for immediate release:
THE Issue for 2002: An End to Mandatory Overtime
Report: February 2002
by Nancy Webber
New York State Nurses Assoc
We Need a 'Nurse Emancipation Act'
Mandatory overtime is becoming the focal point for nurse activism across the United States. Nurses are taking to the picket lines, lobbying legislators, and telling the media that becoming a nurse should not mean giving up all rights to a normal life.
You Call This 'Voluntary?'
Although the simplest definition of mandatory overtime is when a nurse is required to work beyond his or her scheduled hours, in practice, "mandation" can take subtler forms, such as when a supervisor calls the unit and says someone has to "volunteer" to work an extra shift.
"Although this type of overtime can be called "voluntary", there definitely is coercion going on," says Anne Parrish, associate director of NYSNA's Economic & General Welfare Program. "A nurse may agree to work extra hours, even when she doesn't want to, as a favor to her fellow workers. It only adds to the stress nurses experience when they have to choose among the needs of their patients, their colleagues, and their families."
NYSNA's 1999 survey of direct-care nurses found that, during the two days of the survey, 30% had to work at least one hour of overtime. Almost all considered this to be voluntary, however. An online ANA staffing survey conducted last year revealed that 4,258 out of 7,299 RNs who responded, or 58%, were often pressured to work overtime.
Overtime Takes Personal Toll
The personal cost of forced overtime is revealed by the comments nurses included in the 1999 NYSNA survey:
"It strikes me as ironic that in a profession in which nurses face day-to-day risks of exposure to serious communicable diseases, we are harassed when we need to take a sick day. Staffing is so poor that sick days can only be covered using mandatory overtime, further putting our health at risk."
"I had to do mandatory overtime for four hours because of an inadequate number of RNs on the day shift. This need for another RN was known for over two weeks but was never filled."
"Monday was the first day I was able to work due to a month of illness. That day I was mandated to work 16 hours and as a result my illness has relapsed and I am out of work again. For the past six months, our RNs have been mandated multiple times, creating illness, exhaustion, and more mandating."
Overtime Costly to Society
Research upholds these nurses' views. A briefing paper issued last month by the Economic Policy Institute in Washington, D.C., found that too much overtime is costly, in more ways than one. "It is taking its toll, not only on workers, but on their families, communities, and ultimately in many cases, patients, customers, and employers," according to the report.
While employers may see overtime as a way to solve short-term staffing problems, the long-term costs are significant. Researchers have found that frequent mandatory overtime results in a higher rate of errors, more accidents, worker stress, and chronic fatigue. In the U.S., job stress is estimated to cost industry $150 billion per year.
Involuntarily scheduled overtime is a major cause of conflict between the demands of job and family. Individuals who are regularly forced to work overtime are more likely to be depressed, to use alcohol and other drugs to escape job pressures, and to be absent due to illness, according to the report.
In the case of nurses, forced overtime also has an impact on patient care. An astonishing 75% of nurses responding to the ANA survey felt the quality of nursing care at their facilities had declined over the past two years, and more than 40% would not feel comfortable having a family member or someone close to them becoming a patient where they worked.
An Added Concern: "Patient Abandonment"
Many workers may run the risk of being fired if they refuse to work overtime, especially if they don't belong to a union. Nurses have an additional problem - if they refuse to stay past their shift, they can be reported to the State Board for Nursing for patient abandonment.
"As short-staffing and forced overtime have increased, so have the number of calls from nurses asking about patient abandonment," says Janet Haebler, associate director of NYSNA's Practice and Governmental Affairs Program.
Patient abandonment is defined in the state law governing unprofessional conduct as "abandoning or neglecting a patient or client under and in need of immediate professional care, without making reasonable arrangements for the continuation of such care."
"Nurses must use their professional judgment in deciding whether reasonable care arrangements have been made for their patients before they leave," said Haebler. "It's clear that nurses can't walk off the floor with no notice, but beyond that it's a gray area."
Even when nurses do use their best judgment, they can be reported by their employers, although often they are not officially charged with professional misconduct. In 2000, 17 nurses were reported to the State Board for Nursing for patient abandonment (up from 7 in 1999), but charges were brought in only two cases.
"We need a change in the law to take this additional pressure off of nurses," said Haebler. As part of a comprehensive bill to end mandatory overtime, NYSNA has proposed an amendment to the state Education Law specifying that a nurse's refusal to work beyond regularly scheduled hours will not constitute patient abandonment or neglect if the nurse has given a supervisor proper notice of his or her unavailability to work.
Nurses Demand Tougher Contract Language
NYSNA has been fighting the routine use of forced overtime through stringent, specific contract provisions. "Our goal is to prevent employers from routinely using mandatory overtime to fill gaps in their staffing schedules," Parrish said. "One facility showed me documentation that nurses had worked overtime for 75 shifts in a one-month period. That is simply outrageous."
One of the best examples of strong mandatory overtime language was negotiated this fall by NYSNA-represented RNs at Staten Island University Hospital. As of this month, the hospital is prohibited from assigning mandatory overtime except in the case of a disaster or extreme weather conditions.
"Unfortunately, just saying in the contract that a hospital can't use mandatory overtime isn't enough," says Thomas Darby, a NYSNA labor representative. "Now most negotiating committees also want some kind of economic disincentive for the employer."
To that end, the Staten Island contract also includes a provision that makes it less profitable for the hospital to impose overtime on its nursing staff. Nurses who are required to work three or more hours of unscheduled overtime will receive double pay. If it happens again during a calendar month, they'll receive 2-1/2 times their usual pay.
In an effort to tie the misuse of overtime to staffing, the contract also provides that if the hospital uses 360 hours of overtime within a three-month period, it must create another full-time nurse position.
The Time for Legislation is NOW:
Nurses believe that it's time to put the force of law behind the movement to stop mandatory overtime. "Laws will help," said Darby, "because it will make mandatory overtime a more serious offense. Employers will have to answer to government agencies, not just respond to nurses' grievances over contract violations."
Legislation has been introduced in several state legislatures and a bill is pending in Congress. A law banning mandatory overtime was recently adopted in New Jersey and will take effect next year (see January 2001 Report). Maine has enacted a law allowing nurses to refuse to work more than 12 consecutive hours, except in cases of last resort to ensure patient safety or unforeseen emergencies. Oregon's new law allows two hours of mandatory overtime
while a facility tries to find a replacement nurse. Nurses may be forced to work no more than 16 hours within a 24-hour period.
A bill written by NYSNA now before the New York State Legislature (A.7127/S.3515) would prohibit employers from requiring nurses to work beyond their regularly scheduled hours. Exceptions would include a healthcare disaster that unexpectedly requires additional personnel or a federal, state, or county declaration of emergency.
The proposed federal legislation would prevent nurses from being required to work more than 12 hours in a 24-hour period or 80 hours in a consecutive 14-day period. The Safe Nursing and Patient Care Act has been introduced in both the House and Senate and is endorsed by the American Nurses Association.
"This is the year that nurses will mobilize to end mandatory overtime,"
says NYSNA lobbyist Gail Myers. "It is an issue nurses feel passionate about and it's a prime reason why nurses are leaving the profession....
The quickest way to get more nurses working is to encourage RNs to return to doing what they love - patient care - without having to sacrifice their own health or worry that they are too tired to practice safely
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