Are Nurses Who Pick Up Extra Shifts at Risk?

To boost their pay, many nurses pick up extra shifts. But juggling extra work and racking up 50-plus hours a week can take a toll on a nurse's physical and mental health. Plus, it can diminish quality of care and lead to patient errors.

Medscape's RN/LPN Compensation Report 2022 found that more than half of RNs and LPNs don't think they get paid enough. Even though many nurses saw pay increases over the past 2 years, many were still dissatisfied with their earnings. They blamed job stress, staffing shortages, and benefits that cut into their wages.

Why Do Nurses Pick Up Extra Shifts?

Most nurses work extra hours for the money. Incentives like getting paid time and a half or scoring a $200 bonus are hard to pass up.

"I'm a single mother with two kids," said Cynthia West, a critical care nurse in Atlanta, Georgia. "I want to be able to pay my bills and enjoy my life, too." So, West picks up two to three extra shifts a month. She also works on-call for a sexual assault center, earning $350 per exam.

But money isn't the only reason for some nurses. Trang Robinson travels from her home in Atlanta to Palo Alto, California, every other week for her job as a labor and delivery RN.

"If my unit needs extra help, I want to help," she said. "It's not about the extra money, although that helps my family; it's that we've been so short-staffed. My colleagues are burned out. Staff members are burned out. When I'm there, I work as much as I can to help out my unit."

Leslie Wysong, an Atlanta post-anesthesia nurse, worked in intensive care during much of COVID. She said the chance to make level 3 pay was rewarding for many nurses, but most weren't doing it for the money.

"We were doing it to alleviate the strain on our fellow nurses, to get closer to a 2:1 patient/nurse ratio rather than the 3:1 we were dealing with over the pandemic," she said. "It was to help out our colleagues during a desperate situation."

What Are the Risks?

The US Occupational Safety and Health Administration states that a work shift that lasts more than 8 hours can disrupt the body's sleep/wake cycle. It can also lead to physical and mental fatigue resulting in errors, injuries, and accidents.

And a study published in the American Association of Occupational Health Nurses found that extended shifts or shift work impacted nurses in many ways, including:

More medication errors
Falling asleep during work hours
Decreased productivity in the last 4 shift hours (of a 12-hour shift)
Increased risk of mistakes and near-errors associated with decreased vigilance
Critical thinking impairment
More needlestick injuries

Another study, "Negative Impacts of Shiftwork and Long Work Hours," which was published in Rehabilitation Nursing Journal, found even more adverse effects, such as:

Sleep disorders like insomnia and excessive sleepiness
Cognitive impairment such as the reduced ability to concentrate, slower reactions times, and reduced ability to remember information
Higher rates of injury while on the job
More likely to engage in overeating and alcohol misuse
GI issues such as abdominal pain, constipation, and heartburn
Higher rates of heart disease and high blood pressure
Higher risk for breast and prostate cancers
Higher rates of depression and anxiety

These are risks some nurses aren't willing to take. For example, Caitlin Riley, a pediatric ER nurse in Ocala, Florida, only picks up extra shifts when she must, like when Hurricane Ian swept through Central Florida.

"I think working extra hours can compromise your quality of care," she said. "You may make mistakes with things like math calculations or not catch something if you're not totally 'in' it mentally. At the end of the day, it's your nursing license. Sure, the money is great, but I won't do anything to compromise losing my license or patient care."

How Can Nurses Boost Pay Without Working Extra Shifts?

Instead, Riley returned to school and earned an MSN in healthcare leadership/management, knowing that an advanced degree could lead to higher-paying work. According to the Medscape report, RNs with master's and doctoral degrees earned over $10,000 more than those with bachelor's, associate's, or RN diplomas.

The Medscape report also compiled the following earnings data. The data may help nurses find other ways to raise their salaries without taking on extra shifts.

Salaried RNs and LPNs made more than hourly paid nurses.
In-patient hospital RNs and skilled nursing facility LPNs got paid more than nurses in other settings.
Specialty certifications helped RNs earn more money than nurses without specialty certificates.
Union RNs and LPNs earned more than nonunion nurses.
RNs and LPNs who work in big cities or suburbs make more money than those in rural areas.

How to Prevent Burnout and Exhaustion When You Work Extra Shifts

While burnout can happen in any profession, an investigation published in JAMA Network Open suggests it's prevalent among US nurses. The study found that nurses who worked over 40 hours a week were more likely to experience burnout. However, researchers say that adequate staffing and limiting shift hours may alleviate the problem. Here's how the nurses Medscape spoke with battle burnout:

Change departments. Wysong stepped away from the ICU after COVID and switched to post-anesthesia. "The move has made my work life much less stressful," said Wysong. "They are all happy endings in post-anesthesia."
Leave work at work. Riley said she mentally clocks out as she leaves the hospital. "When I put my papers in my shredder at the end of my shift, I let it go," said Riley. "I walk away knowing I did the best for my patients. Once I'm home, it's time for me to be with the people I love and to refuel my own sense of happiness with the people that mean the most to me."
Take time off. "When I'm burned out, I just don't come in," said Robinson. "If I'm mentally or emotionally drained, I give myself a shift off to decompress, or I don't pick up extra shifts."
Engage in relaxing hobbies. Kris Coleman, an ER nurse in Hardeeville, South Carolina, typically works three 12-hours shifts and only picks up an extra 4-hour shift once a week. When he's off, he takes advantage of his time away from work. He said, "Do the things that help you relax on your time off. For me, it's golfing, fishing, and spending time with my family."
Build a support system. "I have a group of friends at work," said West. "We talk to each other and vent. Having a good support system, people that are in it with you who get what you're going through is a helpful way to manage burnout."

Ana Gascon Ivey is a health and medical writer based in Savannah. She also teaches creative writing at a men's correctional facility.

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