Background
Mandatory overtime is one of the many workplace issues that may be contributing to nurses leaving the workforce. Overtime is defined as the hours worked in excess of an agreed upon, predetermined, regularly established work schedule, as identified by contract; usual scheduling practices; policies or procedures.
Concern for the long term effects of overtime leading to fatigue include potential for diminished quality of care, errors or near misses, as well as the negative impact on the care-givers health. Research indicates that risks of making an error are significantly increased when work shifts are longer than 12 hours, when nurses worked overtime, or when they worked more than 40 hours per week.[1] Other industries have been aware for many years of the links between fatigue and accidents, mistakes, errors and near errors. For instance, the airline and trucking industries limit the number of hours pilots and truck drivers can fly/drive. They also require a certain number of hours between "flights" or "runs".
By virtue of licensure, nurses are responsible and accountable for their decisions, actions and/ or inactions. By removing the ability of the nurse to determine fitness for duty, patient safety is not only jeopardized but so is the nurse's ability to fulfill their legal obligations of licensure. The American Nurses Association (ANA) has taken the position that regardless of the number of hours worked, each registered nurse has an ethical responsibility to carefully consider his/her level of fatigue when deciding to accept any assignment extending beyond the regularly scheduled work day or week, including mandatory or voluntary overtime assignment.
To help nurses make the case against working when fatigued, the ANA has added this issue to its’ Nationwide State Legislative Agenda the support of state laws and regulations prohibiting the use of mandatory overtime as well as pursued federal legislation
ANA’s position on Mandatory Overtime may be found at its
ANA Workplace Advocacy page.
Introduced During 2011 – 2012
- Florida HB 305 / SB 454 protections included in this staffing bill, referred to as the Flordia Hosptial Patient Protections Act.
- Illinois HB 1164 provides that no nurse working for a state agency who is paid an hourly wage and who has direct responsibility to oversee or carry out nursing care or related duties may be required to work mandated overtime except in the case of an unforeseen emergent circumstance when such overtime is required only as a last resort, and limits the time of such overtime. Also stipulates if a nurse works 12 consecutive hours, the nurse must be allowed at least 8 consecutive hours of off-duty time before returning to duty. Protects nurses from retaliation if refusing mandated overtime.
- Massachusetts HB 1469, SB 543 ,SB 539, SB 1151 restricts use of mandatory overtime, as a provision of a much broader bill that includes staffing, safe patient handling and other areas. HB 1506 also includes definition for mandatory overtime and it restricted use for federal or state emergencies and affords protections from retaliation for refusing. HD 1294, SD 1768, SB 2210.
- New York AB 410 seeks to add existing protections for home care nurses. SB 1134 includes language in Safe Staffing for Hospital Care Act
- Pennsylvania SB 438 the Health Care Facilities Act, restricts the use of mandatory overtime to fulfill the staffing ratios outlined in the bill.
- Vermont HB 313 includes restrictions to use of mandatory overtime and provides for penalties in this predominantly safe patient handling bill.
States with Restrictions
- Sixteen states have restrictions on the use of mandatory overtime for nurses
- Fourteen identified restrictions in law: AK, CT, IL, MD, MN, NJ, NH, NY, OR, PA, RI, TX, WA, and WV, while two states have provisions in regulations: CA and MO.
- NC (2009) legislated the study of mandatory overtime as a staffing tool.