By Debra Wood, RN, contributor
August 10, 2012 - Nurses in Massachusetts celebrated a major victory this week after Gov. Deval Patrick signed a health care law that includes banning mandatory overtime for nurses.
“Nurses want to get up, prepare for their shift, take the best care of their patients, and then know there is relief at the end, that there is somebody to carry on the care of that patient to a successful outcome,” said staff nurse Donna Kelly-Williams, RN, president of the Massachusetts Nurses Association/National Nurses United (MNA/NNU).
The law prevents a hospital, except in the case of a declared emergency, from requiring a nurse to work beyond a scheduled shift or to work more than 12 hours in a 24-hour period. Nurses can refuse the extra hours without fear of retribution. Any hospital requiring nurses work more than that must report the incident to the Department of Public Health and state why the action was justified. The law takes effect in November 2012.
Members of MNA/NNU, who have pushed for passage of such legislation for the past 12 years, watched as the governor signed the new law protecting patients and nurses. Kelly-Williams said the nurses stayed focused on mandatory overtime, because the practice of requiring a nurse to stay at the bedside without relief had become even more prevalent.
Members of the Massachusetts Nurses Association meet with Gov. Deval Patrick after he signed the mandatory overtime ban into law.
Nurses from the association had worked with legislative leaders to include the overtime ban in a health care payment reform bill. Kelly-Williams explained that the law will create a cost savings. By forcing nurses to work excessive hours, it can endanger patients and errors and complications add to the cost of care.
Multiple studies back that up, and Kelly-Williams said that data was important in convincing legislators to pass the measure.
DeAnn McEwen, RN, MSN, president of the California Nurses Association/National Nurses Organizing Committee and vice president of National Nurses United in Oakland, called mandatory overtime legislation a “no-brainer, because of the evidence linking fatigue and long hours with errors and burnout.”
Keeping Patients Safe: Transforming the Work Environment of Nurses, a 2004 report from the Institute of Medicine, linked overtime and poor nurse staffing with thousands of patient deaths. It called for states to prohibit mandatory overtime and for nurses not to work more than 12 hours in a 24-hour period or 60 hours in a seven-day period.
In 2004, a University of Pennsylvania School of Nursing study, published in Health Affairs, showed that the risk of errors increased significantly when nurses worked more then 12 hours in a shift or 40 hours in a week or worked overtime.
A Robert Wood Johnson Foundation (RWJF)-funded study from 2011, published in Health Services Research, found that having more registered nurses working on a hospital unit and reducing the amount of RNs’ overtime hours correlated with fewer patients being readmitted or visiting the emergency department within the first 30 days after hospital discharge and also reduced costs. Lead author Marianne Weiss, DNSc, RN, associate professor and Wheaton-Franciscan Healthcare/Sister Rosalie Klein professor of women’s health at Marquette University College of Nursing, attributed that to patients not being properly prepared for discharge.
“This study shows us that investing in nursing care hours could potentially be offset by the savings that could be realized in reductions in readmission and emergency department use,” Weiss said in a written statement.
That same year, The Joint Commission issued a Sentinel Event Alert about patient safety risks associated with working while fatigued.
Another RWJF-funded study in 2012, published in Nursing Outlook, found that state caps on nurses’ mandatory overtime hours are effective at reducing overtime hours for newly licensed registered nurses in those states with such laws. The laws also had a positive effect on nurse retention.
With Massachusetts, 17 states now have mandatory overtime bans through legislation or regulation, according to the American Nurses Association (ANA), which has been advocating for such changes at the state and national level for the last several years. The other 16 states include 14 with identified restrictions in law and two states that have provisions in regulations.
NNU is working on national legislation (S 992/HR 2187) to ban mandatory overtime and create other safe staffing measures, such as nurse-to-patient ratios.
“The only way to guarantee patients have access to safe RN staffing is through minimum, specific RN-to-patient ratios, which must be increased based on individual patient need--as mandated by the California law,” McEwen said.
“It shouldn’t be a matter of where you are,” Kelly-Williams concluded. “You should have the same standard of care no matter where you are.”
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