After more than a decade of lobbying for a ban on mandatory overtime, nurses in Massachusetts are declaring victory.
Last week, as part of a major piece of healthcare cost containment legislation, Governor Deval Patrick (D) signed the ban into law, making Massachusetts the 17th state to outlaw mandatory overtime for nurses.
"We have been working on this piece of legislation for over 12 years," says Donna Kelly-Williams, RN, president of Massachusetts Nurses Association/National Nurses United (MNA/NNU). "There was a lot of pushback on it, [and] there was some denial that it was even happening."
Being forced to work mandatory overtime is more than a hassle and an inconvenience. In addition to the physical and emotional strain it places on nurses, patients also suffer when nurses work too many hours without enough rest. Organizations ranging from the ANA to the Institute of Medicine have called for a complete ban on the practice, arguing that it can lead to patient injury and even death.
"Patients are actually at greater risk of having a medication or medical error happen to them when nurses are forced to work beyond their shift," Kelly-Williams says. "There's no denying that this has become a critical problem."
According to MNA/NNU, the ban will prevent mistakes, errors, and complications resulting from RNs being forced to work excessive hours when they're tired.
Under the new law, which will go into effect in a little less than 90 days, a hospital could not, except in the case of a declared emergency, require a nurse to work beyond his or her scheduled shift. A nurse who's worked 12 consecutive hours in a shift must be given at least eight hours off from any work between shifts. Nurse may also refuse overtime without fear of retribution or discipline from their employer.
In addition, hospitals that assign a mandatory overtime shift are required to report those incidents to department of public health, along with the justification for its use.
"That will now be public record," Kelly-Williams says.
Even though the number of states banning mandatory overtime is growing, Kelly-Williams says the practice of requiring nurses to work overtime is not diminished; in fact, she says, it's on the rise.
She says hospitals routinely under-employ nurses in order to achieve the bare minimum staffing levels and save money. But Kelly-Williams argues that it costs hospitals more in the long-run because of errors caused by overworked nurses.
"It is my hope that the staffing will improve as a result of this legislation," she says.
Although Massachusetts hospitals are required to report cases of mandatory overtime under the new law, there's no other way to really enforce the legislation. Research published earlier this year in the journal Nursing Outlook, however, found that state-mandated caps on nurses' mandatory overtime hours have been successful at reducing overtime hours for newly licensed registered nurses (NLRNs) in those states.
"There is just simply no question that mandatory overtime is repugnant to most nurses," Carol Brewer, PhD, RN, FAAN, professor at the School of Nursing, University at Buffalo, told HealthLeaders in January.
Brewer also told HealthLeaders that hospitals in other states shouldn't wait for an official ban. In addition to the stress it places on nurses and the patient safety risks it poses, mandatory overtime is a major source of dissatisfaction for employees.
Hospitals that haven't imposed their own bans on mandatory overtime should look closely at revamping current scheduling practices long before a ban requires them to do so. Kelly-Williams says nurse leaders can affect change in their organizations by listening to the concerns of staff nurses and respond to their concerns.
"A lot of what we do is with our eyes...to really be that safety net to prevent things from happening," Kelly-Williams says. "And you can't do that when you've gone beyond your shift."
Alexandra Wilson Pecci is an editor for HealthLeaders.
