Hospital Groups Oppose Prohibition of Overtime Act

By Taggart, Stephanie Phillips

In the past, when registered nurse, Rose Simchick worked a 12- hour shift and then was mandated by hospital management to work for four more hours, she often felt exhausted.

“If I stopped, I knew I wouldn’t he able to get going again,” she said. “I have been fortunate that I have not made a mistake but when you are tired, patient care is compromised – you just aren’t giving 100 percent.”

To combat the nursing shortage, some hospitals’ policy is to have healthcare workers fill vacancies with mandatory overtime but by doing so, they may be putting the patient at risk.

A 2004 study entitled, “The Working Hours of Hospital Staff Nurses and Patient Safety,” HealthAffairs, July/August, concluded that “the risks of making an error were significantly increased … when nurses worked overtime, or when they worked more than 40 hours per week.” Numerous other studies have made similar conclusions.

In effort to minimize excessive overtime of healthcare workers, the State House of Representatives passed a bill that, if approved by the State Senate, may improve patient safety.

House Bill 957- the Prohibition of Excessive Overtime Act states that, except under limited circumstances, a healthcare facility may not require an employee involved in direct patient care activities or clinical care services to work in excess of an agreed-to, predetermined and regularly-scheduled work shift.

Other employees, such as nurse’s aids, orderlies, technicians and therapists are also covered by the bill. If such workers are required to work overtime, three hours notice must he given except in the event that an unforeseen emergency arises and all reasonable efforts have been made to obtain other staffing.

The bill doesn’t apply to on-call time or when an employee is required to work overtime to complete a patient care procedure already in progress, if the absence of the employee could have an adverse effect on the patient.

“Three hours notice is just not practical,” said Kathleen Mebus, vice president of state legislation for the Hospital

Association of Pennsylvania (HAP), who strongly opposes the bill. “You can’t predict when someone is going to call off.

It sets up a situation that whenever you would have to mandate, hospitals would be faced with fine.”

But a fine, anywhere from $100 to $1,000, may be what it takes to eliminate excessive use of mandating staff.

Betsy Snook, executive administrator of the Pennsylvania State Nurses Association, who supports the bill, says the legislation deters routine use of overtime, at facilities that mandate nurses to address staffing issues.

“I think there is a more creative way to fill staffing shortages. There should be an open dialog between nurses and nursing management staff. There would be greater satisfaction amongst all parties involved,” she said.

In most working environments, happier staff translates into low turn overs which, in the long run, reduces administrative costs associated with hiring and training new personnel. When hospitals repeatedly utilize overtime, they often pay premium wages, which can also strain operational budgets.

Geisinger Health System, which opposes the bill, avoids mandating staff whenever possible.

“A better way than mandating is offering incentives – such as shift differentials. We empower our nurses to work on their own schedule together. That way they each get a piece of what they need For us, this seems to work,” said Curtis McCormick, spokesperson for the hospital.

At smaller hospitals, such as Evangelical Community Hospital in Lewisburg, mandating may not be such a concern.

“Even if the bill is passed, it wouldn’t directly affect us because we don’t usually mandate. By far, there is the willingness; of nurses to work when they are needed. Do we support the bill? When push comes to shove, we support what is best for the patients. If we didn’t have workers to care for the patients, then that would pose a safety issue,” he said.

Like Geisinger and Evangelical, HAP contends that most privately operated hospitals use voluntary staffing pools and outside agencies to fill schedule vacancies, thus negating the need for mandatory overtime.

According to HAPs Mebus, a 2004 report concluded that private hospital nurses were mandated at a rate of 15 percent versus 51 percent amongst those nurses working at hospitals within the state system. Because mandating is a larger issue in the state sector where salary offerings and facility loca tions may be less than desirable – she feels that if the bill is passed, it would improperly impose regulations on privately operated hospitals.

“We are opposed to the legislation,” said Mebus. “Part of our rationale is that this is government intervention and management of how we do our work.”

Some may argue that despite mandating frequencies, safety needs to be considered.

Kathleen Magaro, registered nurse and coordinator of nurse alliance program for Pennsylvania’s Health Care Union, SEIU 1199P, the state’s largest and fastest-growing union of nurses and other healthcare workers that strongly supports the legislation, has worked in acute care in both pri vate providers and state health providers.

“It doesn’t matter in what setting a nurse works. There definitely is a correlation between hours worked and patient safety,” she said.

Yet HAP says this legislation doesn’t totally target patient protection.

“Safety may not be the real issue here,” stated Mebus. “We hear frequently that truck drivers and airline pilots are regulated, but this legislation just affects mandated overtime not voluntary overtime. If you are really worried about patient safety, than limiting mandatory overtime is not the answer you need to regulate voluntary OT as well.”

But Simchick disagrees. She believes there is a clear difference between mandated overtime and voluntary over time.

“If you know you are going to stay, then you can prepare. You can get more sleep and, for the younger nurses, they can make child- care arrangements. There is a difference.”

If voluntary overtime is limited, at least one organization said it might have an ill effect on the industry. The Pennsylvania Organization of Nurse Leaders, which also opposes the legislation, reports that, in Pennsylvania, the practice of nurses holding active positions with two or more healthcare organizations is a mainstay. In a released statement a spokesperson stated.

“These nurses, despite legislation, will still work in excess of 60 hours per week, just not all at one facility. Individual healthcare facilities do not have the means of monitoring such activity amongst staff, Legislating overtime will not stop the practice of nurses working excessive hours, but may, in fact, contribute to it unwittingly through subtle encouragement of nurses to seek additional employment to supplement their income.”

Copyright Northeast Pennsylvania Business Journal Dec 01, 2006

(c) 2006 Northeast Pennsylvania Business Journal. Provided by ProQuest Information and Learning. All rights Reserved.