Nurses say mandatory overtime leads to medical errors, endangers patients
Nurses in Massachusetts are backing a new law that will ban mandatory overtime – a strategy used by hospitals to cut costs.
“Forcing nurses to work when they are exhausted endangers patients and leads to costly, preventable medical errors and complications,” said Donna Kelly-Williams, president of the Massachusetts Nurses Association/National Nurses United. “The practice of mandatory overtime is indefensible by any patient safety standard, and yet hospitals continue to increase their use of this practice.”
A provision banning mandatory overtime in the state is part of a new health care payment reform bill that went into effect Nov. 5.
Rep. Denise C. Garlick, who helped craft the legislation, said the provision was included to prevent hospitals from utilizing the pressure of payment reform as an excuse to cut care at the bedside.
“The legislature understands that the provision of nursing care is central to the delivery of quality patient care, and according to the research, it is also central to the provision of cost effective and yes, cost saving care.”
What the law does
The law prohibits mandatory overtime, which is defined as “any hours worked by a nurse in a hospital setting to deliver patient care beyond the predetermined and regularly scheduled number of hours that the hospital and nurse have agreed that the employee shall work, provided that in no case shall such predetermined and regularly scheduled number of hours exceed 12 hours in any given 24 hour period.” This requirement is in keeping with the recommendations of the Institute of Medicine, which issued a report in 2002 calling for a ban on mandatory overtime.” Garlick explained.
The law prohibits nurses from working mandatory overtime except in the case of “an emergency situation where the safety of the patient requires its use and when there is no reasonable alternative.”
The law also prohibits mandatory overtime being used as an alternative to providing appropriate staffing for the level of patient care required. “This means hospitals cannot do what they have done for years, which is to post schedules with numerous holes built into the schedule,” said Garlick. “It is the hospital’s responsibility to have enough nurses to cover the shifts needed to provide patient care. It is not the nurse’s responsibility to work while fatigued and endanger the patient simply because our hospitals do not want to hire the staff needed to operate safely. The same applies for increases in census, or sick calls by nurses. These are not justifications for declaring an emergency; they are expected consequences of running a hospital. When Hurricane Sandy hit, nurses had no problem working as long as it took to keep their communities safe. But day to day operations of a hospital do not correlate to the requirements for responding to a once in a century storm.”
Barbara Tiller, a nurse at Tufts Medical Center, where nurses almost went on strike over this issue in 2011, explained how her employer and others across the state were cutting staffing and increasing the use of this dangerous practice. “Our employer, like dozens of others in the state, had cut staffing levels and increased the use of forced overtime as a rationale for dealing with pending state and federal payment reform legislation. We were the poster children for what the legislature in their wisdom sought to prevent with the passage of a state law to ban mandatory overtime,” Tiller explained.