How to Manage Overtime in Post-Acute Care

February 24, 2023 Kimberly Anderson-Mutch

How to Manage Overtime in Post-Acute Care

Due to current record-high staffing shortages, many healthcare workers must put in more hours per week than ever before. If your skilled nursing facility is experiencing higher overtime, you may be at risk for medical errors, burnt-out staff, lower-quality patient care, and rising turnover.

These issues can damage your bottom line and make it more difficult to retain employees and attract new residents. While you must ensure your residents get the care they need, turning to mandatory overtime can lead to more challenges. Learning how to properly track and prevent excessive overtime can improve job satisfaction and reduce the burden on your staff members.

Types of Overtime in Healthcare

No matter what type of healthcare facility you manage, you know that overtime is sometimes necessary. Some nursing staff may even request overtime. However, too much overtime can be difficult to oversee. Here are the different types of overtime that most healthcare organizations may experience:

  • Mandatory overtime: Many states currently have mandatory overtime legislation for nursing professionals, which means nursing staff are essentially forced to work beyond their contract hours and can't opt out. This type of overtime often intrudes on staff members' personal lives and mental and physical well-being.
  • Scheduled overtime: Also referred to as planned overtime, scheduled overtime is generally scheduled far in advance to avoid excessive overtime and allow employees to request shifts if they wish.
  • Frictional overtime: This type of overtime most often occurs due to an unexpected change, such as a staff member calling out last minute or not showing up. Frictional overtime is sometimes known as response overtime, as it accumulates due to an unanticipated staffing need. 
  • Incremental overtime: Small amounts of clocked-in time over the course of a week or two can add up and lead to incremental overtime. Incremental overtime is often overlooked because it's not scheduled or expected. This overtime usually occurs when staff members punch in too early before shifts, too late after shifts, or don't clock out for unpaid meal breaks.

The Challenges of Overtime in Healthcare

While you may believe that mandatory overtime can offer a solution to nursing staff shortages, you'll eventually develop additional issues that directly impact nurses and patient care. Let's look at some of the challenges that excessive overtime may create in your post-acute or long-term care facility.

1. Decrease in Productivity

According to a Stanford University study, productivity sharply declines when a person works more than 50 hours per week. This study also states that those who work up to 70 hours a week tend to only get the same amount of work done as someone who works 55 hours a week. Working excessively likely makes your nursing staff lose their desire to develop new skills and put their best foot forward when they're at work.

If they rarely get breaks or never have any days off to manage their personal lives, you may even notice them slacking off at work or going on their phones to answer personal emails and calls. Overworking your staff leads to lower energy levels, which means they're unlikely to feel motivated or maintain the morale your patients need to feel supported and cared for.

2. Low Job Satisfaction

Healthcare workers who enjoy their jobs and work environments show up early, have a positive mindset, work proactively throughout their shifts, and are ready to go the extra mile. However, if they work too much overtime per week and feel stressed, it may cause them to feel less satisfied at their jobs.

As a result, your employees may progressively start to do less work throughout the day or be less likely to volunteer to do additional tasks. Nurses already deal with an emotionally challenging and taxing job, and having them work overtime they don't ask for can make them feel unsupported and undervalued by their managers.

3. High Risk of Errors

Working long hours leads to more stress, and too much stress ultimately leads to burnout. When your nurses are under a lot of pressure and feel physically and emotionally exhausted, they're more likely to make mistakes that may have serious consequences on patient care. One study concluded that nurses who worked fewer than 40 hours a week had higher patient safety competencies than those who worked more.

High Risk of Errors

Nurses who worked more than 50 hours a week had the highest adverse nurse outcome scores. This result indicates that nurses who work too much overtime to compensate for staffing shortages may cost your facility more by reducing patient care and satisfaction and even leading to serious medical errors. 

4. Increase in Absenteeism 

Various research has indicated a positive correlation between absenteeism and stress and burnout. One study even notes that at least 60% of absenteeism results from some type of stress. If nurses and other healthcare staff feel their stress worsen simply by showing up to work, they'll likely feel disengaged with their responsibilities and make excuses to stay away. Some nurses who must work mandatory overtime may even feel resentful or dejected, leading to lower-quality patient care.

