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Mandatory Overtime for Health Care Professionals

Senate Labor and Agriculture Committee
Green Bay, October 2, 2001

Testimony of Robert Kraig, Ph.D.
Political Director, SEIU Wisconsin State Council

My name is Robert Kraig, and I am the Wisconsin State Political Director for Service Employees International Union (SEIU).  SEIU is the largest health care union in North America, and the largest and fastest growing union in the national AFL-CIO.  In Wisconsin, SEIU represents thousands of health care workers who would be affected by SB 211.  Our state-wide nurse's local, SEIU District 1199W/UP, represents hospital nurses, and  health care professionals that work for the state and in local public health departments.  Many of these health professionals face the threat of mandatory overtime on a daily basis. Our largest affiliate, SEIU Local 150, represents nurse aides in nursing homes and hospitals who are also affected by mandatory overtime.  Although mandatory overtime is much more common in hospitals, it is becoming a problem in some nursing homes as well.

Mandatory overtime has become a major issue of the last few years, in Wisconsin and around the country, because of major changes in the way hospitals and other health care facilities are operated.  Beginning in the early 1990s, the “down-sizing” theories that had swept through many industrial sectors reached the hospital industry.  In a deliberate attempt to cut costs, hospitals thinned out their nursing staffs.  The burden of this shift in management philosophy has fallen most heavily on nurses, who, as any one who has spent any time in a hospital knows, provide the bulk of hands-on patient care.  At the same time, acuity rates increased substantially, putting additional pressure on already over-stressed nursing staffs.  This dramatic deterioration of working conditions has driven many nurses out of the profession, and many others into non-direct care settings.

One of the results of this deliberate under staffing has been an increased dependence on mandatory overtime.  While mandatory overtime had been traditionally used only during extreme emergencies, an increasing number of hospitals now use it as a regular practice to fill permanent holes in their staffing schedules. At UW Hospital, for example, according to records released by the hospital, there were 14, 472 hours of mandatory overtime in 2000. This number, shocking as it is, is a dramatic underestimate.  The hospital does not even keep records on mandatory overtime incidents that are less than four hours in duration.  There is no federal or state requirement that hospitals keep statistics on mandatory overtime. Spokespersons have tried to use there own failure to keep and release such records to claim that mandatory overtime is not a problem in Wisconsin, but the testimony of nurses throughout the state shows that it is an increasingly common in many Wisconsin hospitals.

Having worked on this problem for a long time, I have become convinced that the case against the regular use of mandatory overtime is overwhelming. I have been surprised by the feebleness, and indeed the on-face inconsistency, of the arguments that have been advanced  in opposition to SB 211, and its companion bill, AB 457.  In order to highlight the case for this bill, I will review the major arguments against the bill that have been leveled in the press, in the lobbying of the Wisconsin Health and Hospital Association and their allies, and in the first public hearing in Janesville.

Claim: Mandatory overtime is rare, and is only used in emergencies to protect patients in need of vital care. 

Response: If this is really true, opponents should not oppose the bill.  All SB 211 does is codify this practice, only allowing mandatory overtime in unforeseen emergencies.  Only hospitals that use mandatory overtime as a regular staffing practice will be effected by the bill.  The hospital association’s vehement opposition to the bill is itself evidence that mandatory overtime is used in non-emergency situations by many hospitals.

Claim: SB 211 treats a symptom of the nursing shortage, not its root causes.

Response: To the contrary, a ban on non-emergency mandatory overtime treats the primary cause of the nursing shortage--the deterioration of working conditions.  Recent studies by the federal government, major universities, and even a report by a hospital credit reporting firm, have shown that oppressive working conditions have prompted tens of thousands of nurses to vote with their feet, either by seeking non-direct care nursing positions or leaving the professional altogether. A record half-million nurses are not even using their licenses.  Even worse, according to a study by the University of Pennsylvania one in three nurses under 30 years of age plan to leave the profession within the next year. To stem the nursing shortage, hospitals need to focus on retention, and the best way to do that is to improve working conditions.  Limiting mandatory overtime would be a major step in this direction. As the Chicago Tribune concluded in a major investigative series on hospital care last year: “Hospitals across the country regularly blame the shortage of nurses for staffing deficiencies, but in reality, there is more often a shortage of nurses willing to work in hospitals. Deteriorating oppressive working conditions–from mandatory overtime to stagnant pay–have made hospital jobs less appealing. . . . Mandatory overtime and 16-shifts have driven many nurses away.”

Claim: The solution to the staffing is to train more nurses.

Response: This solution is convenient for the hospital association because it does not focus attention on their own operations.  As the hospitals would have it, the nursing shortage is a product of environmental factors beyond their control, and they are the passive victims. In fact, much of the nursing shortage has been brought on by short-sighted management practices. Recruitment alone is obviously an incomplete response, because if working conditions are not improved newly trained nurses will not be retained.  In fact, these recruitment efforts themselves may fail.  As nursing expert Suzanne Gordon has recently written: “Veteran nurses and even recent nursing graduates are discouraging others from entering the field and even advising nursing students to get out of bedside care as soon as they can. Without substantive changes in working conditions, luring more people into the profession will aggravate, not alleviate, the situation and encourage the “management by churn” that has reduced customer service quality in fast food, retail sales, and telemarketing, where the consequences are far less serious for customers than in health care.”

Claim: Banning mandatory overtime is dangerous for patients because of the shortage of nurses. If the bill is passed, patients will not get the care they need.

Response: This claim is obviously entirely inconsistent with the claim that mandatory overtime is rare, and only used in emergencies. Moreover, numbers from a recent General Accounting Office study released earlier this year, and from a workforce study released by the Wisconsin Health and Hospital Association last week, demonstrate that the nursing shortage has not yet hit Wisconsin as it has the rest of the country. According to hospital association, vacancy rates in Wisconsin hospitals are nearly half the national average. This means we have time to get at the root causes of the shortage, by improving working conditions.  In addition to aggravating the nursing shortage, mandatory overtime is a practice that is very dangerous for patients.  Fatigued nurses are much more likely to make errors, or to miss subtle changes in the condition of patients. Although 75% of hospitals do not report medical errors, a major federal study found that as many as 98,000 people die each year as a result of medical errors in hospitals.

Claim: SB 211 needs a tighter definition of emergency

Response: This argument is disingenuous, because opponents of the bill have made it clear that they would also oppose more specific definitions. The definition in this bill is designed to allow some flexibility, to assure that nurses will be available in any unforeseen emergency. The federal mandatory overtime bill, and the bills introduced in many other states, actually require a unit of government to declare an emergency.  Ironically, before SB 211 was introduced it was attacked by one hospital spokesperson for requiring a governmental unit to declare a state of emergency.  I cannot speak for the sponsors and co-sponsors of the bill, but we would certainly be open to any constructive discussions about how to define an emergency, as long as the aim of these discussions is not to undermine the bill, but to make it better.