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. Author manuscript; available in PMC: 2025 May 27.
Published in final edited form as: Workplace Health Saf. 2022 Jan;70(1):24–30. doi: 10.1177/21650799211027868

Cost Analysis of Providing Overtime to Current Nurses vs. Hiring a Dedicated Nurse for COVID-19 Management in a Processing Plant

Jennifer Naylor 1, Gordon Lee Gillespie 2, Cynthia Betcher 3, C Edward Orr 4
PMCID: PMC12110321  NIHMSID: NIHMS2077633  PMID: 35037511

Abstract

Background:

U.S. meat and poultry processing workers experienced a disproportionate burden of COVID-19 illness following the declaration of the COVID-19 pandemic. Managing prevention and surveillance activities for COVID-19 prevention required additional work for occupational health nurses (OHNs). The purpose of this project was to conduct a cost analysis for two staffing options to address the increased workload for OHNs.

Methods:

An economic quality improvement design was used for this study. The project was performed at a meat and poultry processing plant with 1,800 employees and six OHNs. Two staffing options were considered. Option 1 was to continue to pay current OHNs overtime and Option 2 was to hire a COVID-dedicated nurse to manage the increased workload. A cost analysis was conducted for wages per hour plus benefits at three time points: 3 months, 1 year, and 3 years.

Findings:

Costs for Option 1 (continuing overtime) at 3 months, 1 year, and 3 years were estimated at $27,370, $109,517, and $328,550, respectively. Costs for Option 2 (hiring a COVID-dedicated nurse) at 3 months, 1 year, and 3 years estimated at $44,279, $94,979, and $230,179, respectively.

Conclusions/Application to Practice:

Hiring a dedicated COVID nurse would save the processing plant extensive salary costs by year 3. Reducing overtime had the potential to decrease the COVID-19 related workload and potential experiences of fatigue and burnout in OHNs.

Keywords: occupational health nursing, pandemic, cost analysis, dedicated COVID-19 nurse, nurse burnout

Background

In March 2020, the Director-General of the World Health Organization declared the spread of coronavirus disease (COVID-19) a global pandemic (World Health Organization, 2020). While the pandemic led to stay-at-home orders in many states in the U.S., some businesses remained open due to their critical mission for continuing the U.S. food supply chain. The U.S. Department of Homeland Security (2020) listed food and agricultural workers, specifically food manufacturer workers in processing plants, as essential critical infrastructure workers.

During the early period of the COVID-19 pandemic (April 1, 2020 to July 31, 2020), Herstein et al. (2021) studied COVID-19 spread and safety practices used by Nebraska meat and poultry processing plants during this 4-month period. They identified 5,002 confirmed cases of COVID-19, which accounted for 19% of the Nebraska meat and poultry processing workforce. Of the workforce testing positive for COVID-19, the majority were symptomatic (85%, n = 4,237) and self-identified as Hispanic or Latino (67%, n = 3,343). At the time of their study, use of masks and physical barriers between employees and in common areas such as breakrooms was inconsistent. Waltenburg et al. (2021) found similar results when examining data provided by 31 states for meat and poultry processing workers. By May 31, 2020, there were 28,364 (15.2%) of 186,011 meat and poultry processing workers with a confirmed COVID-19 diagnosis; the majority (83.2%, n = 4,957) were symptomatic. The percentage of meat and poultry processing workers diagnosed with COVID-19 was significantly higher and the rate of COVID-19 mortality was generally higher than the U.S. population as of April 26, 2000 (Asher et al., 2021). Asher et al. (2021) posited that the higher burden of COVID-19 in this population was likely due to the close proximity these workers conduct their work as well as a lack of COVID-19 safety guidelines before April 26, 2000. These early findings demonstrated the importance of screening all workers for fever and other COVID-related symptoms prior to entry into the plant to prevent the spread of COVID-19 among this workforce (U.S. Centers for Disease Control and Prevention [CDC], 2020a).

