ANA head says overtime puts patients at risk

Mandatory overtime is compromising the care provided by registered nurses and putting patients at risk, according to American Nurses Association (ANA) president Mary Foley, RN, MS, who recently issued a warning that called the long work hours "an alarming trend" among hospitals.

"More and more hospitals are forcing registered nurses to work mandatory overtime, placing both patients and nurses at increased risk," Foley says. "Nurses should never be forced to work excessive overtime, especially when they are tired, overworked, and have others depending on their arrival at home."

Foley tells Healthcare Risk Management that long hours can make it difficult for nurses to provide the sophisticated thinking, decision making, and technical skills required in delivering quality patient care. Regularly forcing RNs to work 16 hours or more at a stretch is dangerous, she says, and her recent warning to consumers was intended to alert the American public to that practice and the risk it presents to patients.

"Of course, real emergencies happen, and nurses can always be counted on to respond, but using excessive mandatory overtime as a way to deal with ongoing staffing shortages is wrong," she says.

Foley notes that the staffing issues come on the heels of the Institute of Medicine’s (IOM) report on medical errors, which found that, in the United States, between 44,000 and 98,000 patient deaths per year are due to medical errors. The IOM recommends that part of the solution rests in developing safe health care systems that address work hours, workloads, sufficient staffing and personnel support, and shift assignments as well as the impact on patient care when nurses work beyond their ability to provide safe and quality services. Foley calls it "absolutely derelict, in light of the IOM’s findings and recommendations, that hospitals are still willing to jeopardize patient care."

Many hospitals claim a nursing shortage as the reason to mandate overtime. While an RN shortage is a real issue in some areas, Foley says there are ways to address staffing that do not force RNs to work long hours. Mandating excessive overtime is a calculated business practice aimed at saving hospitals money, she says, at a time when hospitals are reporting profit margins higher than they have enjoyed in the past.

Recent American Hospital Association data show the nation’s hospitals reporting record profits of $21.9 billion, giving them a profit margin of 6.6%, the second highest aggregate margin ever. Hospitals reduce expenses — thus increasing profit — by employing insufficient numbers of nurses and minimizing the number of employees who are paid benefits, Foley says. Hospitals routinely keep too few RNs on staff to provide appropriate coverage or address fluctuating patient care needs, she says.

"ANA supports the RNs currently on strike in Nyack, NY, and in Worcester, MA, who have gone out in protest over mandatory overtime," Foley says. "It is never easy to decide to strike, but, as we have seen time and time again, RNs are forced to take this action when hospitals fail to support safe standards of nursing practice. These nurses are on strike to protect both their own health and well-being and the unsuspecting patients who assume that hospitals provide safe, quality nursing care, not exhausted, overworked labor."

The New York State Nurses Association and the Massachusetts Nurses Association have advised Nyack Hospital and St. Vincent Hospital, owned by for-profit Tenet Health Care Corp., to reduce the mandatory overtime.

"Tenet, like many hospital organizations, is quite profitable," Foley says. "Its recently released third-quarter earnings report shows a 23% rise in net profits over the same period last year. While realizing that kind of profit, Tenet still insists on the right to require as much as eight hours of mandatory overtime, even following an original eight-hour shift. This practice forces some RNs to work up to 16 nonstop hours."

Foley says nurses who refuse the overtime can be threatened with losing their jobs or licenses under an alleged patient abandonment charge. She labels that threat "blatant intimidation."

"Nurses themselves know that working while exhausted will increase the risk of committing an error that harms a patient or predisposes themselves to injures — like needlesticks — on the job," she says. "However, when threatened with job loss or action against their license, some nurses feel obligated to stay."

Hospital managers who rely on mandatory overtime ignore general standards and acceptable practices that relate to public safety and well-being, Foley says. She suggests that hospitals should be required to follow the same sort of rules that the public transportation, airline, and trucking industry use regarding shift lengths and the amount of rest an employee must have before coming onto an assignment.

The ANA encourages consumers to inquire about nursing staffing before being treated at a hospital.