PA Nurses Exec Testifies on Nursing Overtime Proposed Bill



May 1, 2005 -- Should a law govern overtime for nurses That's part of the question that was explored and testified too during a public hearing by the House Professional Licensure Committee yesterday morning at the state capitol. Testimony was presented by healthcare and related industry professionals discussing House Bill number 957, which is sponsored by Representative George Hasay, R-117 Luzerne County.

"Time and time again workplace conditions have been noted as key reasons why nurses leave the bedside or even the profession and why people in general are not looking to nursing as a career," testified Michele P. Campbell, MSN, RNC the Executive Administrator for PA State Nurses Association. "Mandatory overtime and staffing ratios have been named as two of the main deterrents," she added.
Campbell was the first to testify to the committee after opening remarks and concerns presented by the bill's author Hasay. She shared concerns about overtime effects and patient safety as well as industry statistics with the committee, noted the definition of mandatory overtime in her testimony. Closing, she shared two recent correspondences from nursing professionals and their tribulations in the field with the overtime issue.

PA State Nurses supports the bill as it stands with just two suggested amendments, the first to revise language on the definitions of a workweek/workday hours; the second request to expand the bill to include other healthcare workers.

Hasay sponsored House Bill 957 earlier this month, which is the prohibition of excessive overtime for Nurse Act. Currently there are no provisions or statutes in the commonwealth pertaining to overtime for nursing.
Highlights of some of the bills provisions include:
- a health care facility would not be able to require a nurse to work in excess of 12 hours a day or more than 60 hours a week
- but this limitation would not apply if an unforeseen emergency arises, or for on-call time
- it would not affect collective bargaining agreements or negotiation of same or contracts executed prior to the acts effective date
- the Department of Labor and Industry would implement the act and regulations and be responsible for enforcement and levying fines against act violators.

Testimony was also presented by:
Paula Bussard, Senior VP Hospital and Healthsystem Association of PA; Candace Dewar, RN, VP & Chief Nursing Officer Susquehanna Health System; Neal Bisno Secretary Treasurer of District 1199P and Elaine Oley CNA, both of Service Employees International Union; Sheri Matter, VP of Nursing and Chief Nursing Officer, Pinnacle Health; Gilbert Gall, UniServe Representative for Health Care in PA; Pennsylvania State Education Association; Teri Evans, RN, President, Pennsylvania Association Staff Nurses and Allied Professionals; Frederick Ackler, CRNA, MS, Secretary for Pennsylvania Association of Nurse Anesthetists; James Eronesi, Board Member, Pennsylvania Organization of Nurse Leaders.


The PA State Nurses Association (PA Nurses) is a non-profit organization representing the over 200,000 practicing nurses in the Commonwealth of Pennsylvania. PA State Nurses Association works to advance the profession of nursing through education, advocacy, practice, and legislation. PA Nurses is a constituent member of the American Nurses Association and is the official voice for nursing in Pennsylvania. www.panurses.org

Testimony
Presented by
Michele P. Campbell, MSN, RNC

Before the
House Professional Licensure Committee
On
House Bill 957
Prohibition of Excess Overtime for Nurses Act

April 28, 2005
Chairman Gannon and distinguished Members of the House Professional Licensure Committee thank you for calling this important hearing today and for inviting the Pennsylvania State Nurses Association to discuss House Bill 957 as it pertains to the issue of mandatory overtime for registered nurses.

My name is Michele Campbell and I have been a nurse and nurse administrator for many years prior to taking this position as Executive Administrator for the PA State Nurses Association. The Pennsylvania State Nurses Association represents the nearly 200,000 registered nurses throughout the Commonwealth. I have been through 2-3 cycles of nursing shortages in my health career and I will be honest and tell you that this shortage is by far the worst I have seen. And although we are doing an excellent job recruiting into the profession the forecasted demand for registered nurses in relation to the projected supply as far out as the year 2020 is still dismal. There is a 30% gap predicted in PA. The most compelling statistic was reflected in the 2004 Department of Health Special Report on the Characteristics of the Registered Nurse population in PA. In this report, 46% of registered nurses surveyed stated they were likely to leave nursing within the next 6-10 years.

Time and time again workplace conditions have been noted as key reasons why nurses leave the bedside or even the profession and why people in general are not looking to nursing as a career. Mandatory overtime and staffing ratios have been named as two of the main deterrents.

The definition of mandatory overtime hours are those hours above the standard work week (usually 40) that the employer makes compulsory with the threat of job loss or the threat of other reprisals such as demotion or assignment to unattractive tasks or work shifts or licensure removal in the case of nurses. Overall in the United States there has been an increase in overtime hours in general for American workers over the last two decades. Almost one third of the workforce regularly works more than the 40-hour week and one fifth work more than 50 hours. It has been no different in health care. ("Time After Time: Mandatory Overtime in the US Economy" Briefing Paper: January 2002)

In a 2002 New England Journal of Medicine article by Dr. Robert Steinbrook, there was reference to a survey conducted by the American Organization of Nurse Leaders in which 61% of nurses said they had observed increases in overtime or double shifts during the past year. Forty five percent stated that working overtime was strictly voluntary, 32% stated it was voluntary but it feels like it is required and 20% stated it was required. In the American Nurses Association Health and Safety Survey, 67% of respondents stated they work some type of mandatory or unplanned overtime every month.

