From the Massachusetts Nurse Newsletter
September/October 2012 Edition
|Mandatory overtime success: MNA nurses (above) with Rep. Steve Walsh (D-Lynn), co-chair of the Committee on Health Care Financing, (holding his son, Coleman) and Rep. Denise Garlick (D-Needham), left, former MNA president and (below), with Rep. James O’Day (D-West Boylston), the original sponsor of our mandatory overtime legislation, and Garlick.|
On Aug. 6, in a Massachusetts State House ceremony held in Nurses Hall and packed with nurses, health care advocates, labor associates and legislators, Gov. Deval Patrick signed a sweeping bill that many have called Massachusetts Health Reform, Part II. The legislation is considered the second phase of the groundbreaking universal health care law that was signed by former Gov. Mitt Romney in 2006 and which then became the basis for the national health reform plan, the Affordable Care Act, signed by Barack Obama in 2010 and upheld in large part by the U.S. Supreme Court this summer.
The new Massachusetts law allows health spending to grow no faster than the state’s economy through 2017. For five years afï»¿ter that, spending would slow further, to half a percentage point below the growth of the economy, although leaders would have the power under certain circumstances to soften that target. Both pieces of Massachusetts legislation are groundbreaking, “first-in-the-nation” bills. The newly signed Massachusetts law includes a ban on the common hospital practice of using mandatory overtime rather than provide safe registered nurse staffing levels in acute care hospitals. The inclusion of the ban on mandatory overtime in this major piece of legislation has served to highlight it as a major success for nurses in Massachusetts.
“This is a landmark achievement in our state’s efforts to control costs, while maintaining safe, quality patient care,” said Donna Kelly-Williams, RN and president of the MNA. “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 law will put an end to that.”
The MNA filed a bill to ban mandatory overtime at the beginning of the 2010-2012 legislative session. In recent months, the MNA ramped up its work with legislative leaders in both branches to incorporate the mandatory overtime ban in the payment reform bill.
Under the law, a hospital will be prohibited, except in an emergency, from requiring nurses to work beyond their scheduled shift, and no nurse would be required to work more than 12 hours in a 24-hour period. It is important to note that the definition of “emergency” is yet to be determined by a commission to be created by this law. Should a hospital assign a nurse to work a mandatory overtime shift, it will now be required to report such incidents to the Massachusetts Department of Public Health, along with the justification for the assignment. These reports become public documents. The law takes effect Nov. 5.
The law also includes an anti-retaliation measure, which prohibits hospitals from discriminating against or terminating nurses who refuse to accept a work assignment in excess of the specified limitations. A nurse can refuse overtime without fear of retribution or discipline by their employer. Moreover, even in the event of an emergency before mandating overtime, hospitals must make a good faith effort to cover the overtime on a voluntary basis.
The law also sets maximum shift lengths for nurses. Hospitals are prohibited from regularly scheduling a nurse to work more than 12 hours in a 24-hour period. Hospitals are further prohibited from permitting a nurse to work more than 16 consecutive hours in a 24-hour period. In the event a nurse works 16 consecutive hours, the hospital must provide that nurse with at least eight hours of consecutive off-duty time immediately following the 16-hour shift.
The dangers and costs of mandatory overtime have been well documented in a number of scientific studies published in the last decade. For example, it has been found that nurses working mandatory overtime are three times more likely to make costly medical errors, and that overtime for nurses is associated with an increased risk of catheter-related urinary tract infections and bedsores, both of which are preventable medical complications.
The new cost containment law has both critics and proponents. Some say that the new commission that will monitor the growth in spending does not have an enforcement mechanism that is strong enough to control providers that fail to meet spending targets. Others say the law goes too far toward a government-centered approach, imposes millions of dollars in new fees on hospitals and insurers that will be passed on to consumers, and could discourage doctors from practicing in Massachusetts.
The 349-page law creates several new boards, task forces and commissions, which will need new appointees before details are finalized, including development of the definition of “emergency,” important to enforcement of the ban on mandatory overtime.
Stay tuned for updates on progress by state agencies in implementing the specific provisions of the law, including the ban on mandatory overtime. But for now, we can celebrate this tremendous success.
|MNA thanks Speaker DeLeo for his support of ban on mandatory OT
MNA President Donna Kelly-Williams and Massachusetts House Speaker Robert DeLeo (D-Winthrop). The MNA appreciates the Speaker’s support which helped us have a successful legislative session. Thanks to Speaker DeLeo and other key legislative support, Taunton State Hospital will remain open, there will be a comprehensive review of the mental health system in Massachusetts, and a ban has been placed on the dangerous practice of mandatory overtime.