A common challenge for COVID-19 prevention is reducing workers’ exposures before coming to work (Rubinstein et al., 2021). For example, Rubenstein et al. (2020) reported that workers could be potentially exposed in non-work settings such as grocery stores (73.8%), gas stations (52.4%), laundromats (19.5%), and liquor stores (14.2%). Another potential source of infection occurs during carpooling to the processing plant with non-familial coworkers. In May 2020, Rubenstein et al. (2020) queried poultry processing workers on wearing a mask when carpooling. While approximately 71% of U.S. born and 93% of foreign-born poultry processing workers reported wearing a mask while carpooling, there was still a portion of workers particularly those who were U.S. born who did not. In addition, the actual use of mask-wearing may be less than reported, because respondents in the study were selected by plant management and the consistency of mask-wearing was not reported. Carpooling posed a unique risk to workers because their chance of infecting one another increased as well as the spread to their respective families and social networks. An important consideration for occupational health is to query employees with fever or other COVID-19 symptoms about their commuting practices and the need to conduct contact tracing to quarantine coworkers who carpool with them.

The CDC (2020a; 2020b), Herstein et al. (2021), and the U.S. Occupational Safety and Health Administration (OSHA, 2020) provided recommendations to prevent COVID-19. General recommendations for all employers included requesting employees to pre-screen at home; screening employees prior to plant entry for fever and other COVID-related symptoms; wearing cloth masks; maintaining six feet of social distancing; cleaning and disinfecting workspaces, common areas, and equipment on a regular basis; minimizing the number of employees simultaneously working in the plant; increasing ventilation in rooms; and implementing stress reduction messages (CDC, 2020a; Herstein et al., 2021; OSHA, 2020). Specific recommendations for meat and poultry processing plants included adding touch free hand sanitizer stations, adding additional clock in/out machines, staggering work shifts and break times, adding shifts to reduce the number of workers per shift while maintaining overall production goals, reconfiguring workers’ positions in relation to their coworkers including spreading workers to be a minimum of 6 feet side-by-side, adding partitions between employees, and removing workers from working immediately across a conveyor belt (CDC, 2020a). When workers need to work in tandem, a partition can be installed above the belt laterally between workers to allow food movement on the belt while reducing spread of COVID-19 between coworkers across the belt (CDC, 2020a). The use of personal fans can be reduced to prevent COVID-19 infection between workers. Herstein et al. (2021) noted that after full implementation of mask usage and physical barriers in Nebraska meat and poultry processing plants, infection rates decreased in the majority of their study sites.

The responsibility for implementing COVID-19 safety precautions is the responsibility of the occupational safety and health team, including occupational health nurses (OHNs). As the workload of OHNs increases, they are more likely to experience exhaustion, fatigue, and burnout (Benfante et al., 2020; OSHA, n.d.; Schlak et al., 2021; Sriharan et al., 2021). As plants extended their operating hours to stagger shifts and add shifts per CDC (2020a) recommendations, OHNs needed to increase their shift hours through overtime to lead COVID-19 prevention efforts. Overtime is the number of hours worked after having already worked 40 hours in a single week (U.S. Department of Labor, n.d.). The increased hours spent working in a stressful environment coupled with fatigue can lead to nurses making errors in patient care or harming another person unintentionally (Caruso, 2014; Caruso et al., 2017; Committee on the Work Environment for Nurses and Patient Safety et al., 2004; Keller, 2009; Schlak et al., 2021).

The workload burden and community fear of COVID-19 also can promote symptoms of acute and chronic stress and burnout symptoms resulting from worrying about becoming infected, spreading COVID-19 to family members, and evolving work conditions and workload (Benfante et al., 2020; Sriharan et al., 2021; Zhang et al., 2020). These negative outcomes including a negative general well-being, depression, anxiety, and burnout coupled with the perceived inability to control the spread of COVID-19 could negatively impact OHNs’ ability to prevent work-related accidents (Garcia et al., 2019; Ünal, 2020).

For the current project, the implementation of COVID safety precautions became the responsibility of the plant’s occupational safety and health department. As the plant adopted safety practices including increased surveillance, additional shifts to reduce the number of employees in the plant at any time, etc., the OHNs needed to extend their work days resulting in overtime hours. In order to balance the increased expense of COVID-19 precautions and additional workload for the OHNs and mitigate OHNs’ reports of experiencing burnout, the occupational safety and health department manager considered two options. Option 1 was to continue paying overtime to the existing six OHNs until the work conditions returned to a pre-COVID-19 normal state. Option 2 was to hire a COVID-dedicated OHN eliminating the need for ongoing OHN overtime. The purpose of the current project was to conduct a cost analysis for these two options to address the increased workload for OHNs.

