Integrative review: an evaluation of the methods used to explore the relationship between overtime and patient outcomes.
OBJECTIVE
To analyse, critically, methods employed to explore the relationship between nursing overtime and patient outcomes to strengthen future research.


BACKGROUND
Nursing overtime hours have been increasing in the Western world since the 1980's; however, research detailing its implications for patient outcomes has not kept pace. Studies exploring the relationship between nursing overtime and patient outcomes have produced conflicting results and are deficient in number and rigour.


METHODS
Whittemore and Knafl's revised framework for integrative reviews guided the analysis.


METHODS
A comprehensive multi-step search (1980-2012) of literature related to nursing overtime and patient outcomes in the CINAHL, Medline, PubMED, EMBASE and PsychInfo databases was performed. Reference lists and Google searches were completed for additional sources. Nine research papers met the inclusion criteria.


METHODS
All nine articles were included in the review. A systematic, iterative approach was used to extract and reduce the data to draw conclusions.


RESULTS
There appears to be a positive relationship between nursing overtime and patient outcomes, however, eight of the nine studies revealed limitations in: (1) the definition and measurement of overtime; (2) data aggregation (organizationally and temporally) and (3) recognition or control of potential confounding variables.


CONCLUSIONS
The quality in this research sample limits the ability of this body of work to be the basis of staffing policies. Future researchers need to be explicit in detailing their methods alongside a renewed commitment from administration to develop a tracking system of important parameters at the individual and bedside level.
McMaster University, Hamilton, Ontario, Canada.
Vanessa
V
Lobo
Anita
A
Fisher
Gladys
G
Peachey
Jenny
J
Ploeg
Noori
N
Akhtar-Danesh
D005069:Evaluation Studies as Topic; D009740:Nursing Staff; D010561:Personnel Staffing and Scheduling; D016896:Treatment Outcome
integrative review; methodology; nursing; overtime; patient outcomes