Nursing Students Want to Talk About Mandatory Overtime and Quality of Care

As final-year nursing students, we are concerned about the recent hospital funding changes in Ontario which are impacting the quality of patient care, and requiring both nurses and students to engage in increased amounts of mandatory overtime (OT). We are especially concerned that mandatory OT is becoming a permanent solution to staffing shortages, risky patient-to-nurse ratios, and the impact this is having on the identity of nurses. We have seen mandatory OT require our preceptors to work long shifts without sufficient breaks, extending their shifts due to sick calls and hospital units operating above capacity. Mandatory OT has been linked to nurse stress, fatigue, and increased risk for a compromised standard of care[1]. The increased workload caused by these staffing challenges are sometimes falling onto nursing student’s shoulders, as we have felt required to pick-up the slack by participating in mandatory OT, despite receiving no remuneration. In fact, we contend that our position as nursing students makes it difficult for us to speak-out, for fear of how our criticism might affect future employment opportunities.

Recent public awareness campaigns launched by the Ontario Nurses Association have made it clear that nurses, and by extension nursing students, are shouldering an immense part of the increased workload burden, caused by funding changes to Ontario hospitals[2]. This increased workload detracts from the learning experience and can place students in challenging ethical dilemmas in which they need to navigate a system that increasingly utilizes them as a subsidy for institutional staffing shortages. As nursing students, we find ourselves in a quasi-professional role without concise representation, and our outlets to voice concerns, especially regarding quality of care and mandatory OT, are far and few between. Further, the space for being critical within the nursing profession is very limited as evidenced by the recent action taken against Nurse Carolyn Strom. Nurse Carolyn Strom publicly critiqued her profession and the facility where her family member passed away, and was subsequently disciplined by her provincial regulatory body with a fine of almost $30,000[3][4][5].

Nursing interventions are becoming increasingly measureable in a more monetary and economic context, which is at odds with nurses’ ability to establish an emotional and relational connection with their patient. The short-term freezes to hospital funding and incorporation of quality based practice by Local Integrated Health Networks in Ontario, further create a nursing profession in which everything intervention has a price. How can you put a price on caring for a patient? It is our opinion that this lack of therapeutic relationship, and requirements for mandatory OT, are eroding the sense of identity of future nurses. With mandatory OT being a direct response to these funding issues, the consequences affect not only the patient and registered nurse, but the student nurse as well.

Is mandatory OT really a safe and effective means of compensating for staffing shortages if it compromises quality of patient care, staff health, and the nursing identity? Is it appropriate to utilize nursing students as staffing extensions, and require them to share this burden? We are disturbed by the clear disconnect between the university and college-taught identity of nursing, and the identity the health care system is forcing onto nursing. We are troubled with the clear risk that is associated with critiquing and reflecting on the forces that effect nursing. This risk is perhaps doubled outside the realm of academia. Most importantly, we are concerned for the quality of care our patients are receiving.

Written by six undergraduate nursing students from the University of Ottawa including:

  • Christopher White, MSc, BScN – Second-Entry student, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ontario
  • Daniela Gambarotta, BSc, Biology, BScN – Second-Entry student, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ontario
  • Katie Boxler, BA Communication, BScN – Second-Entry student, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ontario
  • Benjamin Gallacher, BScHK, BScN – Second-Entry student, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ontario

[1] Bae, S. H. (2012). Nursing overtime: why, how much, and under what working conditions?. Nursing Economics, 30(2), 60.

[2] Ontario Nurses Association – Nurses Know Campaign. http://www.nursesknow.ona.org

[3] SRNA Decision of the Disciplinary Committee (Oct. 18, 2016). http://www.srna.org/images/stories/RN_Competence/Comp_Assurance_Hearings/SRNA_Discipline_Decision_Strom_Redacted_Oct_27_2016.pdf

[4] Nurses want to talk about silence: https://radicalnursesite.wordpress.com/2016/12/04/nursing-students-want-to-talk-about-silence/

[5] When nurses muzzle their own: https://radicalnursesite.wordpress.com/2017/02/22/when-nurses-muzzle-their-own/

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