Overtime work in nursing, while helping to cover vacancies and sick leave for nursing personnel, has unhealthy social costs. It is taking its toll not only on the nurses but also on their families, communities and ultimately in many cases, patients. More hours spent at work means less time with family, less time to help a child with homework, less time for play, and less time for sleep. These sacrifices can translate into increased risk for accidents and injuries; greater chronic fatigue, stress and related diseases; reduced parenting and family time and diminished quality of services-a serious public concern particularly in health care. High patient load and fatigue from long hours can result in inadequate compliance with procedures and decreased monitoring of patients. As a result, overtime can compromise patient's health or safety.

In the 2004 report from the Institute of Medicine on Keeping Patients Safe: Transforming the Work Environment of Nurses, they strongly urged regulatory bodies to prohibit nursing staff from providing patient care in any combination of scheduled shifts, mandatory overtime or voluntary overtime in excess of 12 hours in any given 24 hour period and in excess of 60 hours per 7-day period.

In July/August 2004, Dr. Ann Rogers from University of Pennsylvania released a study on the "Working Hours of Hospital Staff Nurses and Patient Safety". She found that the risk of making an error greatly increased when nurses worked shifts that were longer than 12 hours, worked significant overtime or when they worked more than 40 hours per week. Overall nurses reported being unable to leave work at the end of their scheduled shift more than 80% of the time.
(Health Affairs, Volume 23, Number 4 The Working Hours of Hospital Staff Nurses and Patient Safety July-August 2004)

With the current emphasis of this legislature on patient safety endeavors such as the enactment of Act 13, this issue should be of high concern.

The characteristics that entice persons into a career in nursing are the same characteristics that do not always allow nurses to say no to the request for overtime regardless of their state of mind, physical state or even personal or family commitments. They stay because of their commitment to the patients, their peers and the community. When a nurse needs to refuse to stay an extra shift it is because they feel strongly about their physical incapacity or prior commitments.

Unfortunately the Fair Labor Standards Act of 1938 which regulates overtime, currently imposes no limits on overtime hours nor does it prohibit dismissal or any other sanction for declining over time work. Legislation is needed to protect health care workers against excessive work hours and mandatory overtime and to protect the public from the dangers of an overburdened stressed workforce. Nurses should have the legal right to refuse overtime after having worked a certain number of hours Without fear of job loss or other sanctions.

As of April 2004, ten states have enacted regulations/legislation to prohibit the use of mandatory overtime and 12 states have introduced or will be introducing legislation/regulation similar to PA.

In April 2004, the Department of Health released the Special Report on the Characteristics of the Registered Nurse population in PA. Registered nurses were asked to list the regularly scheduled and overtime hours worked in the past two weeks and to determine if the overtime was mandatory. The results indicated that 12.1% of nurses reported mandatory overtime in that time period. Of that 13%, 43% were in state inpatient facilities, 19% were employed in military/federal facilities and 13.6 were in hospitals. For the year 2002-2003 licensure period, total overtime reported was equivalent to 4,373 full time equivalents with mandatory overtime being equivalent to 1,123 full time equivalents. Also in the survey, job satisfaction was linked to working conditions such as mandatory overtime.

I receive monthly emails/phone calls regarding overtime issues as they pertain to employees' rights to refuse mandated overtime. I explain to these individuals that under standards of nursing conduct in the regulations of the State Board of Nursing, their license will not be revoked for patient abandonment if the hours mandated to work are beyond the normal working hours. I also explain that they are employees at will, meaning that the employer can dismiss an employee for any reason or for no reason except gender, race, age or disability.

To that end, I am ending today by reading you two of the aforementioned emails: "I work as a Registered Nurse at a hospital in ________,PA. I have worked here for over 30 years. I am in my 50's and had knee replacement surgery 4 months ago. I was off work for 8 weeks and came back to work gradually. I am now back to working full time. I work on a busy medical-surgical floor and am on my feet constantly. At the end of my shift, my knee is always swollen and I go home and ice it up. Last week the supervisor approached me and told me I had to stay for the next shift as there was a call off and she couldn't find anyone to work. My knee was swollen to twice its normal size and I told her that I really could not stay. She said that I had no choice as it was 'my turn". I asked her what would happen to me if I did not stay. She left me and went and made a phone call. When she came back she told me that I would have a letter of reprimand placed in my file and would be entered into the disciplinary process. I ended up staying although I limped through the next shift and I was in excruciating pain by the end of my shift."

Another example:
"I work for a state facility and I was mandated to stay over my shift three times in the last three weeks. I told my supervisor I was tired and could not do this again and she replied that I had to as they had no other choice. I am going to resign because I cannot continue at this pace. It saddens me because my patients really need me but it is getting to the point where I am no longer good for them because I am so tired."

Because the PA State Nurses Association represents RN's, we support Representative Hasay's bill but we would like to suggest two amendments. The first amendment would be to revise the language to not require an employee to work in excess of an agreed to, predetermined and regularly scheduled daily work shift not to exceed 80 hours in a two-week period vs. the current language of not requiring a nurse to work in excess of 12 hours per workday, or in excess of 12 hours per workday or in excess of 60 hours per work week. The second amendment would expand this bill to include other health care workers. When the workplace environment is unhealthy for any worker, it affects the whole team and thus ultimately affects the patients.

We do understand the dilemma this will pose for health care facility administrators as they may be forced to close beds or divert patients. But we have a deeper concern for rendering unsafe care to our community. Thank you for having me hear today, I am open to any questions.





PA Nurses Exec Testifies on Nursing Overtime Proposed Bill