Methods

This project was an economic quality improvement project. The project was conducted in a meat and poultry processing plant in the Southwestern U.S., which had an occupational health department. Salary costs to manage COVID-19 were compared for six OHNs employed at the time the project was conducted to salary costs for an additional COVID-dedicated OHN.

The company had approximately 1,800 employees and the occupational safety and health department had six full-time OHNs. The OHNs were scheduled to work 8-hour shifts with staggered start times providing coverage 21 hours per day beginning at 6:00 a.m. and ending at 3:00 a.m. Prior to COVID-19, the OHNs’ main responsibilities were assessing, evaluating, and treating injuries and illnesses of employees; assessing non-work-related emergencies; and workers’ compensation case management. Daily activities included employee education in ergonomics, drug testing policies, hearing conservation training and monitoring programs, plant hygiene requirements, bloodborne pathogen exposure, and respiratory fit testing.

In March 2020, COVID-19 surveillance and prevention became a primary and additional focus for the occupational safety and health department. The OHNs were becoming overwhelmed with new and changing guidelines pertaining to the COVID-19 pandemic. In order to meet the new demands, the OHNs increased the number of hours they worked from 40 hours per week to an average of 46.55 hours per weeks. The OHNs spent time writing and implementing operational practices created to maintain employee safety. Safety practices included placement of plexiglass barriers between each employee workstations, breakrooms, and cafeteria tables. They advised employees to wear facial coverings or masks, practice good hygiene through handwashing or using hand sanitizer with minimum of 60% alcohol, and social distancing. The company bought sanitizers for each of the main entrances and had the entrances staffed to ensure use and placed them strategically throughout the facility. Infrared thermometers with cameras were placed by the sanitizer stations. Stickers were placed on floors to remind employees to maintain social distance of six feet.

The OHNs were assigned additional responsibilities for assessing employees, answering increased calls related to COVID-19, testing for COVID-19, contacting outside resources related to COVID-19, conducting COVID-19 screening with employees before they entered the plant, distributing masks as needed, conducting weekly safety walkthroughs, mitigating COVID-19 safety concerns, and continuing to assist in assessment of safety concerns and needs of the company. In addition, the OHNs contacted employees who called off work using the COVID-19 hotline, performed COVID-19 contact tracing and testing, and answered or responded to increased phone calls.

The occupational safety and health department manager provided the project team with details on OHNs’ average wage per hour, costs for benefits, and average overtime hours worked per week by OHNs, and anticipated wage for a new COVID-dedicated nurse. Average wage for the six OHNs was $27.48 per hour. Costs of benefits per nurse was 30%. Benefits are additional non-wage compensation provided to employees; some benefits are considered taxable income (Internal Revenue Service, 2021). Examples of benefits are health insurance, adoption and dependent care assistance, group-term life insurance coverage, and retirement fund allocations (Internal Revenue Service, 2021). Overtime wages were calculated as one and one-half times the regular wage rate for the OHNs (U.S. Department of Labor, n.d.). The anticipated wage for a new COVID-dedicated nurse was $25 per hour based on a pay range of $23-$28 per hour.

Salary expenses were calculated for three time periods (i.e., 3 months, 1 year, 3 years) for two departmental employment options (Option 1: continue to pay current OHNs overtime; Option 2: hire COVID-dedicated nurse). An end date of 3 years was selected based on the probability for a functional end of the COVID-19 pandemic in the U.S. (Charumilind et al., 2020). Analysis for Option 1 was based on overtime pay: wage per hour times 1.5 plus 30% costs for benefits. This statistic was multiplied by six to represent the overtime worked by six OHNs. This statistic was then multiplied by 13, 52, and 156 to represent salary costs at 3 months (13 weeks), 1 year (52 weeks), and 3 years (156 weeks).

Analysis for Option 2 was based on anticipated wage per hour for the new COVID-dedicated nurse plus 30% costs for benefits. This statistic was multiplied by 13, 52, and 156 to represent salary costs at 3 months, 1 year, and 3 years. During the first 3 months of employment for the new COVID-dedicated nurse, the current OHNs would need to continue working overtime. The salary costs for the six current OHNs for 3 months calculated for Option 1 were added as a one-time expense to the Option 2 salary costs for a new COVID-dedicated nurse at 3 months, 1 year, and 3 years.

