Exhausted nurses who work at Lahey Health’s Beverly Hospital and Addison Gilbert Hospital in Gloucester are sounding the alarm and taking action to address unsafe patient care conditions at their facilities, as Lahey management is deliberately and repeatedly forcing nurses to work mandatory overtime in direct violation of a 2012 state law that prohibits the dangerous practice as an alternative to providing safe RN staffing.
The nurses are going public with their concerns as the use of mandatory overtime has increased steadily at both facilities, thereby jeopardizing patient safety. And, despite the RNs’ vigilant reporting efforts, Lahey management appears to have no intention of changing its behavior or complying with the law. Between Jan. and May, the Department of Public Health reports more than 50 instances of mandatory overtime at the two facilities, more than any hospital in the Commonwealth. Each of these official reports includes a rationale provided by the employer for its use of forced overtime. In each of these cases, the rationale provided by Lahey management is in direct violation of the law.
The passage of a law to ban the practice in Massachusetts hospitals followed years of efforts by the state’s hospitals to boost profits by cutting back on staffing and utilizing mandatory overtime to cover for the lack of available staff, which has compromised care for patients in the Commonwealth. 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. The prestigious Institute of Medicine published a groundbreaking report in 2002 linking understaffing of nurses and the use of mandatory overtime to thousands of patient deaths. The Institute’s report stated that the use of mandatory overtime is so dangerous that patients and/or their families being cared for by a nurse working forced overtime should be informed of the situation and given the option of seeking care at another hospital.
This ongoing issue came to a head when MNA nurses at both facilities recently completed an internal audit revealing that in just three and a half months (January 25, 2015 through May 2, 2015) RNs had filed 54 forms documenting the illegal use of mandatory overtime. That equates to the hospital violating the law — and staffing its units inappropriately as a result — once every 1.8 days. “54 incidents of violating the state’s mandatory overtime law in a mere 98 days is terrifying,” said Jeanine Burns, RN and chairperson of the MNA bargaining unit at Addison Gilbert Hospital, “because mandating a nurse to work overtime is 1) indicative of management consistently understaffing the hospitals and 2) means that exhausted nurses who have literally been awake for too many hours in a row are delivering patient care.”
“But what is even more worrisome,” added Burns, “is that we know there were many, many more instances of mandatory overtime that nurses never reported over the same time period.”
The MNA filed a class action grievance with hospital management over this issue on May 8, 2015. That grievance has been rejected by hospital management, which denies any wrongdoing and refuses to change its practices. As a result, the nurses and MNA plan to submit the issue to arbitration in the hopes of changing management’s behavior and improving patient safety.
If the hospital fails to stop this dangerous practice, the MNA will be meeting with the Health Policy Commission, which developed the regulations underpinning the law, and the Department of Public Health, which oversees the implementation and compliance with the law, to ensure Lahey complies with the law and protects its patient population.
According to Julie Pinkham, executive director of MNA, “The practice of mandatory overtime is indefensible by any patient safety standard, and yet this employer continues to increase their use of this practice in blatant violation of state law. We intend to do whatever is necessary to ensure Lahey Health follows the law and provides safe care for the patients at these hospitals.”
Specifics of the Mandatory Overtime Law
On August 6, 2012, former Governor Deval Patrick signed into law a health care payment reform bill that included a ban on mandatory overtime proposed by the MNA. The law went into effect on Monday, Nov. 5, 2012 and, as a result, all hospitals in the state are required to comply with the measure. Highlights of the law include:
- 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.”
- 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” was defined by the Health Policy Commission, and includes such cases as an internal or external hospital disaster, such as a roof collapse, or state declared emergency. Follow this link to learn more about the guidelines for determining what constitutes an emergency situation: http://www.massnurses.org/news-and-events/p/openItem/8420.
- The law expressly prohibits mandatory overtime from being used as an alternative to providing appropriate staffing for the level of patient care required. Under the law, unfilled holes in the schedule, a high census, a sick call or leaves of absence by staff can in no way be construed as an emergency, as they are the direct result of the hospital’s failure to provide appropriate staff, yet in nearly every instance of the hospital’s reporting to DPH on their use of mandatory overtime, they site a sick call or increase in census as justification, which is in direct violation of the law.
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.
“High Census Does Not Justify Mandatory Overtime”
Lahey management has attempted to justify its use of mandatory overtime by blaming the “high census” both hospitals are dealing with, but the MNA nurses working inside both facilities say otherwise.
“The ‘high census’ has existed for more than two years now,” said Mary Keller, RN and co-chair of the bargaining unit, “which means it is, in fact, the new normal and management should be staffing for that new normal each and every day. Instead, they force exhausted RNs to stay hours beyond their regularly scheduled shifts, and their ability to deliver safe patient care is placed at risk. Consequently, it is reasonable to concern ourselves with the probability of an exhausted RN making an error, which is a huge consideration for patient safety.”
The situation is only expected to get worse during the summer months, as hospital management is fast-tracking its implementation of “EPIC,” a new electronic medical records system that nurses are being required to spend several hours at a time in related trainings and meetings.
“To be told a mere 15 minutes before the end of your regular shift that you must stay and work another four hours is both dangerous and unreasonable,” added Keller. “Our nurses are tired. Our nurses are overworked. And our nurses are stressed. The state of Massachusetts recognized years ago that RNs who are forced to work in such conditions run the risk of making medical errors while delivering patient care. Hence, the mandatory overtime law. Yet Lahey management somehow thinks it is above this law, otherwise we wouldn’t be looking at 54 mandatory overtime violation reports in 98 days. We won’t stand for this any longer.”