Joyce Welsh, MSN, RN, remembers a time during her 28 years in the nursing field when staffs would face a common dilemma: they were nearing the end of their shifts but had a high influx of patients, more work than the next shift could handle alone.
“They’d be told, ‘you have to stay; we have sick patients,'” she recalled. “But they needed to get their kids off the bus. So it came down to helping your patient but not seeing your family fairly often.”
And though Welsh, chief nursing officer and vice president for patient care services at Emerson Hospital in Concord, Mass., has never witnessed this problem at Emerson, that doesn’t mean many nurses across the country aren’t. In fact, they absolutely are.
Still an Issue
According to the American Nurses Association’s (ANA) 2011 Health and Safety Survey, nurses across the country worked, on average, 11 hours of mandatory, planned or unplanned overtime (OT) per month. Thankfully, about 47% of nurses report never working mandatory OT.
However, that means half of the respondents are potentially suffering the effects of working mandatory OT.
“OT can cause fatigue, emotional exhaustion and burnout, as well as diminished quality of care, errors and near misses,” explained Janet Haebler, MSN, RN, associate director, ANA State Government Affairs. “Overall, the stress can cause detrimental impacts to a nurse’s health.”
This is not something to be taken lightly – according to the ANA 2011 Health and Safety Survey, nearly one out of 10 nurses report that job fatigue contributed to an auto accident.
The mandatory OT issue is by no means a new one. “This is something that’s been going on in hospitals for a very long time,” Welsh noted. “But I don’t think it was focused on as much in the past.”
In 2006, the ANA addressed the issue by adopting this policy:
“.[R]egardless of the number of hours worked, each registered nurse has an ethical responsibility to carefully consider her/his level of fatigue when deciding whether to accept any assignment extending beyond the regularly scheduled work day or week, including a mandatory or voluntary OT assignment.”
“We also believe that employers should ensure sufficient systems and resources that include a work schedule allowing adequate rest between scheduled hours and sufficient compensation and staffing levels so a nurse isn’t compelled to seek supplemental income through OT,” Haebler said.
Besides mandatory OT, nurses face similar issues with length of shifts.
The ANA 2011 Health and Safety Survey found that typical shift lengths have increase slightly over the past decade, Haebler said.
Fifty-six percent of respondents reported their usual shift lasts 10 hours or more. And even though the eight-hour shift is still the most common, fewer nurses noted working them than in the 2001 survey.
There may be even more cases of undocumented mandatory OT. Even in states that have OT laws, many nurses don’t report violations, Haebler said.
“Nurses may be fearful that they will be retaliated against for reporting abuses of mandatory OT or being forced to work hours beyond their scheduled shift. This inhibits reporting,” she added.
Not an Adequate Staffing Solution
Some hospitals use mandatory OT to “fill the slots in the shifts,” Welsh explained. “But you need a planned schedule that fills the acuity and census levels.”
“It’s a management issue that you have to be able to plan your core staff and the influx of patients,” Welsh said.
The ANA does not support that hospitals can’t fill their nursing shifts without using mandatory OT, Haebler stressed. One solution, she added, is to hire more nurses.
“Studies show that more nurse staffing equates to better patient outcomes and shorter lengths of stay,” she noted. “These higher staffing levels decrease costs over the long term.”
Mandatory OT around the Country
Mandatory OT appears to be happening more frequently overall. Some states may be seeing it more than others. Haebler reported that, according to state nurses associations:
Even though the state has a mandatory OT law, Connecticut nurses have witnessed an increase in mandatory OT.
“Employers circumvent law by reducing nursing positions, creating a staffing shortage,” Haebler said. “Then they can mandate OT for ’emergent situations,’ as defined in law.” Pennsylvania has reported a similar increase and staffing situation, she added.
“Oregon nursing officials say nurses are feeling compelled to voluntarily work OT due to staffing shortages caused by a number of factors,” she said. Again, some hospitals reduce workforce either permanently or temporarily to get around the law. “Then they cannot manage patient surges, creating an urgent situation that allows for mandatory OT,” Haebler noted.
Though low staffing levels may demand routine use of mandatory OT, it also spurs high turnover and hinders nurse recruitment efforts-a self-fulfilling prophecy, Haebler explained.
“The ANA contends that if hospitals provide more scheduling options and flexibility, healthcare facilities would have less difficulty staffing and would improve recruitment,” she said.
While the field is waiting for hospitals to catch on to better staffing solutions, the ANA is hard at work providing model language for legislation and supporting legislative initiatives in states. The following states have identified restrictions for mandatory OT in law: Alaska, Connecticut, Illinois, Maryland, Minnesota, New Hampshire, New York, Oregon, Pennsylvania, Rhode Island, Texas, Washington and West Virginia. California and Missouri have provisions in mandatory OT regulations.
“Laws vary but essentially keep nurses from being forced to accept work in excess of the agreed upon, predetermined scheduled work shift/hours, except during specified circumstances,” Haebler reported. “Examples include declared emergencies, disasters, and in some cases when the employer has exhausted all good faith, reasonable attempts to ensure that appropriate staff is available.”
Thankfully, many hospitals and health systems do not support mandatory OT, like Welsh’s Emerson. Another example is INTEGRIS Health, Oklahoma City.
“As a rule, INTEGRIS Health does not support the practice of requiring mandatory OT. Routine use of OT is strongly discouraged as a staffing tool,” said Linda Merkey, MBA, RN, NEA-BC, INTEGRIS System Chief Nursing Officer.
“Our goal is to promote a healthy work environment for our nurses and to encourage work/life balance.”
On occasion due to an unexpected event or a very high census, voluntary OT may be used to assure patient safety, Merkey added. However, it is the nurse’s responsibility to assess his or her level of fatigue before accepting an assignment that goes beyond the scheduled workday.
NURSE ON THE RUN
What You Can Do
In Haebler’s opinion, there should be no need for mandatory OT except for in emergency cases. “And in those cases, RNs will step up to work,” she added.
Welsh can wholeheartedly agree with that. She noted that nurses at Emerson feel so respected that the hospital doesn’t enforce mandatory OT that they are more than willing to help in an emergency situation.
“We have tough winters and well-predicted storms,” Welsh said. “One winter, our staff was volunteering to stay and sleep in the hospital before their shifts started so they could be there to help. At one point, we had more nurses than we could possibly need. We set up cots in the conference room so people could stay.”
What should nurses do if they are feeling the strain of mandatory OT in their hospitals?
Besides reaching out to the ANA and/or state nurses associations, they may consider consulting a lawyer, noted Leonard Emma, an attorney with Employment Lawyers (www.employment-lawyers.com) in San Francisco who has represented nurses in workplace issues.
“In the absence of laws restricting mandatory OT, local unions may be able to negotiate limitations to mandatory OT within collective bargaining agreements,” he noted.
Amanda Koehler is a freelance writer.