Hospitals, Nurses Battle Over Overtime

California’s hospitals and nurses are feuding over whether nurses ought to be compelled to work overtime shifts--yet another controversy resulting from the growing nursing shortage.

Far from agreeing on a solution, the two sides can’t even agree on whether such extra shifts constitute a problem.

The California Nurses Assn. drafted legislation that would ban mandatory shifts, saying the practice leads to fatigue among nurses. Their loss of physical stamina and mental alertness increases the potential for errors and oversights in caring for patients, the group says.

Hospitals say the nurses’ proposal would remove a necessary --though little used--tool for making sure patients are attended by registered nurses when replacement RNs cannot be found.

Hospital leaders insist that they exhaust all other options before they tell a nurse that she must stay put when her regular shift ends.

“No one wants nurses to work when they’re tired,” said Jan Emerson, spokeswoman for the California Healthcare Assn., a hospital trade group.

“But given the serious nursing shortage that we face--with 20% job vacancy rates across the state--there are times when hospitals have no other choice.”

This is the second battle in as many legislative sessions pitting the nurses against the hospitals. In 1999, Gov. Gray Davis signed a bill imposing minimum nurse-to-patient ratios in hospitals, a top priority for nurses. The Department of Health Services, however, is still trying to determine exactly what those ratios should be before they take effect on Jan. 1.

The Senate passed the mandatory overtime bill, 23-12, in June, and the Assembly Health Committee endorsed it last month. The bill could either die or go to the full Assembly later this month.

The governor and his staff have not taken a public position on the legislation.

The bill has drawn the support of a broad coalition of consumer groups, labor unions, environmentalists, lawyers and senior citizens. It is opposed by Los Angeles and Orange counties, along with the University of California system, on cost grounds.

UCLA Westwood Medical Center predicts that it alone would be forced to spend $1.3 million to $2.7 million more each year to hire enough nurses to avoid mandatory overtime.

The bill would allow mandatory overtime in two situations: an emergency declared by government officials or a major unforeseen catastrophe such as a plane crash or traffic pileup.

Pediatric intensive care nurse Dan Jacobson said his hospital first tried to entice nurses to sign up for extra shifts by offering them cash bonuses. When not enough nurses agreed, he said Children’s Hospital and Health Center San Diego decided to require each nurse to work one 12-hour overtime shift every month for the past two winters.

“It’s essential to have time to rest and rejuvenate,” Jacobson said. “If you don’t have that time, it’s quite possible that you’ll come to work scattered and with a low energy level. It’s hard to focus and concentrate once you do many shifts in a row.”

Officials at the Children’s Hospital said they understand the complaints raised by some employees, but they noted that two-thirds of the nursing staff agreed to work an extra shift per month.

“We’re trying everything else we can to recruit and retain staff,” said Mary Fagan, senior managing director for clinical initiatives. “We’re faced with a huge shortage that’s here now and is only going to get worse.”

Nurses are allowed to pick the timing of their extra shift each month so they can plan accordingly, Fagan said.

Zeny Bingham, a nurse at Kaiser Redwood City hospital, said she was suspended for three days without pay in late April after telling her supervisor that she was too tired to stay past her eight-hour shift. After she protested, the hospital agreed to pay her lost wages.

“I know my limitations and I know I couldn’t function,” Bingham said. “I need to be really alert and awake to be able to take care of those kinds of patients. They’re very sick. They’re heart patients. They’re on a monitor.”

Kaiser Permanente officials acknowledged Bingham’s version of events, and spokesman Terry Lightfoot said the suspension was “an inappropriate action for the manager to take.” Though the health care giant has no policy on mandatory overtime, hospitals generally try other means before asking nurses to stay.

“It wouldn’t be appropriate to say it is rare, but it’s not common,” Lightfoot said of mandatory overtime. “The reality of the situation is that, as long as there is a need for more nurses and we’re continually trying to meet that need, situations like this can occur, and we try to deal with them the best we can.”

To recruit nurses, Kaiser will increase their pay in Northern California by 14% over the next year. In addition, Kaiser has said it will adopt strict nurse-to-patient ratios to improve working conditions. But some nurses fear that lower ratios will lead to more mandatory overtime.