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Issues Update

American Journal of Nursing - December, 2000 - Volume 100, Issue 12

A National Uprising
United actions push mandatory overtime, inadequate staffing to forefront

By Cindy Price

Nurses from coast to coast have been saying “no more” to the inadequate staffing and mandatory overtime that put them and their patients at risk.

The protest exploded on October 22, 1999, when 400 health care professionals, including nurses (represented by the District of Columbia Nurses Association) walked off the job at Howard University Hospital for one day because of severe staffing problems, including mandatory overtime. The following December, 450 nurses at Nyack Hospital in New York, represented by the New York State Nurses Association, hit the picket line to protest inadequate staffing and mandatory overtime. In March, more than 600 Massachusetts Nurses Association members went on strike over the same issues at St. Vincent’s Hospital in Worcester. And California’s Stanford University Hospital became the next symbol of faulty bottom-line thinking in July, when 2,000 nurses walked off the job to register their concerns regarding short staffing.

And the revolt continues. On September 20, the 1,200 nurses who work at the Washington Hospital Center (WHC) in the nation’s capital walked off the job, protesting mandatory overtime and conditions that endanger patient safety. In a bold move designed to keep patient care at the forefront, the nurses rejected management’s offer of a 16.5% wage hike, offering instead to take only a 16% wage increase if management agreed to also address their workplace and patient safety concerns.

“It’s not about the money,” said Sharon Clark, RN, president of the DCNA, which represents the center’s nurses, who at press time had reached a tentative agreement with WHC. “The nurses put patients first every day, 24 hours a day. The question is whether management is willing to do the same.”

New Wave of Awareness

Overtime has always been necessary in cases of emergencies and disasters. What’s different today is the pervasiveness and mandatory nature of overtime as a fix for short staffing.

The national uprising of nurses over mandatory overtime is also relatively new. The strikes in New York, Massachusetts, California, and the District of Columbia represent nursings’ universal demands: restrictions on the use of mandatory overtime and a voice on the hospital committees that make decisions about adequate staffing.

These demands have recently been echoed by the media, which has begun publicizing the effects that short staffing and mandatory overtime are having on patient safety. In mid-September, the Chicago Tribune printed a three-part series examining the relationship between inadequate nurse staffing and medical errors. A week later, Good Morning America cast a spotlight on overworked Americans, highlighting nursing’s daily battle against mandatory overtime.

ANA Initiatives

In the midst of nurse activism, media scrutiny, and public outrage, action is being taken to rectify the situation. For example, the ANA and other nursing groups worked with Congress for many months to secure the introduction of a bill in mid-September that would place restrictions on mandatory overtime for nurses. The Registered Nurses and Patients Protection Act (H.R. 5179), introduced into the House of Representatives by Tom Lantos (D-CA), would amend the Fair Labor Standards Act so that no RN would be required to work more than eight hours in any workday or 80 hours in any 14-day work period.

In 1998, the ANA launched the National Database of Nursing Quality Indicators, a repository for data from constituent member associations (CMAs) and individual acute-care facilities. The institutions provide data on 10 nursing-sensitive quality indicators, which include the mix of RNs, LPNs, and unlicensed staff caring for patients in acute care settings; total nursing care hours provided per patient per day; and patient satisfaction with pain management, educational information, overall care, and nursing care. The ANA is continually recruiting hospitals to participate in the data collection program; it’s hoped that the information generated will help to affirm the theory that better staffing means better patient outcomes.

In addition, the ANA has created resources to provide assistance in tackling day-to-day staffing problems. These include published guidelines, the Principles for Nurse Staffing, which outline the critical considerations needed to determine appropriate staffing. Other ANA resources include research that links nurse staffing to length of stay, nursing-sensitive outcomes, and occupational injuries. The ANA has also created model language for use in legislative initiatives to thwart mandatory overtime, to prohibit inappropriate use of unlicensed personnel, and to require public reporting of facility staffing and patient outcomes information.

On the labor front, the ANA’s newly established labor arm, the United American Nurses (UAN), is organizing nurses and perfecting contract language to ensure that nurses’ voices are included in hospital decisions that relate to patient safety, training, and resources. The UAN also is calling for contracts that prohibit mandatory overtime, such as the following:

• Nurses at Nyack and St. Vincent’s hospitals were able to secure limits on mandatory overtime in their contracts as a result of their strikes.
• Howard University Hospital nurses used the ANA’s Principles for Nurse Staffingas a guideline for negotiating their latest contract.
• In Lima, Ohio, nurses at Lima Memorial Hospital have a contract that prohibits mandatory overtime.
• At Holy Family Hospital in Spokane, Washington, state nurses negotiated no mandatory overtime, no required overtime for any nurse floated off of her regular unit, and no required overtime when a nurse works on her scheduled day off.