Nurses no longer forced to work O.T.

A law that forbids hospitals from ordering nurses to work overtime to cover staffing shortages has been in place for three weeks, but there is still debate about what affect it will have on patient care, on the nursing profession and on the labor costs of the hospitals themselves.

The union representing many of the nurses and nurse aides said early last week it has received one complaint about a possible violation of the law, which prohibits mandatory overtime expect in emergency situations.

“Our sense is that the hospitals are taking the law very seriously and appear to be taking important steps to comply with it,” said Rick Brooks, director of the United Nurses & Allied Professionals, in Providence.

Indeed, Lifespan – which operates four hospitals in Rhode Island – said it has handled the new law smoothly, in part, by beefing up the number of part-time nurses it keeps on call to respond to shortages, and adding incentives for employees to take overtime voluntarily.

Brandon Melton, Lifespan senior vice president of human resources, said mandatory overtime had been rarely used, but it was a critical tool in making up for last-minute scheduling problems.

“It takes away a last resort,” he said recently. “Our commitment is to provide safe, high-quality care for our patients. We didn’t want any single method taken away from use to provide that high-quality, safe care. We can’t walk away from those patients.”

Because the law took effect earlier this month, it’s too early to determine what effects it will have.

“It has the potential to cost additional dollars,” said Edward Quinlan, president of the Hospital Association of Rhode Island. “We have to comply, at a cost. But to precisely measure that cost is difficult right now.”

Mandatory overtime has been a sore point for nurses for years. Labor leaders insisted that forcing nurses and nurse aides to work longer hours increases the potential for medical errors.

The industry has been hamstrung in recent years by a shortage of nurses – with experienced ones leaving the profession or retiring and fewer people taking their places. That has left many medical facilities relying on overtime to cover the scheduling holes.

Mandatory overtime has in recent years been a contentious area in contract negotiation between the labor unions and several hospitals, such as Rhode Island Hospital, Landmark Medical Center and Memorial Hospital.

In the case of Rhode Island Hospital, Melton said managers tried to deal with last-minute scheduling problems fairly, first asking if anyone would voluntarily stay later, and then going to a per-diem list of nurses.

If that didn’t solve the problem, managers ordered someone to stay on duty based on a listing of when which nurses were last given mandatory overtime, Melton said.

He said it didn’t happen often. And at some hospitals, such as Lifespan’s Newport Hospital and The Miriam Hospital, it didn’t happen at all. A spokesman for Memorial did not return a call before press time for comment.

Monthly reports on mandatory overtime filed by most of the hospitals backed up Melton’s claim, according to the hospital association. For instance, Quinlan said nurses and nurse aides at the association’s member hospitals worked a total of 676,739 hours in the month of December – only 655 of those hours were mandatory overtime.

Melton did acknowledge that some departments were burdened with mandatory overtime more than others. Managers in the emergency department at Rhode Island Hospital relied on it more because of the unpredictably of the department. “There can be incredibly wild fluctuations in the volume,” Melton said.

“We didn’t believe, as an employer, that mandatory overtime was a good thing,” Melton said. “We, too, didn’t like it. It was always a last resort.”

For several years, however, hospitals successfully fought against legislative attempts to prohibit the practice, until last year. That’s when a bill not only passed, the General Assembly even overrode a veto by Gov. Donald L. Carcieri.

Under the provisions of the law, private, public or state hospitals cannot make employees work in excess of a predetermined shift of either eight, 10 or 12 hours, unless there’s an “unforeseeable emergent circumstance.”

The law doesn’t apply in times of “declared national, state or municipal emergency, or a disaster or other catastrophic event.”

“We have never doubted that nurses are willing to [work overtime] and understand the need in those kinds of circumstances,” Brooks said. “It’s the mandatory overtime that results from poor planning that is what demoralizes nurses and causes resentment.”

The R.I. Department of Labor and Training is charged with enforcing the law, and each violation will result in a $300 fine.

Why don’t the hospitals hire more nurses?

Melton said there aren’t enough out there right now. “Even if we tried to hire more nurses, we wouldn’t be able to do it.”

Lifespan uses 45 traveling nurses – contract laborers from other parts of the country that fill some labor needs three months at a time. “If we had enough nurses to replace them, we would because they’re expensive,” he said.

As a result, Lifespan relies on overtime. Managers spent $13.9 million on overtime through the Lifespan network in fiscal year 2007, only a small percentage of which was considered mandatory.

“A fair number of our employees like overtime,” Melton said.

Brooks said prohibiting mandatory overtime might in a small way reduce the nursing shortage because the burnout rate will be reduced. He has already heard from one nurse who left the profession because of the long hours and has decided to return as a result of the law.

“There might be a bit of truth to that,” Melton said. “But I don’t think [mandatory overtime] was a major driver of burning nurses out.” •