Assessing the relationships between nurse work hours/overtime and nurse and patient outcomes: systematic literature review

Nurs Outlook. 2014 Mar-Apr;62(2):138-56. doi: 10.1016/j.outlook.2013.10.009. Epub 2013 Nov 9.


Background: The effects of work hours/overtime on nurse and patient outcomes and specific components of work hours (per shift and per week) and overtime on these effects have not been systematically examined.

Purpose: The purpose of this review was to systematically evaluate the effect of nurse overtime and long work hours on nurse and patient outcomes.

Methods: An online search of six electronic bibliographic databases was conducted for research published from 2000 to 2013.

Discussion: Twenty-one nurse outcome measures and 19 patient outcome measures were found in relationships with work hours and overtime. A total of 67 relationships to nurse outcomes and 41 relationships to patient outcomes were examined.

Conclusions: The findings of this review suggested that evidence supporting positive relationships between working long hours and adverse outcomes to the nurses is strong. However, to make a conclusion of the positive relationship between long work hours and adverse patient outcomes, more evidence is needed.

Keywords: Adverse nurse outcomes; Adverse patient outcomes; Nurse overtime; Nurse work hours.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Fatigue / epidemiology
  • Fatigue / psychology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nursing Care / statistics & numerical data*
  • Nursing Staff, Hospital / psychology*
  • Nursing Staff, Hospital / statistics & numerical data*
  • Outcome Assessment, Health Care / statistics & numerical data*
  • Personnel Staffing and Scheduling / statistics & numerical data*
  • Quality of Health Care / statistics & numerical data*
  • Treatment Outcome
  • Work Schedule Tolerance / psychology*