REPORT ON BILLS FAVORABLY REPORTED BY COMMITTEE
Public Health Committee
March 9, 2004
TITLE OF BILL:
AN ACT CONCERNING MANDATORY LIMITS ON OVERTIME IN HOSPITALS AND NURSE-TO-PATIENT RATIOS.
SPONSORS OF BILL:
Public Health Committee
REASONS FOR BILL:
The purpose of the bill is to regulate the number of overtime hours a hospital nurse, as defined in the bill, may work. A nurse may volunteer for additional hours, but cannot be penalized for not accepting additional hours. The bill also sets certain provisions for times when this bill won't apply; surgical procedures, critical care units, times of public health or other institutional emergencies.
RESPONSE FROM ADMINISTRATION/AGENCY:
The Connecticut Department of Public Health submitted the following:
Sect 1(1) refers to a "nurse's aide registered pursuant to chapter 378a of the general statutes." This reference is unclear, as chapter 378a refers to nurse's aides working in nursing homes. It does not address individuals who are employed as nurse's aides or patient care aides in hospitals.
NATURE AND SOURCES OF SUPPORT:
Lori Pelletier, Secretary-Treasurer of the CT AFL-CIO
Ms. Pelletier supports the proposal. Her testimony indicates that there is no nursing shortage in the United States, and that the shortage falls only on "bedside duty" nurses, mainly due to mandatory overtime. She notes that Danbury Hospital, through their collective bargaining agreement, does not require mandatory overtime. Ms. Pelletier would like to know if Danbury Hospital doesn't require mandatory overtime, why do other hospitals have no choice but to require it.
Ms. Pelletier also stated her concern about the familial relationship of nurses. Noting that the profession is mainly women, "many of whom are single mothers", there is a need for those nurses to be available to their children, otherwise incurring the cost of additional childcare and stress. It may put the mother/nurse in an unfortunate position of having to choose between being a responsible parent and leaving their desired profession. This would reduce the pool of available nurses, and further complicate the problem.
Joanne Chapin, Member, CT Quality of Care Advisory Board
RN at New Milford Hospital
Vice President of Health Care for AFT/CT
Ms. Chapin believes that mandatory overtime is forced overtime due to poor staffing patterns. In July 2001 the US General Accounting Office reported that job dissatisfaction, including mandatory overtime as a key contributor, is a major factor in recruiting and retaining nurses. The New England Journal of Medicine notes the safety hazard of mandatory overtime in a Health Policy Report from May 2002, "Exhausted nurses, like exhausted physicians, can pose safety risks. By far the riskiest result of understaffing is the abuse of mandatory overtime as a staffing tool." Ms. Chapin states that Danbury Hospital operates without mandatory overtime, and "wish[es] they would share their secrets."
NATURE AND SOURCES OF OPPOSITION:
University of Connecticut Health Center
Through negotiations with the bargaining unit, the Director of Nursing at John Dempsey Hospital can determine when a patient care unit is in need of emergency coverage, and through the voluntary staffing program require coverage in that unit. The union president is made aware of the situation when emergency coverage is required. The testimony states that most patients in hospitals today are in critical need of care, regardless of where the patient is in the hospital and adequate staffing is pursued. Hospital staffing levels are implemented with the patients care in mind and any statute addressing this issue should be careful done so as not to supersede the hospital management's ability to ensure adequate staffing.
Linda Berger Spivack, Connecticut Hospital Association (CHA)
Vice President of Patient Care Services at MidState Medical Center
The CHA opposes this bill. Mandatory overtime is used as a last resort to ensure the care and safety of patients. While the bill does address certain times and departments when mandatory overtime is necessary, it fails to address the patient care implications. The bill also fails to address the "on call" nature of operating rooms. There are provisions for surgical procedures, but those provisions aren't extended to the "on call" employees that staff the operating and emergency rooms. If the "on call" time is considered overtime, it would adversely affect the staffing levels of the operating rooms and the ability for hospitals to provide emergency surgery. This same concern also applies to the Post-Anesthesia Care Units (PACU).
The bill also exempts critical care units, but most hospital patients are in critical need of care regardless of what department they are in. Mandating overtime would restrict the ability of hospitals and employees to be creative in developing solutions to ease the problem. Staffing a hospital is a very complex task, the responsibility and the right of the hospital, and those that manage it better will become the employer of choice. This legislation will add an unnecessary level of complexity to the process and drain resources that could be used more effectively to deliver patient care.
Mag Morelli, President
Connecticut Association of Not-For-Profit Providers of the Aging (CANPFA)
CANPFA recognizes that mandatory overtime isn't a pressing issue among their members, but oppose the proposed legislation. Health care facilities provide round the clock service and given the current labor market, are having to rely on mandatory overtime to fill shifts when no other alternative is available. The testimony states that the real issue at hand is the nursing shortage and the association would like this issue to be addressed.
Allison Breault, President, Connecticut Organization of Nurse Executives
Vice President of Patient Care Services, Windham Community Memorial Hospital
The CT Organization of Nurse Executives opposes this bill. She stated that mandatory overtime is used as a last resort to maintain quality patient care and adequate staffing levels. One concern of the group is that it doesn't address Post Anesthesia Care Units and ongoing issues in operating rooms that are staffed by "on call" employees. Emergency services would be adversely affected, resulting in closing of beds and emergency departments, if these employees are limited in the amount of time they can be available to offer services.
Mary Jane Williams, Chair, Connecticut Nurses' Association Government Relations Committee
The Connecticut Nurses' Association opposes the use of mandatory overtime to create staffing patterns. Any legislation to this effect should provide clear definitions, provide times when mandatory overtime is appropriate, and include penalties for violations. Mandatory overtime not only affects the quality of patient care, it also adversely affects much of a nurses' non-work and familial responsibilities. Ms. Williams testimony includes the ANA's model legislation and the current legislation from New Jersey for mandatory overtime.
March 10, 2004