to be satisfied with these shifts
00:08:04
and they are actively involved in
00:08:06
scheduling them and so despite the fact
00:08:09
that they seem satisfied with this
00:08:11
scheduling there's a disconnect because
00:08:13
those nurses were also at highest
00:08:15
highest risk for being burned out and
00:08:16
dissatisfied so we have to uncover a
00:08:19
little bit more between what's going on
00:08:21
there so maybe that's a topic for future
00:08:24
research certainly uh and one final
00:08:26
question uh based on your research what
00:08:29
advice would you give high school
00:08:31
students who may be considering going
00:08:33
into nursing as a career I would
00:08:35
definitely recommend it it's a very
00:08:37
rewarding career and there's many many
00:08:40
opportunities um as a nurse and many
00:08:42
different places to work aside from just
00:08:44
hospitals um I would um caution nurses
00:08:47
to make sure though that when they go
00:08:48
out on their first job that they ask
00:08:51
about their scheduling and how much
00:08:53
overtime is used on their unit and just
00:08:55
make sure that they um take care of
00:08:57
themselves so that they can take care of
00:08:59
their patience Amy thank you so much for
00:09:01
speaking with knowledge at Horton thank
00:09:03
you
00:09:07
[Music]
