Nurses say the widespread abuse of mandatory overtime is to blame for medical errors and is driving nurses away from the inpatient setting, but hospitals say they rarely, if ever, force nurses to work extra shifts.
Restricting the use of mandatory overtime was the central issue in a three-month nurses strike at Brockton (Mass.) Hospital, which was settled on Aug. 24 with Sen. John Kerry (D-Mass.) mediating a final 14-hour negotiating session. But a Brockton spokesman said mandatory overtime accounted for only one-quarter of 1% of all nursing hours for the first half of the current fiscal year at the 232-bed hospital. Most of the mandatory overtime was used as a last resort when nurses called in sick, according to the hospital.
Unions say hospitals now regularly rely on mandatory overtime as a strategy to fill gaps in staffing because they don't hire enough nurses.
"Mandatory overtime has become standard operating procedure instead of an emergency response to urgent circumstances," said Gerald Shea, assistant to the president of the AFL-CIO during a Senate committee hearing in May on healthcare staffing issues.
Unions have blamed the abuse of mandatory overtime for fatigued nurses' making mistakes with their patients and the rise in nurse vacancy rates in hospitals around the country. Inpatient nurses, unions say, opt to leave the hospital workforce when they are continually made to work extra shifts.
A law to restrict mandatory overtime by nurses has passed in Maine, and proposed legislation has been introduced in nine other states. A federal bill to ban mandatory overtime beyond an eight-hour day and 80 hours in any two-week period for most healthcare workers was introduced in the U.S. House earlier this year. Sen. Edward Kennedy (D-Mass.), who was personally involved in settling a strike over mandatory overtime at Saint Vincent Hospital/Worcester (Mass.) Medical Center last year, said he will introduce a bill later this month to ban mandatory overtime.
But hospital officials from around the country interviewed for this article said they either don't use mandatory overtime or use it only in rare circumstances that amount to a handful of times a year.
"Our position on (mandatory overtime) is that it is a tool of last resort and should only be used when all other avenues have been exhausted," said Pam Thompson, a registered nurse and executive director of the American Organization of Nurse Executives, a subsidiary of the American Hospital Association.
The Brockton nurses won an agreement from the hospital to restrict shifts to a maximum of 12 hours, to cap at eight the number of mandatory overtime assignments a nurse can be given in a year, and to allow nurses to refuse a mandatory overtime assignment if they feel too tired or sick to work. The hospital also agreed to make its "best efforts" to staff appropriately to minimize the need for overtime.
But Brockton officials suspect that mandatory overtime may have served only as a convenient rallying issue for the Massachusetts Nurses Association, which represented the Brockton nurses. The strike was the first for the MNA since it disaffiliated from the American Nurses Association last December, and the hospital earlier charged the union with creating the strike as a way to grab media attention. "We have said consistently that this wasn't exclusively about Brockton Hospital; it was about the MNA's statewide agenda," said Robert Hughes, a Brockton vice president.
The nurses strike at Brockton was one of 13 that have taken place over staffing this year, according to the United Nurses Association. The UNA estimates that most of these centered around the mandatory overtime issue.
There are no national studies on the prevalence or impact of hospitals' use of mandatory overtime. A survey of registered nurses released last May by the Service Employees International Union Nurse Alliance found that nurses in acute-care hospitals work an additional eight and a half weeks of overtime on average per year. But the survey did not indicate whether the nurses were made to work extra or did so voluntarily.
Some evidence of the widespread use of mandatory overtime by hospitals exists at the state level. A survey of North Carolina hospitals completed last year by the North Carolina Center for Nursing found that 43% of rural hospitals having difficulty finding medical/surgical nurses use mandatory overtime as a strategy to adequately staff their facilities; 38% of urban hospitals with difficulty finding medical/surgical nurses said they use mandatory overtime.
Nursing groups and unions define mandatory overtime as a time when nurses are made to work extra shifts under the threat of being fired or disciplined in some way if they refuse. The American Association of Critical Care Nurses and other groups do not consider mandatory overtime to include "staffing up" for unforeseen emergencies, such as mass casualties or snowstorms, or scheduled "on call" time when a nurse may be paged to come in to work.
Labor groups say that even with rules to block hospitals from mandating nurse overtime, nurses will feel moral and professional pressure to do so if the hospital doesn't staff adequately. The MNA said it struck at Brockton to make the hospital increase its nursing staff. The hospital had given the nurses the overtime restrictions they sought before the walkout began on May 25.
Brockton's 450 nurses will vote Sept. 4 on whether to accept the contract, which also includes a 13% pay increase spread over three years.