BOSTON, Mass — Representatives from the Massachusetts Nurses Association/National Nurses United, along with State Representative Denise Garlick, RN (D-Needham) held a press conference at the State House today to brief reporters on a new law to ban the dangerous practice of mandatory overtime as an alternative to providing safe registered nurse staffing levels in the state’s acute care hospitals. The new law goes into effect on Monday, Nov. 5.
On August 6, Governor Deval Patrick signed into law a health care payment reform bill that includes a ban on mandatory overtime proposed by the MNA/NNU. This measure will protect patients and save money by preventing medical errors and complications resulting from RNs being forced to work excessive hours, according to Rep. Garlick, who serves on the legislature’s joint committees on Public Health and Health Care Financing, which played a key role in crafting the legislation.
“While the legislature was working hard to craft payment reform legislation that held down costs in health care, the inclusion of the mandatory overtime ban was a crucial component of this effort because we did not want hospitals to utilize the pressure of payment reform as an excuse to cut care at the bedside,” Garlick explained.
“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.”
MNA/NNU President Donna Kelly-Williams called the new law a “landmark achievement. Forcing nurses to work when they are exhausted endangers patients and leads to costly, preventable medical errors and complications. The practice of mandatory overtime is indefensible by any patient safety standard, and yet hospitals continue to increase their use of this practice. This legislation will put an end to that as of Monday."
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, the most prestigious medical research body, 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.”
“Emergency situation” will be defined by a newly established health policy commission that will conduct a public hearing and consult nurses to determine what constitutes an emergency situation. Garlick added, “However, it is my position that once a nurse’s shift ends, be it 8, 10 or 12 hours, she or he cannot be required to work mandatory overtime, with the only exception being for a county, state or nationally declared emergency, such as that we just experienced with Hurricane Sandy. “
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.”
The law requires that hospitals report all instances of mandatory overtime to the Massachusetts Department of Public Health and that these reports be made available to the public.
The law protects nurses by prohibiting any discrimination, dismissal, discharge or any other employment decision based on a nurses' refusal to accept work in excess of the limitations on mandatory overtime.
MNA/NNU to Monitor and Report Compliance by Employers
“We understand that this law represents a significant change in how hospitals conduct their operations, but as a matter of public safety, we expect hospitals to comply with this law,” said Garlick.
The MNA/NNU is not taking any chances. According to Kelly-Williams, “A major concern of our organization beginning on Monday will be to ensure that the industry is complying with the law. We have already heard reports from both union and non union facilities, which indicate that some employers may be planning on finding ways to skirt or avoid complying with the law.
“In anticipation of this we have already done one mailing to all nurses in the state about the law informing them of their rights,” said Kelly Williams. “We have also set up a page on our web site, which contains an online form for nurses to report any instances where they have been mandated to work overtime. We will be gathering that data and sharing it with the DPH, the legislature’s public health committee and other responsible agencies to ensure that the industry is held accountable for following this law.”
The dangers and costs of mandatory overtime have been well documented in a number of scientific studies published in the last decade, which included findings that nurses working mandatory overtime are three times more likely to make costly medical errors. Over a decade ago MNA Nurses went on strike at St. Vincent Hospital in Worcester and Brockton Hospital –for 49 and 104 days respectively – to stop the dangerous practice of mandatory overtime. After a period of relative stability, we have seen hospitals revert back to the dangerous practice of mandatory overtime as their primary staffing tool. In the past two years alone this practice has been at the core of contentious negotiations at Tufts Medical Center and Morton Hospital in Taunton (where the nurses voted to go on strike over the issue), Baystate Franklin Medical Center and Cape Cod Hospital.
"Twelve years ago, the nurses at St. Vincent Hospital were forced to strike to protect our patients from the dangerous practice of mandatory overtime. Patients will now be protected from being subjected to a nurse who is too fatigued to practice safely. Nurses can no longer be forced to work excessive hours and put our patients and our licenses at risk," said Marie Ritacco, a registered nurse at St. Vincent Hospital in Worcester who spoke at the press conference.
Kathy Metzger, a nurse at Brockton Hospital on strike for 104 days in 2001 added, “The bottom line here is that no nurse should have to go on strike to force their employer to provide safe patient care. And while I would love to see all nurses belong to my union, patients cared for by nurses in non union hospitals should not be subject to a lower standard of care. Thankfully, this law will now protect all nurses and all patients as a matter of sound public health policy.”
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. “Now, thanks to this law, we have a means of holding hospitals accountable for providing safe conditions to ensure safe patient care.”
In concluding the press conference, Garlick made a point of thanking her colleagues who took the lead on moving this initiative towards passage. “I want to thank those in the legislature who worked so hard to make this law a reality. First, the lion’s share of the credit goes to Chairman Steve Walsh of Lynn, who led the effort in the House on payment reform. In addition, I want to thank Representative Jim O’Day of Worcester, the lead sponsor of this legislation, Speaker DeLeo and Senate President Therese Murray for their leadership and commitment to this critical issue.