Chapter 11 Flashcards
Mandatory Overtime
Also called compulsory or forced overtime
Working > hours than standard (usually 40 hrs/week) or risking employer reprisals if refusing to do so
Highly variable
View as more standard operating procedure instead of last resort to short staffing
AFL-CIO: growing reliance on use of mandatory overtime to meet routine staffing needs
AORN position statement (see Box 11.1)
Way of life in U.S.; not new; not restricted to nursing
Argument that mandatory overtime for nurses not comparable to other fields
Possible life-and-death consequences of overly fatigued nurses
Proponents: economic reality due to limited health care labor resources
Legislating Mandatory Overtime
Fair Labor Standards Act (FLSA) of 1938
Exemptions from FLSA (effective 2004)
Increased amount of money earnable before no longer eligible for OT pay
Employees who direct, supervise 2+ other employees under executive exemption
Exclusion of employees with authority to hire, fire, promote
Or if primary duties involve office or nonmanual work
Concern that nurses would be reclassified as exempt from OT protections due to “learned professionals”
June 2007 Supreme Court ruling
Nurses eligible for OT pay, protection under FLSA if classified as hourly employees
Salaried employees not eligible for OT
Legislating limits
No national legislation passed
States increasing role in defining mandatory OT, putting delimiters around its use
ANA including mandatory OT to Nationwide State Legislative Agenda
Legislating limits
Currently 14 states with restrictions on use of mandatory OT for nurses
11 enacting legislation
3 with provisions in regulation
True or False: A nurse who receives a salary would be eligible to receive overtime pay.
False: Nurses are eligible for overtime pay only if they are classified as hourly employees. Salaried employees are not eligible.
Patient Abandonment
Patient abandonment: most common reason cited
ANA: no support for forced OT
Nurse not held accountable for patient abandonment if assignment turned down that could be unsafe to patients or self
Better not to accept assignment than to accept assignment and then change mind
Patient abandonment vs. employee abandonment; patient abandonment vs. refusal to accept assignment
Numerous variables determine patient abandonment
Patient Abandonment 3 requirements:
Established provider-patient relationship (duty); patient reasonably expected care to be provided
Provider negligently failed to carry out obligation (breach of duty)
Injury (damage) caused (actual or proximate) by abandonment
Which of the following would be cited as the most common reason for nurses working mandatory overtime?
Increased pay
Fear of employer reprisal
Loss of licensure
Patient abandonment
Patient abandonment: One of the most common reasons nurses cite for working mandatory overtime is the threat that refusal to do so would be construed as patient abandonment.
Patient abandonment could result in loss of licensure.
Many believe they have no actual choice.
Increased pay is not a common reason.
Although fear of employer reprisal may be involved, it is not the most common reason.
Consequences of Mandatory Overtime
Length of time for safe working: no consensus
Fatigue becomes factor after certain time
Leads to increased likelihood of errors, near errors, mistakes, lapses in judgment
Results of research studies Benchmark study (Rogers, et al., 2004) Dramatic increase in errors for nurses working shifts longer than 12 hours, working significant OT, or working > 40 hrs/wk
Findings reinforcing HCS and IOM report: Keeping Patients Safe: Transforming the Work Environment of Nurses
Limited number of hours worked per day and consecutive days of work as a fundamental safety precaution
Minimum criteria to meet for safe staffing (see Box 11.3)
Other studies suggesting association between RN OT, lower rates of mortality
Possibly result of increased OT by permanent nursing staff than increased hours by temporary staff
Results possibly due to random variation, not actual association
Mandatory OT and nurse dissatisfaction, turnover
Working conditions often cited as primary cause for nurses leaving profession or reducing work hours
True or False: Studies indicate that the maximum time for working should be limited to 12 hours in one shift.
False: Research has revealed no consensus as to the length of time a nurse can provide safe patient care.
However, dramatic increases in errors were noted for nurses working shifts longer than 12 hours.
Professional Duty and Conscience
Nurses with associated duty to ensure accepting patient care assignments only if mentally, physically able to provide minimum safe care
Variability in number of hours nurse can work and still provide competent safe care
ANA: each RN with ethical responsibility to consider level of fatigue when deciding to accept assignment beyond regularly scheduled work day or week
Conscientious objection: option if nurse does not want to work mandatory OT
Tools for resolving ethical conflicts
ANA Code of Ethics
Bill of Rights
Unions and Mandatory Overtime
Most unions in favor of eliminating mandatory OT
Variations in contracts, strategies to reduce mandatory OT
American Federation of Teachers (AFT)
Service Employees International Union (SEIU)
American Federation of State, County and Municipal Employees (AFSCME)
Alternatives to Mandatory Overtime
Commonalities: incentives to induce employees to willingly work extra hours; giving employees some degree of control over when they work
Shift bidding
Pay enhancement program
Nurse resource team
True or False: Collective bargaining agreements typically include similar recommendations and guidelines for reducing mandatory OT.
False: Most unions are in favor of eliminating mandatory OT.
Great variations exist in contracts, strategies to address issue
