ANA Calls for Action on Legislation
to Limit Mandatory Overtime

Cites New Study that Shows Link between Patient Safety and Nurses' Work Hours

Washington, DC - The American Nurses Association (ANA) praised a new study released yesterday that shows a strong link between medical errors and the long work hours of nurses and called on Congress to take action on the Safe Nursing and Patient Care Act (H.R. 745, S. 373), which would strictly limit the use of mandatory overtime for nurses.

The study, published in the July/August issue of Health Affairs, found that the risk of making an error greatly increased when nurses had to work shifts that were longer than 12 hours, when they worked significant overtime or when they worked more than 40 hours per week. It reinforced findings of the 2003 Institute of Medicine Report, "Keeping Patients Safe: Transforming the Work Environment of Nurses," which said that nurses' long working hours pose a serious threat to patient safety.

"This study is more evidence that patient safety is closely linked to nurses' working conditions," said ANA President Barbara Blakeney, MS, APRN,BC, ANP. "The growing trend of mandatory overtime for nurses is one of the greatest threats to patients' and nurses' safety. We call on Congress to protect the public by taking action to limit mandatory overtime for nurses. Doing so will help protect patients from preventable errors and retain nurses in the workforce."

To date, 10 states have taken action to limit mandatory overtime for nurses, and similar measures have been proposed in 20 other states.

The study, "The Working Hours of Hospital Staff Nurses and Patient Safety," by Ann Rogers, PhD, RN, and colleagues at the University of Pennsylvania School of Nursing, was funded by the Agency for Health Care Research and Quality. Researchers examined logbooks kept by 393 registered nurses around the country who worked full-time in hospitals. Data collected on 5,317 work shifts revealed that in nearly 40 percent of the cases, nurses worked at least 12.5 consecutive hours. More than 25 percent of the participants in the study reported working mandatory overtime at least once during a one-month period.

According to a 2001 ANA health and safety survey, 67 percent of respondents reported working some form of mandatory or unplanned overtime every month. The ANA has long warned that mandatory overtime is dangerous for patients and nurses, and that the practice has been driving nurses away from the profession, thus exacerbating an emerging nursing shortage that is expected to worsen dramatically over the next 10 years.

"Poor working conditions are a major contributor to the nursing shortage," said Blakeney. "As this study shows, nurses are consistently working long and unpredictable hours, often caring for a large number of critically ill patients. To improve the quality of care and patient safety, we must value nurses' contributions more and make a greater investment in nursing," she said.

To counter staffing insufficiencies that are already occurring, many health care facilities across the nation have increasingly imposed mandatory overtime as a common practice.

Typically, an employer may insist that a nurse work an extra shift (or more) or face dismissal for insubordination, as well as being reported to the state board of nursing for patient abandonment, a charge that could lead to a loss of license for the nurse. At the same time, ethical nursing practice prohibits nurses from engaging in behavior that they know could harm patients, thus leading to a dilemma for many nurses.

The Safe Nursing and Patient Care Act would prohibit health care facilities from forcing exhausted nurses to work extra shifts, an unsafe practice that puts both patients and nurses at risk.

The Safe Nursing and Patient Care Act would:

• Prohibit health care facilities that receive Medicare funding from requiring a registered nurse (RN) or licensed practical nurse (LPN) to work beyond an agreed-to, predetermined, regularly scheduled shift.

  In no instance could a nurse be required to work more than 12 hours in a 24-hour period or for more than 80 hours in a two-week period - a provision that would prevent an institution from altering shift schedules in a way that would undermine the law.

• Include nondiscrimination protections for nurses who refuse overtime and for nurses who provide information and/or cooperate with investigations about the use of overtime.

• Include an exception in the case of a declared national, state or local emergency. Such an emergency would be in response to an unpredictable disaster, not in response to a staffing deficiency resulting from management practices.

• Provide for a study by the Department of Health and Human Services on the maximum number of hours that may be worked by a nurse without compromising patient safety.

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The American Nurses Association is the only full-service professional organization representing the nation's 2.7 million registered nurses (RNs) through its 54 constituent member associations. The ANA advances the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public.

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