Copied and pasted from here
http://www.roanoke.com//business/23651.html
Nurses long on hours
Long hours are physically and emotionally taxing.
By Jeff Sturgeon
981-3251
The Roanoke Times
It was 8:30 p.m. on a Saturday, 12 hours after nurse Kim Merrill of Christiansburg arrived at work. She and her co-workers were not even close to finishing a big project due the next day.
They had to check the charts of all 240 patients in the Salem nursing home where they worked.
It was clear to Merrill by mid-evening she and two colleagues would be unable to finish the task without working all night. So they did.
Merrill, who was assistant nursing director at Salem Health and Rehabilitation Center, said she left Sunday morning about 11:30.
She had been on the job that March weekend, without sleep, for 27 hours.
While Merrill presents an extreme example, plenty of people are concerned that some nurses are working too many hours - for their own good and for that of patients. The issue has caught the attention of state and federal lawmakers, who wonder if new laws would head off fatigue-driven errors.
In Virginia, there are no legal limits on how long a nursing home or hospital can work a nurse.
There is tension stemming from how many hours hospitals and nursing homes need their nurses to work and how many hours the nurses feel they can safely work and desire to work - not in every hospital and nursing home, but in those coping least well with a nationwide shortage of nurses. In Virginia, a shortfall of 7,500 nurses today is expected to rise to 22,600 in 2020, or 32 percent of the total needed, according to the State Council for Higher Education in Virginia.
The long hours are physically and emotionally taxing.
"I never knew when to tell my kids I would be home," recalled Merrill, 39, a nurse for the past 15 years.
In two other instances during the preceding six months, Merrill said she worked 24 hours consecutively: her normal 12-hour shift as a manager, 8 hours to cover for a nurse who did not come to work and for whom a substitute could not be found and four hours in between.
Del. Benny Keister, D-Pulaski County, said there is "no way" nurses should work 24 hours straight.
As for working 27 hours, "that's plumb ridiculous," Keister said.
The issue of long nursing shifts in Virginia health care facilities "needs to be looked into because when you work those long hours, that's when you tend to make mistakes."
Keister, who sits on the House of Delegates Health, Welfare and Institutions Committee, said he was contacted recently about the issue of long nurse hours by two people, one a hospital nurse and one a nurse other than Merrill who left Salem Health and Rehabilitation Center. He predicted nurses will petition the Virginia General Assembly for relief, possibly in time for the issue to receive consideration during next year's session.
Researchers recently tried to determine whether long hours increase errors. They found that they do.
A University of Pennsylvania-led team mailed 4,320 randomly chosen members of the American Nurses Association an invitation to log their hours, errors and near-errors in notebooks for a month.
According to the final data, based on information from 393 nurses, nurses leftwork at the end of their scheduled shifts only about 20 percent of the time. On average, they worked an extra 55 minutes per shift.
In total, about half of the shifts were up to 8 1/2 hours, a fifth were 8 1/2 to 12 1/2 hours and a third were 12 1/2 hours or longer. "The likelihood of making an error increased with longer work hours and was three times higher when nurses worked shifts lasting ... 12.5 hours or more," said the study, written by Ann Rogers, Linda Aiken and three others.
In addition, "working overtime increased the odds of making at least one error, regardless of how long the shift was originally scheduled to be."
The writers called for ending overtime and cutting back on routine use of 12-hour shifts for registered nurses.
In response to the reported risk of errors found in this study and others like it, Lewis-Gale Medical Center in Salem last month ended a practice of scheduling nurses for 16-hour shifts when nurses requested it for personal reasons. Carilion Health System said it still allows nurses to work 16 straight hours voluntarily, though no more, but monitors work loads to ensure no one volunteers too often. Neither mandates overtime.
The Veterans Affairs Medical Center in Salem may mandate nurses work up to four hours extra following an eight-hour or 12-hour shift, but the work load is spread around so no individual is overtaxed.
Jay Douglas, who directs the Virginia Board of Nursing, hears from nurses with concerns.
"Nurses increasingly are being put in a position of being asked to work longer hours," Douglas said. "It's certainly a real issue in the environment."