Prior to implementation, this economic quality improvement project was reviewed by a member of the University’s Institutional Review Board (IRB) and determined to be exempt, non-human subjects research.

Findings

A cost analysis was completed for the two staffing options. Option 1 was to continue having current OHNs work overtime for COVID-19 management. The current OHNs averaged 6.55 overtime hours per week per OHN. The average overtime wage was $41.22 per hour ($27.48 per hour x 1.5) plus 30% benefits. The overtime salary costs over 3 months was estimated to total $27,379. The overtime salary costs for ongoing COVID-19 management at 1 year would total $109,517 and at 3 years would total $328,550.

Option 2 was to hire a COVID-dedicated nurse for COVID-19 management. This dedicated nurse would be hired to work 40 hours per week at an estimated $25 per hour and be required to complete a 3-month orientation period. Salary costs (wages plus benefits) for the nurse during the 3-month orientation period would be $16,900. Overtime salary costs of $27,379 for the current six OHNs would continue to be incurred during the 3-month orientation period resulting in total salary costs over 3 months of $44,279. Salary costs for Option 2 at 1 year including one-time 3-month overtime salary costs during the orientation period would total $94,979 and at 3 years would total $230,179.

The difference in salary costs for Option 2 compared to Option 1 was $16,900 at 3 months. At 1 year, salary costs for Option 1 were $14,538 greater than Option 2 and at 3 years, salary costs for Option 1 were estimated to $98,371 greater than Option 2. By year 1, the cost analysis indicated Option 2 with a COVID-dedicated nurse would be more cost effective than continuing the current practice of paying overtime to six OHNs on a long-term basis.

Discussion

Based on the cost analysis, hiring a COVID-dedicated nurse was a more economically feasible option. While the expenses for a new nurse were greater at 3 months compared to current OHNs working nearly 7 hours overtime every week, the expense for a new COVID-dedicated nurse at 1 year was lower and by 3 years was considerably lower compared to persistent overtime. An additional consideration not explored in the cost analysis was whether the new OHN would be needed after 3 years when COVID-19 would presumably no longer be impacting the safety and health of the processing plant workers. This option may need to consider having a 3-year contract in place when hiring the COVID-dedicated nurse.

Following the cost analysis, the department manager opted to hire a COVID-dedicated nurse. The nurse hired into this role was an experienced OHN and as a result, the salary costs for Option 2 were higher than reported in this paper. Even with a higher wage per hour, Option 2 remained an economically preferable option. Another consideration introduced by the department manager was the increased burden of training a new nurse. Training a new nurse while simultaneously managing COVID-19 would lead to additional workload and burden for current OHNs.

An added value of hiring a COVID-dedicated nurse was the ability for consistent implementation of a COVID-19 management plan. Due to the high risk associated with COVID-19, a current OHN at the facility may be best situated to assume this role while the new (but experienced) nurse assumes the general OHN responsibilities, unless the new nurse has experience managing communicable emerging and re-emerging infectious diseases (e.g., Ebola virus disease, severe acute respiratory syndrome [SARS], influenza A virus [H1N1]) in a comparable industry.

Given the fatigue and burnout symptoms reported for nurses working with COVID-19 patients in the literature and the self-reported burnout being experienced by the OHNs in the current project, interventions were warranted for the OHNs providing COVID-19 management to the processing plant workers. Zhang et al. (2020) discussed that nurses working in Wuhan, China during the pandemic used a variety of coping activities to address stress and burnout. Coping activities used by the nurses included participating in professional development activities about COVID-19, trying to reverse any negative thoughts that COVID-19 could not be effectively managed, participating in recreational activities, and engaging in health-promoting activities such as rest, exercise, and eating a balanced diet. OHNs may need to take more frequent rest breaks during the workday to allow time for their COVID-related ruminations to subside. These breaks can allow time to regain their personal energy and increase their focus after returning to COVID-19 management and other routine OHN activities. Baskin (2020) reported that a key aspect for COVID-19 related burnout was an imbalance between workload and resources available; resources include human resources. The department manager’s intent to hire a COVID-dedicated nurse was a proactive strategy to address the potential burnout in the OHNs.