Working excessive overtime also reduces the amount of free time a person has to handle their life outside of work, such as maintaining a social life, spending time with family, getting plenty of sleep, and managing their health. This lack of work-life balance can lead some employees to call out sick simply so they can get more rest, get their grocery shopping done, or give themselves a day to recover from their last shift, which can lower staff productivity and put more strain on the nurses who have to fill in for the absent employee.

5. Lack of Focus

Your nurses are already working in a high-intensity environment and must maintain plenty of energy and vigilance during their shifts to keep patients safe. If they're working too much, they'll likely become extremely tired and begin to lose focus when concentrating on a task like medication dispensing. A lack of focus or poor attention during their shifts can endanger them, the patients under their care, and other staff members.

Nurses should be able to direct their attention toward a single priority, particularly when dealing with patients. Research shows that nurses who have even moderate levels of fatigue are more at risk for performance deterioration and significant attention failure.

What Is Considered Excessive Overtime?

According to the Fair Labor and Standards Act (FLSA), there's no limit to the amount of hours employees older than 16 may work in any given workweek, unless they qualify for an exemption. However, research shows that detrimental and long-term effects can occur when people work too much. For instance, one study shows that those who work more than 61 hours a week have an increased risk of elevated blood pressure.

Another study found that women who worked more than 60 hours per week—or 12 hours per day—were approximately three times more likely to develop cancer, heart disease, diabetes, or arthritis. These women were also two times more likely to develop chronic asthma or lung disease than women working a 40-hour work week. Even those who worked closer to 50 hours per week seemed to have a higher chance of long-term disease. 

With this information in mind, it's important for employers to carefully consider how much overtime a staff member should take on in any given work week. While voluntary overtime can be beneficial for staff looking to get extra money, working 10 or more hours of overtime every week can begin to create an overtime-dependent workforce that is burnt out. If your facility needs excessive overtime from employees, evaluate the need to hire additional staff to ease this burden.

What Is Overtime Management for Post-Acute Care?

What Is Overtime Management for Post-Acute Care? 

Overtime management refers to how well your facility can control the amount of overtime your staff works and prevent them from becoming burnt out. This includes working with your nurse managers and administrative staff to find the right policies and solutions so that you don't have to implement mandatory overtime. Overtime management can also consist of the financial aspect of overtime, which includes following the regulations set by the FLSA for overtime pay.

According to these federal provisions, any staff members working more than 40 hours per week must be paid time and a half of their base pay rate. Overtime management may look different in every skilled nursing facility. Still, it's important to use the proper resources to prevent your staff members from working too much and becoming exhausted or distracted while taking care of patients.

Why Is Overtime Management for Senior Living Staff Important? 

Contrary to popular belief, resorting to mandatory or excessive overtime can do more harm than good. Controlling overtime simply means balancing meeting your facility's needs and protecting your nursing staff from burnout. By reducing overtime to acceptable levels with the right solutions, you may see an improved workforce and better morale.

Here are some of the top reasons to manage and reduce overtime: 

  • To attract and retain talent: If your facility has a reputation for excessive overtime, it can be difficult to attract new nurses and retain your current staff. Because there's already a widespread and increasing staffing shortage for nurses in the nation, facilities that don't manage overtime properly may have trouble hiring new talent. On the other hand, facilities with an efficient management solution in place may look more attractive to employees.
  • To reduce employee burnout: Nurses who work excessive overtime can quickly become stressed and burnt out and develop a poor work-life balance and job dissatisfaction. Overtime management solutions help your staff stick to a more consistent schedule and allow them to work overtime voluntarily when it meets their needs.
  • To reduce the risk of error: Overworked nurses suffering from burnout and fatigue may have trouble concentrating on tasks, leading to medical errors and missed care. Understaffed facilities face an increased risk of patient infection, falls, and mortality. Overtime management can help reduce nurses' hours and help them feel more focused and energized during their shifts.
  • To control labor costs: Paying nurses excessive overtime can quickly add up and may even be more expensive than hiring additional staff to ease the workload and cover shifts. With an effective scheduling solution, you can reduce overtime costs and focus your resources on hiring long-term nurses at your facility.

How to Manage Overtime in Healthcare

Managing overtime can be difficult if you don't have the tools, resources, or knowledge to implement a change. Here are the top strategies for reducing overtime in your post-acute care facility.