The callers "have been working long hours and they're saying 'no' to their employer," Douglas said.
According to Douglas, the nurses most often want to know if they can be sanctioned by the board for what's known as patient abandonment if they decline a shift their employer wants them to work. Douglas said the board would not consider the situation patient abandonment - departing without leaving time for alternative arrangements to be made - unless the nurse left part way through a shift.
Declining a supplemental work assignment is not abandonment, however.
The Virginia Board of Nursing requires that nurses ensure they're capable of practicing nursing safely at all times they're on duty. However, as a nurse-licensing agency, it does not regulate the hours employers set or demand of their nurses.
Other observers don't see a problem.
Sandee Levin, who directs the Virginia Association of Nonprofit Homes for the Aging, said the nursing shortage isn't lengthening shifts but boosting temporary nurse agencies, which "are doing a booming business."
As a business strategy, she said, working nurses long hours is in conflict with the industry's priority to improve the quality of care.
Sheri Jacobs, a certified nurse aide at The Avante of Roanoke nursing home, said she likes her hours. She works a 16-hour shift starting each Monday afternoon, a second 16-hour shift starting each Tuesday afternoon and eight hours each on Saturday and Sunday every other weekend. It adds up to 40 hours a week and gives her long stretches of time off during which she enjoys her grandchildren.
Overtime debated
Merrill said she began her extraordinary 27-hour shift on Saturday, March 19, at 8:30 a.m. Administrators believed a surveyor from the Virginia Department of Health was due to inspect the facility, and they wanted patient files reviewed and problems corrected beforehand, Merrill said.
Inspectors had cited the nursing home in recent months, finding, among other problems, four cases of substandard care, state records show. The nursing home has since cleared up the citations, records show.
She didn't earn overtime pay because she was in management, just the same paycheck she would have received had she worked eight hours at her usual wage of $26 an hour.
Twenty-seven hours is more than three times the average shift for a nursing home nurse, according to Charlene Harrington, professor of sociology and nursing at the University of California at San Francisco.
Medical Facilities of America, a Roanoke County-based nursing home chain that operates Salem Health and Rehabilitation Center, declined to comment on Merrill or the circumstances surrounding the marathon shift.
Spokesman Kurt Dullnig, who confirmed Merrill was an employee, said the typical shift of an MFA nurse is eight hours. When nurses work longer, they do so by choice, he said.
"If there's any extra shifts worked, by policy it's purely voluntary on their part," Dullnig said. He said he knew of no exceptions to the policy.
Merrill disagreed. She said a superior told her the project had to be done by the next morning, adding "no excuses." Management insisted workers finish the project no matter what, said another former nurse who worked all night on the project, and who asked not to be identified because she feared speaking publicly might jeopardize future employment opportunities.
The American Nurses Association opposes mandatory overtime for nurses and agrees with the concept behind federal legislation pending in Congress to ban mandatory overtime in excess of 12 hours during a 24-hour period and 80 hours during a 14-day period. It would apply only to hospital nurses and not those in nursing homes, but the office of U.S. Rep. Pete Stark, D-California, the bill's sponsor, said similar initiatives are moving forward for nursing homes.
Dependence on mandatory overtime, especially last-minute directives to nurses that they must work another shift for an absent colleague, "alleviates a sense of urgency or necessity to proactively find safer and more appropriate staffing," the ANA said.
Merrill doesn't think she made any errors during that marathon shift.
She was just wiped out and had a migraine because she had exceeded her limit. Merrill said that limit depends on a worker's age, stamina and sleep requirements but generally is 16 hours and, certainly, 20 hours.
While driving back to the New River Valley after the long shift, "I was kind of like heaving," she said.
She threw up when she got home. She didn't see a doctor, but, "I'm sure it was extreme fatigue," she said.
She called in sick the next day. She received a phone call later saying she had been suspended for reasons including failure to perform her job duties, she said. After first planning to fight the suspension, she now accepts it and does not plan to return to work at the nursing home, having found work as a hospital psychiatric nurse.
She works 8 a.m. to 4:30 p.m. weekdays.
Would you like to comment?
I AM SO GLAD SHE FOUND SOMETHING ELSE.