The OHNs and department manager can monitor one another for warning signs of excessive stress as demonstrated by cognitive, emotional, behavioral, and/or physical changes. These changes listed by the American Psychiatric Nurses Association (n.d.) may require a purposeful assessment on a regular basis. For example, the department manager could meet monthly with each OHN to conduct a “check-in”. During this meeting, the manager may describe changes observed in the OHN or the OHN may offer self-identified changes since the onset of COVID-19. The two could mutually discuss strategies to help the OHN return to an optimal state of being. Strategies include a referral to an employee assistance program, practicing yoga, eating regularly scheduled meals, using mindfulness exercises, journaling, team-building activities, web-based stress management programs, Reiki massage, and sleeping 7–9 hours per night (American Psychiatric Nurses Association, n.d.; Baskin, 2000; CDC, 2021; de Oliveira et al., 2019; Zhang et al., 2020).

This project had three limitations. The first limitation was the use of a single site employer as a case study for the cost analysis. The occupational health department in other plants may have different payroll expenses or better capacity to absorb the increased workload with minimal overtime hours. Second, the information received for the cost analysis was self-reported data from the company and based on estimations. Calculating actual overtime salary costs at the individual level may have yielded a smaller difference between options (e.g., overtime may have been predominantly worked by nurses earning less than the average wage per hour for current nurses, which would have resulted in lower salary costs than those reported in this paper at 3 months, 1 year, and 3 years). Third, nurse burnout was not measured in this study. It was not known if hiring a new COVID-dedicated nurse would have improved self-reports of nurse burnout or the impact that state lockdown orders may contribute to perceptions of nurse burnout.

Conclusion

Cost analysis showed a long-term economical preference for hiring a COVID-dedicated nurse in this processing plant company. This approach could be considered in other plants to manage the increased workload assigned to OHNs for COVID-19 management. Additional considerations including length of time to maintain additional human resources and indirect costs related to OHN burnout, which can be incorporated into decision-making when considering staffing options. Further research is needed to determine the degree of burnout in OHNs working longer shifts in processing plants. In addition, a final cost analysis can be conducted to determine actual costs and relate to them to reductions of COVID-19 infections in processing plant workers.

Table 1.

Cost Analysis of Two Options for Managing the Increased COVID-19 Workload of Six Occupational Health Nurses at a Meat and Poultry Processing Plant.

Variables Option 1: Manage COVID-19 using persistent overtime (6.55 hours per week x6 nurses) Option 2: Manage COVID-19 using new COVID-dedicated nurse Cost Difference for Option 2 Percentage Change for Option 2
Wage per hour $27.48 $25.00
Overtime wage per hour $41.22 NAa
Wage per hour + benefits (30%) NA $32.50
Overtime wage per hour + benefits (30%) $53.59 NA
Salary costs (wages + benefits) for 3 months orientation (40 hours per week) NA $16,900
Overtime salary costs (overtime wages + benefits) for 3 months for 6 nurses $27,379 $27,379b
Total salary costs for 3 months $27,379 $44,279 $16,900 61.7%
Total salary costs for 1 year $109,517 $94,979 ($14,538) (13.3%)
Total salary costs for 3 years $328,550 $230,179 ($98,371) (29.9%)
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a

not applicable,

b

Occupational health nurses’ overtime will continue for the 3-month period that the new COVID-dedicated nurse would be in training

Applications to Professional Practice.

The impact of the COVID-19 pandemic is anticipated to last for several years, and occupational health nurses will be responsible for COVID-19 prevention and surveillance activities. This increased workload can be accomplished by occupational health nurses working extended hours through overtime, which places them at risk for fatigue, burnout, and errors in care. Options such as hiring a COVID-dedicated nurse need to be considered to mitigate the increased workload on existing human resources versus the continuation of overtime for a prolonged period. As options are considered, occupational health leadership can consider salary costs inclusive of overtime, benefits, and training as well as fatigue, burnout, and general well-being of existing occupational health.

Funding:

Partial funding was provided by the National Institute for Occupational Safety and Health through the University of Cincinnati Education and Research Center Grant #T42OH008432.

Contributor Information

Jennifer Naylor, University of Cincinnati College of Nursing; Cincinnati, OH, United States.

Gordon Lee Gillespie, University of Cincinnati College of Nursing; Cincinnati, OH, United States.

Cynthia Betcher, University of Cincinnati College of Nursing; Cincinnati, OH, United States.

C. Edward Orr, Tyson Foods.

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