Nurses to Voice Mandatory Overtime Concerns Today at State House

Friday, April 26, 2013

Kate Nagle, GoLocalWorcester News Team

The Massachusetts Health Policy Commission is holding a hearing this morning regarding guidelines governing the use of mandatory overtime for nurses in a hospital setting -- and two nurses from UMass Memorial Medical Center are testifying to express their concerns with language in the recently approved law giving hospital administrators a say in declaring emergencies that require nurses to work overtime.

"Hospital administrators cannot be allowed to define what is an emergency and you cannot sanction conscious decisions by irresponsible managers to deliberately understaff hospitals and use forced overtime as a cost containment strategy," said Colleen Wolfe, one of two registered nurses at UMass Memorial Medical Center providing testimony to the Commission this morning.

Last August, Governor Deval Patrick signed into law a health care reform bill that included a ban on mandatory overtime, which had been proposed by the Massachusetts Nurses Association/National Nurses United (MNA/NNA).

This measure, which was enacted in November, prohibits a hospital from requiring a nurse to work mandatory overtime -- no more than 12 hours in a 24 hour period -- except in the case of an emergency situation "where the safety of the patient requires its use and when there is no reasonable alternative".

The Commission is seeking input from nurses and other parties on the recently unveiled proposed guidelines to determine what constitutes an emergency situation for purposes of allowing mandatory overtime.

Defining Emergency Situations

According to the Health Policy Commission, "an emergency situation for the purposes of allowing mandatory overtime...means an unforeseen event that could not be prudently planned for or anticipated by a hospital and affects patient safety in the hospital and where there is a government declaration of emergency, catastrophic event, or patient care emergency."

"We think the guidance on mandatory overtime proposed by the Commission is balanced, fair, and appropriately keeps the needs of patients front and center," said Lorraine Schoen, MS, BSN, RN, who is Director of Clinical Affairs at the Massachusetts Hospital Association. "The Commission clearly put a lot of thought into their recommendations, and the proposed language is consistent with the standards established by other states that have addressed the issue."

Sharon Gale, MSN, RN, and Chief Executive Officer of the Organization of Nurse Leaders, MA-RI, offered the following.

"We have over 700 leaders from Massachusetts and Rhode Island whose roles include Chief Nurse Officer, Nurse Directors, managers and supervisors who are responsible for dealing with staffing to assure that there are appropriate number of staff and other team member to make sure patient care need are met."

Gale continued, "The guidance issued by the HPC reflects a thoughtful study of approaches adopted by other states that takes into account the myriad factors that need to be considered to assure the care needs of all patients are met when unexpected nurse staffing needs occur."

The MNA/NNA, and two UMass Memorial Medical Center nurses, have expressed concerns however as to what constitutes a patient care emergency -- and who makes that decision.

Nurses Association -- and Nurses -- Concerned about Hospitals' Powers

In a press release that went out Thursday, the Massachusetts Nurses Association wrote the following. "Supported by other advocates, [we have] been seeking a very clear definition of an emergency that includes “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.”

The language in the release continued, "The nurses want to ensure that the final definition takes any interpretation of what constitutes an emergency out of the hands of hospital administrators who have and will continue to seek any opportunity to skirt the law."

In her testimony, Wolfe was highly critical of current administrative practices at UMass Memorial Medical Center. "UMass, on a periodic basis, issues what they call a "code help" and implements what they have termed a "hospital-wide disaster" plan. When this happens, no nurse is allowed to leave the facility and mandatory overtime becomes the staffing tool."

"The code help "disasters" at UMass were caused by UMass administrators alone and such events are preventable by ensuring that the hospital is staffed with an adequate number of nurses to care for patients, however we have no doubt that with the patient care emergency language now in the guidelines, our administration would use this [existing] language to justify continuing its current practices," said Wolfe.

Lisa Cargill, a registered nurse in the operating room at UMass Memorial Medical Center, provided the following in prepared testimony regarding OR (operating room) staffing procedures.

"The solution is a simple one -- hospitals need to make sure that they don't start surgical procedures knowing that the OR nurse's shift will end before the case can be finished, or in cases in which it would be unsafe to the patent for that nurse to be relieved. If they need to add another shift of nurses, so be it -- the revenue generated from the surgery is far greater than the cost of nurse."

David Schildmeier with the MNA spoke with GoLocalWorcester on Thursday. "Look, in Boston last week, hundreds of nurses, not on shift, not required, went to [the hospitals] to help the bomb victims, unasked, and stayed for long periods of time to assist. Sandy, Nemo -- nurses know when there's an emergency, and they don't care. It's the hospital-created "patient care emergencies" that often result from under-staffing that we're concerned about as it pertains to the current mandatory overtime language."

Next Steps

Following today's public hearing, the Committee will hold another meeting and the Committee Chair will present final guidelines for approval at a Commission meeting schedule for June 19th.