Hospitals in New York that used mandatory overtime to cover scheduling gaps lost the option in the fall when a state law went into effect that prohibits forced overtime except in circumstances such as a healthcare disaster or government declaration of emergency.
Several nursing leaders at New York’s largest hospitals said staffs and patients won’t see big changes because the facilities had banned mandatory overtime years ago.
Mary Walsh, RN, MSN, NEA-BC, CEN, vice president of patient care services and CNO at Beth Israel Medical Center in Manhattan, N.Y., said the hospital has used mandatory overtime only once in recent years and that was to cover sick calls in labor and delivery.
At Beth Israel, as required by the law, coverage plans are posted for all staff to review. Staff members also discuss the plans and other professional issues in monthly meetings.Lori Baker-Stone, RN
“I think the law is really asking us to work more collaboratively with our staff, and that’s what we’ve been trying to do,” she said.
Sick calls are one of the big reasons hospitals use mandatory overtime. Offering a desirable work environment and involving nurses in discussions about professional issues can keep nurses from calling in sick in the first place, Walsh said. Programs such as their buy-back program — giving nurses money back for unused sick days — have really helped in that area, she said. “It’s also much cheaper for us than paying the person’s sick time as well as replacing them,” she said.
Filling all vacancies also cuts down on the need for overtime, which under part 177 of the Restrictions on Consecutive Hours of Work for Nurses law, is defined as time worked beyond regularly scheduled or previously agreed to hours. “We’re under 3% vacant right now,” Walsh said, “and our turnover is mostly associated with retirement.”
Another strategy has to do with the health needs of an aging nursing workforce. In New York, more than 50% of nurses were 50 or older in 2011, according to the Healthcare Association of New York State report, “2011 Health Care Professionals Work Force Survey.” Anticipating an increase in medical leaves for aging nurses is part of their coverage plan.
“If you’re going to be out with a knee replacement for three months, we’re going to replace you with a qualified traveler nurse,” Walsh said.
Nurse availability listSusan Dietz, RN
At Sound Shore Medical Center in New Rochelle, N.Y., a popular staffing strategy came from the nurses. Typical nursing shifts there are 12.5 hours, three days a week. If a nurse is available to work an extra shift or even a half-shift on another day, he or she signs up. At this point the hospital has more volunteers than shifts to offer, said Lori Baker-Stone, RN, MS, vice president of nursing services.
It’s rare that a nurse would work overtime the same day as a 12.5 hour shift, but in that case, it would be only one to two hours, Baker-Stone, said.
If overtime is necessary, the availability list is consulted first, then a list of internal per diems and a list of agency nurses. Each call is documented with details such as who was asked to do overtime, whether it was accepted, the reason for overtime and hours worked.
Baker-Stone said mandatory overtime has been used rarely in recent years and while the law is good for promoting patient safety, it hasn’t changed nursing at her hospital.
“It just validates that what we have been doing has always been in the interest of safety for the patients as well as the staff,” she said.
Before retiring Feb. 17, Susan Dietz, RN, BSN, MA, CNAA, vice president for patient care services and CNO at St. Luke’s-Roosevelt Hospital Center in Manhattan, said having a good coverage plan and a healthy working environment often negates the need for such legislation. She said banning mandatory overtime was a “non-issue” for her staff because they weren’t using that option anyway and said passing a law to ban it “is a waste of effort.”
“Mandatory overtime is an ugly thing under any circumstance. You never want to do that,” she said.
Study finds laws workLee Xippolitos, RN
But on a national level, researchers with the Robert Wood Johnson Foundation-funded RN Work Project found the laws are having a positive effect. As of 2010, the study found 16 states had imposed restrictions on mandatory overtime: Arkansas, California, Connecticut, Illinois, Maryland, Minnesota, Missouri, New Hampshire, New Jersey, New York, Oregon, Pennsylvania, Rhode Island, Texas, Washington and West Virginia.
Results published online in Nursing Outlook in 2011 found that in the states with rules governing mandatory overtime, newly licensed RNs were 59% less likely to work mandatory overtime than their colleagues in unregulated states. (Not all states with overtime rules prohibit mandatory overtime; some simply limit total work hours.) Also, in the states regulating overtime, newly licensed RNs worked an average of 50 fewer minutes per week than their colleagues in states without overtime regulations. Testing this population was key because many nurses leave during the first year of nursing.
One of the lead researchers for that study, Christine Kovner, RN, PhD, FAAN, professor at the College of Nursing, New York University in Manhattan, said they expected the study might find nurses were making up the lack of mandatory overtime with voluntary overtime, thus defeating the purpose, but the study found no such correlation, Kovner said. That could be a result of better scheduling and hiring, she said, though the study didn’t study the solutions.
“I think when you mandate there’s no mandatory overtime, people have to find a way to solve that problem. The logical way to do that is hire more staff,” she said.
Hurricane didn’t trigger mandatory OTChristine Kovner, RN
Positive results from regulating overtime come as no surprise to Lee Xippolitos, RN, PhD, CARN, CS, NPP, CNAA, BC, CNO of Stony Brook (N.Y.) University Hospital and dean of Stony Brook University School of Nursing, where there has been no mandatory overtime for 10 years. Because their nurses work 12-hour shifts, even voluntary overtime shifts are limited to four hours.
“We believe (eliminating mandatory overtime) improved quality of life for nurses and improved patient care,” Xippolitos said.
Permanent staff cover maternity leaves, and even natural disasters with voluntary overtime, she said. Even when Hurricane Irene swept up the Atlantic Coast in August 2011, overtime was voluntary. “Some nurses were not able to come into work, so the ones who could make it in slept in different parts of the hospital,” she said.
Their scheduling system, which updates three times a day and has a forecasting function, monitors the number of nurses and all providers needed for the number and acuity of patients.
“Nurses are professionals. If you appeal to their professional nature, they’re not going to abandon their patients,” Xippolitos said. “By the same [token], you have to demonstrate to them you’re doing everything you can to have the right number of nurses with the right competencies to take care of the patients.