American Journal of Nursing - November, 2001 - Volume 101, Issue 12
Prohibiting Mandatory Overtime
The ANA and lawmakers are working to eliminate this dangerous practice.
by Stephanie Reed
In recent years, reports of excessive use of mandatory overtime by hospitals have been on the rise. In fact, 67% of nurses who responded last summer to an ANA-NursingWorld survey on health and safety reported that they worked some form of mandatory or unplanned overtime every month. This results in an unsafe and unhealthy environment for both patients and nurses and exacerbates the growing nursing shortage as RNs are driven from bedside practice.
To address this issue, the ANA has made the prohibition of mandatory overtime--at both the state and federal levels--a major legislative priority. Since the convening of the current Congress in January 2001, the ANA has worked with other organizations representing nurses to develop a consensus on mandatory overtime, to identify sponsors for it in Congress, and to review drafts of the bill as it was being developed.
These efforts are paying off. At press time, legislation was slated to be introduced in both the House and the Senate to make a prohibition on mandatory overtime for nurses a requirement in Medicare provider agreements.
The House bill was to be introduced by Representative Pete Stark (D-CA), the ranking Democrat on the Ways and Means Health Subcommittee, which has jurisdiction over the Medicare program. The Senate bill was to be introduced by Senators Edward M. Kennedy (D-MA) and John Kerry (D-MA). Senator Kerry is a member of the Finance Committee, which has Senate jurisdiction over Medicare, and Senator Kennedy chairs the Committee on Health, Education, Labor, and Pensions (HELP) and is a leading champion of progressive health care reform.
Addressing the problem through the Medicare system ensures that this measure would apply to salaried nurses as well as those who are paid on an hourly basis, and to nurses who work in state and local public hospitals. By using health care law, Congress is recognizing that mandatory overtime is a health care crisis that must be addressed if patients are to receive safe and effective care. The ANA believes that emphasizing patient safety and public health aspects of the problem is necessary to develop broad-based support among members of Congress and the public. In that respect, the legislation is similar to special public safety regulations governing transportation workers' hours, which are part of transportation law rather than labor law.
The mandatory overtime legislation would
*prohibit health care facilities from requiring a nurse (RN or LPN) to work past an agreed upon, predetermined, regularly scheduled shift. In no case could a nurse be required to work more than 12 hours in a 24-hour period or for more than 80 hours in a two-week period--a provision that would prevent an institution from altering shift schedules in order to undermine the law.
*apply only to mandatory--not voluntary--overtime. Throughout the negotiations the ANA has consistently maintained that, although there is evidence of the detrimental effects of fatigue on workers' judgment and ability to perform, there is not yet sufficient scientific information on the maximum number of hours it is safe for nurses to work to justify enacting absolute limits. The ANA believes that individual registered nurses should be able to make their own judgments about whether or not they are able to provide safe care in overtime situations.
*include nondiscrimination protections for nurses who refuse overtime and for nurses who provide information or cooperate with investigations about the use of overtime.
*include an exception in the case of a declared national, state, or local emergency. Such an emergency would be in response to an unpredictable disaster, not in response to a staffing deficiency resulting from management practices. While it is clear to the nursing community that nurses always respond to true emergencies without regard to overtime, this exception may be reassuring to lawmakers and the public.
*provide for a study by the Department of Health and Human Services on the maximum number of hours that may be worked by a nurse without compromising patient safety
Stephanie Reed is an associate director of government affairs at the ANA.