As more states pass laws to prevent hospital administrators from forcing nurses to work overtime hours, officials at the major national healthcare unions say they plan to press for a federal ban this year.
In December 2008, a signature from Gov. Ed Rendell made Pennsylvania at least the 15th state in the nation to have a law or labor regulation on the books forbidding mandatory overtime hours for hospital nurses, except during declared emergencies. Supporters say Wisconsin may be the next state to see such a law in the coming legislative session.
Observers say the number of state laws has led the movement to a tipping point for a federal ban, especially with Democrats now taking power in Washington. Unions leading the charge for a federal law include the American Federation of Teachers, California Nurses Association/National Nurses Organizing Committee, Service Employees International Union and United American Nurses.
You dont want a nurse thats been working for 16 hours taking care of you in a hospital, unless its an emergency, said Deborah Burger, a registered nurse in California and one of four union presidents with the CNA.
Critics say labor leaders prefer to focus such debates on patient-safety issues, while ignoring the financial effects on their hospital employers that would have to regularly maintain a staff large enough to cover every shift during lean holiday weeks.
What its saying to hospitals is, Youre going to have to overstaff, said Bruce Clarke, president and chief executive officer of Capital Associated Industries, a human resources consulting firm in Raleigh, N.C. Overstaffing is first and foremost a cost, and a strain on hospital budgets.
Any push to ban mandatory nurse overtime early in President-elect Barack Obamas administration is likely to come amid one of the most financially challenging times for healthcare providers in recent memory. But union leaders said the federal and state laws are more necessary in recent years because of rising profit motives at hospitalseven not-for-profit providers that seem to place as much emphasis on profit margins as their investor-owned counterparts. The increased demand for profits has caused hospitals to cut their staffs, labor officials said. This has led to the need for overtime at the same time that administrators are using hospitalist physicians to cut average inpatient stays by discharging patients at all hours of the day. That creates more room for error by nurses who have to learn more patient-care plans in the same period of time even though studies show that the most common error in patient care by nurses comes from administering drugs.
When youre in the hospital, youre usually there for highly technical nursing care, highly toxic drugs, highly specialized care, Burger said. Mistakes made then can be lethal.
Thomas Dolan, president and CEO of the American College of Healthcare Executives, said there are two sides to the patient-safety argument. If people work too long, theyre more likely to make mistakes. But on the other hand, if you bring in temps, you also have more mistakes, said Dolan, who personally opposes the mandatory overtime ban, although the ACHE does not officially take a position on the issue.
A study published in the July/August 2004 issue of Health Affairs, titled The Working Hours of Hospital Staff Nurses and Patient Safety, concluded that nurses made three times as many errors on shifts that lasted longer than 12 hours, regardless of whether the shifts were mandatory or voluntary. Since fewer than 20% of the 5,317 shifts studied ended on time, the researchers recommended hospitals stop using nurse overtime, especially on shifts scheduled to last 12 hours.
The long and unpredictable hours documented here suggest a link between poor working conditions and threats to patient safety, the studys authors concluded.
Yet a study in the May 1, 2006 issue of Policy, Politics, & Nursing Practice, titled Impact of Nursing Overtime on Nurse-Sensitive Patient Outcomes in New York Hospitals, found an association between nurse overtime and lower rates of mortality, though the authors said they did not consider the report definitive. Clarke said that mandatory overtime bans decrease flexibility that administrators can use in creating innovative schedules, like those involving longer shifts over fewer days per week. The laws also hurt the workers for whom the unions dont speakthose who relish the chance to bring home bigger paychecks by working overtime. The downside depends on how (the law) is written, Clarke said.
In 1987, members of the Minnesota Nurses Association became the first in the nation to have a mandatory overtime ban included in all of their labor agreements, with a state law coming several years later that was amended as recently as 2008, union spokeswoman Jan Rabbers said.
Today, at least 15 states have laws or labor regulations banning mandatory nurse overtime: California, Connecticut, Illinois, Maryland, Minnesota, Missouri, New Hampshire, New Jersey, New York, Oregon, Pennsylvania, Rhode Island, Texas, Washington and West Virginia.
Some are more inclusive than others. New Yorks law, which was passed last June, applies the ban only to nurses, while in neighboring Pennsylvania the law applies to a far broader swath of workers that includes most direct-care nonsupervisory hospital workers, as well as laboratory technicians. We had to fight hard to keep everyone in, said Cathy Stoddard, a Pennsylvania RN and executive board member of SEIU Healthcare Pennsylvania. We had people saying, Drop everyone but nurses. We had to hold on and fight to keep everyone in.
Rather than pursue the issue in a vacuum, labor leaders said that they hope to get a federal mandatory overtime ban passed as part of a sweeping healthcare reform package that incorporates cost containment, improving access and keeping quality high.
Candice Owley, national chairwoman of AFT Healthcare and president of the Wisconsin Federation of Nurses and Health Professionals, said she sees mandatory overtime as an aspect of the quality debate.
You have to work on quality and cost containment at the same time. If you look at just cost, the consequence to quality can be significant, Owley said. Its a mistake to try to handle just one at a time.
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