How to Manage Overtime in Healthcare

1. Set a Clear Overtime Policy

The first step to managing overtime in your nursing facility is to review your existing overtime policies and procedures and adjust them. It's essential to cap and monitor overtime limits to manage hours effectively and ensure no staff members work well past the reasonable amount.

If your nursing facility schedules 12-hour shifts, for example, you may not want to offer overtime opportunities unless in cases of emergency or filling in for another employee. While eliminating overtime would be ideal, it's not realistic.

However, working more than 12 hours in one day can lead to worker fatigue, so ensure your policy clearly communicates these limits. If you have a handful of staff members who you feel work too much, consider spreading out voluntary overtime by basing it on seniority.

Put the names of those who take the most overtime on the bottom of the list to give others a chance at overtime and ensure it rotates to give everyone a fair chance at extra pay without them overdoing it. Your facility may also follow a unique system for scheduling, so cover these details in your overtime policy and include whether you'll allow staff members to swap overtime hours with co-workers.

2. Emphasize Safety

Extended or unusual work shifts can lead to many employee issues, such as irritability and increased susceptibility to illness. As a CEO, nurse manager, or administrator at your nursing facility, it's critical for you to emphasize employee safety by preventing staff members from working too much or not having enough days off to recuperate during the week.

Check that all staff members follow safety procedures and don't on too many hours. Encourage your nursing staff to prioritize their well-being and take time off for vacations and mental health days, and consider holding regular check-ins with all nursing staff to ensure they don't feel overworked or stressed out.

Employers who make their staff members feel heard, appreciated, and valued are more likely to see higher engagement, improved employee morale, and reduced turnover.

3. Keep Tabs on Staff Members

Incremental overtime occurs when managers and employers can't properly monitor schedules and logged hours. Some of your nursing staff may have a habit of clocking in 15-30 minutes early every shift, which can add up to a few hours of overtime they weren't scheduled for. If this issue gets out of hand, you may want to consider implementing a policy that states employees can only clock in five minutes early. Additionally, be sure to watch for overtime hoarders.

When overtime is voluntary, there may be a few staff members who want to rack up the additional pay and request excessive hours. Try to spread out the overtime evenly among nurses and communicate any overtime changes to your staff, so they understand the reasons behind it.

4. Implement Workforce Management Software

One of the most effective ways to reduce nursing staff overtime and avoid the negative effects that come with it is by investing in a workforce management suite that offers nurse scheduling software. With this solution, you can minimize overtime, create a more balanced schedule, and allow your staff to have more control over their shifts. Giving your nurses access to their schedules creates transparency in your facility and makes communication much more efficient.

Scheduling software empowers your employees to request open shifts when they become available and get notifications on their phones about scheduling changes, open shifts, and time-off request approvals. This solution gives more flexibility to your nurses and aims to reduce the stress and fatigue surrounding their hectic schedules, which can help maintain employee satisfaction and improve productivity. 

With a workforce management solution, you can also access a large staffing marketplace, where your nursing facility can connect to nursing agencies and fill your shifts with agency talent to keep a stable and consistent schedule. This software prevents your current full-time staff from becoming overworked and ensures your residents get the care they need. Staffing marketplace solutions are a critical component to overcoming staffing challenges because they help your facility attract and keep staff, allowing you to future-proof your organization and improve employee satisfaction.

Effectively Manage Scheduling and Overtime With Smartlinx 

Your nurses are the most valuable asset you have. If they work too much overtime, it can impact their well-being and job satisfaction. Using nursing workforce management software that gives you more control over scheduling and attendance can reduce overtime costs and lighten the workload on your nurses.

When using the Schedule Optimizer from Smartlinx, you can decrease excessive overtime by creating schedules that quickly adapt to your continually changing needs. With mobile access from the Smartlinx Go App, your nursing staff can instantly manage their schedules and communicate shift changes from their devices. This real-time data makes it easier for you to stay on top of personnel rotations, turnover, and overtime.

At Smartlinx, we know scheduling can be a hassle, and while some overtime is expected, it's vital to ensure it doesn't get out of hand. Request a free demo today to see how we can help you solve the scheduling puzzle.

Effectively Manage Scheduling and Overtime With Smartlinx

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