Local Nurses Say Hospitals “Skirting the Law”

Saturday, February 23, 2013

Ashley Klann, GoLocalWorcester Contributor

Area nurses and healthcare advocates met in Worcester with the Health Policy Commission on Friday to fight against mandatory overtime practices being used at local hospitals to skirt the issue of poor staffing.

“You cannot allow this to continue,” said Colleen Wolfe, RN at UMass Memorial in her testimony to the commission. “Our patients are suffering every day from deplorable care resulting from understaffing of this hospital, and staff is being forced to practice while exhausted…”

Speakers made testimonials before the board speaking in favor of writing more strict language to define an “emergency situation,” when mandatory overtime practices are used to keep nurses on call. Nurses testified that these practices are both dangerous to patients and costly for the hospital in readmission charges and overtime.

Nurses with the Massachusetts Nurses Association (MNA) from different regions testified that over the past few years, many area hospitals have abused this term to skirt around low staffing numbers, forcing nurses to work long hours.

The Health Policy Commission, is an independent state agency that monitors the reform of the health care and develops policy to reduce cost growth while improving the quality of patient care. Their intention of the meeting was to listen to employers and employees that would be affected by mandatory overtime and to gather information on the issue.

State rep. Mary Keefe (D-Worcester) and president of the Mass. AFL-CIO, Steve Tolman, were among those to speak in person in favor of local nurses.

The Organization of Nurse Leaders (ONL) said, "ONL realizes that the demand for nursing care will continue to exceed the supply of nurses and is expected to worsen over the next decade. ONL is committed to working with nursing
organizations, legislators, public policy leaders, and other organizations to develop short and long-term strategies to address workforce issues that are the root cause of the Mandatory Overtime problem."

Nurses and MNA vice president, Karen Coughlin, delivering their testimonies.

A Danger for Patients

Many spoke about the dangers that mandatory overtime poses to patients because nurses are forced to work longer shifts.

“The dangers and costs of mandated overtime have been well documented including findings that those working under mandatory overtime are three times more likely to make costly medical errors,” Keefe said. “Mandatory overtime is unsafe and should be used only under the most dire situations. Those situations cannot include routine events at a hospital including not being prepared for more than the average number of sick calls during flu season.”

Tolman spoke passionately about the issue, saying, “It makes sense. You have to have a standard. Like workers and other essential positions, nurses understand the will be called up on during these emergencies. Therefore allowing the use of mandatory overtime during these situations will not be a problem.”

“The definition we support has a clear and logical standard. Mandatory overtime is unsafe and should be used only in the most critical events,” he said.

Marie Ritacco, RN at St. Vincent Hospital, recounted the strike at that hospital twelve years ago, including about 700 nurses.

“While this was one of the hardest decisions in my nursing career, it was absolutely the best decision I could have made, because what was at stake in that strike was the integrity of my nursing practice and the safety of my patients,” she said.

The Health Policy Commission Board

Local Politicians Chime In

State representatives and senators from all over the area also sent written proposals to the board, including James O’Day, John Mahoney, Michael Moore, Harriette Chandler, and John Mahoney.

“It’s common sense,” they said in written testimonies. “When RNs are forced to work excessive hours, mistakes, errors and patient complications become more likely. This harms patients and drives up costs. This measure would put an end to it.”

The Proposal

The MNA proposed that the definition be set as “any declared national, state or municipal disaster or other catastrophic event, such as a natural disaster, act of terrorism or extended power outage, that will substantially alter the public’s health care requirements.”

Many nurses who testified against hospitals abusing this practice said that there is no question that nurses are willing to work long hours when the need arises, but not to endure mandatory overtime simply due to staffing issues.

“You cannot allow hospital administrators to define what an emergency is and you cannot sanction conscious decisions by irresponsible managers to deliberately understaff hospitals and use forced overtime as a cost containment strategy,” Wolfe said.

Another RN, Ann Marie McDonagh, of Tufts Medical Center, said, “…Without a clear cut definition of emergency as proposed by the MNA, one that takes these decisions out of the incapable hands of the hospitals, more patients will be placed in jeopardy.”

"Mandatory overtime is defined as hours worked by a nurse, necessary to deliver patient care, beyond the nurses scheduled hours," said the OLH. "Mandatory overtime is unexpected and a nurse has no choice over this scheduling requirement. The use of mandatory overtime is not consistent with a professional practice environment for nurses."

When asked by the board about who should be in charge of assessing when an emergency is taking place, AFL-CIO president, Tolman, suggested “someone responsible,” specifically the governor. But the board also questioned what to do in the case of an internal, hospital emergency.

To this, testifying nurses said that this type of situation has happened in the past and would need to be handled, but that nurses had no issue working longer hours during the recent snowstorm and other emergencies.

The Massachusetts Hospital Association released a statement in regards to the meeting: "Massachusetts hospitals do not use mandatory overtime as a standard staffing practice. Nurse leaders have developed internal procedures and best practices for all hospitals to avoid the use of mandatory overtime and regularly share those best practices with their colleagues. Because of these efforts, the use of mandatory overtime is rarely required. Once the DPH reporting process is established, the state will have a full record of those instances."

The group added that it welcomes the opportunity to work with the commission on establishing new procedures.

State Rep. Mary Keefe (D-Worcester)

Previous Measures

On November 5th, Governor Deval Patrick signed a bill that outlawed mandatory overtime unless in cases of emergency, which stated, “in no case shall such predetermined and regularly scheduled number of hours exceed 12 hours in any given 24 hour period.”

This reform also started that whenever there is an emergency situation where the safety of a patient requires its use and when there is no reasonable alternative, “the facility stall, before requiring mandatory overtime, make a good faith effort to have overtime covered on a voluntary basis.”

“That is not happening at UMass Medical Center,” Wolfe said. “In the last two years we have gone from being the best staffed hospital to Worcester to the worst staffed hospital… UMass has embraced the Toyota model of lean staffing processes, which have resulted in no less than six rounds of layoffs in the last two years. In cutting out staff, they have publicly stated that this was done in response to federal and state efforts of cost containment and health reform.”

Ritacco agreed that the issue is still a problem in area hospitals, saying, “I have heard from colleagues at other hospitals that even with this law being passed, mandatory overtime is still being used as a staffing practice… If hospitals are staffed appropriately, there is no reason – other than a state or national emergency – for hospitals to use mandatory overtime.”

Kathy Metzer, RN of Brockton Hopsital also testified, saying, “The bottom line here is that no nurse should have to go on strike to force their employer to provide safe patient care.”

Brockton Hospital also saw a strike over similar issues that included over 400 nurses, lasting 104 “grueling days.”

State senator, Michael Moore said, “Our legislative intent with this law was clear – mandatory overtime is unsafe and should only be used in the most dire circumstance.”

A Solution

Although no solution was reached at the meeting – something that will be announced at a public hearing on the issue from the committee at a future date – the board did question what measures Brockton Hospital and Saint Vincent had taken to overcome these same problems.

The nurses from other hospitals said they see “fewer holes in our schedules being posted,” and attributed some of the success to “float pools” of employees used to fill at these times. They also said that there has been more input from administration. They said there is more of a process when the practice is used.

Saint Vincent’s is required to staff at a certain level beforehand to keep this issue from happening, according to those testifying.