Pushing Health Caregivers
Past the Point of Safety
Information Provided by
Pennsylvania’s Health Care Union, SEIU 1199P
What is Mandatory Overtime?
Every day nurses and other caregivers in hospitals, nursing homes and state facilities are forced
to work past their regularly scheduled shift. This “mandation” may come without warning and
extend for a few hours or an entire second shift.
If the health caregiver refuses to stay, they may face discipline, termination or even the loss of
their professional license.
Because mandatory overtime comes with little or no warning, caregivers cannot prepare for the
longer shift. They are forced to work whether or not they are well-rested enough to continue
safely and irregardless of their personal and family responsibilities – such as picking up their
children from day care or caring for an elderly parent.
Support Legislation to Stop Mandatory Overtime.
Restrictions and prohibitions on mandatory overtime have been passed in 11 states including
Connecticut, Illinois, Maine, Massachusetts, Minnesota, Oregon, Washington, Wisconsin, and
our neighboring states of New Jersey, West Virginia, and Maryland.
In the Pennsylvania House, a bill banning mandatory overtime for nurses and other direct patient
caregivers (HB 834) was passed on the House floor in May 2007 by an overwhelming majority
(166-31) and strong bipartisan support. House Bill 834 is currently in the Senate Labor Relations
Committee (as of 6/6/2007).
A very similar bill is being circulated for co-sponsorship in the Senate by Senator Christine
Mandatory Overtime Puts Patients at Risk
It’s well-known that physical and mental exhaustion can affect one’s ability to think clearly and
act safely. Truck drivers, airline pilots and flight attendants all have restrictions on the number of
hours they may work to protect the public safety. Yet there are no such restrictions for health
care workers, who may be making life or death decisions and observations.
Extensive research has demonstrated the link between overtime in health care and medical errors.
The Institute of Medicine (IOM) estimated hospital deaths due to medical errors at
44,000 to 98,000 annually, and research has confirmed that long work hours and
overtime contribute to medical errors.1
A 1992 study in the American Journal of Public Health showed that nurses who worked
variable schedules (including mandatory overtime) were twice as likely to report
errors or accidents related to sleepiness, and at least two studies have linked infection
outbreaks at hospitals to overtime work.2
The Institute of Medicine reported that “the number of hours worked has been identified
as a contributing factor to the commission of errors by nurses,” and cites one study that
“found that shift durations of greater than 12 hours were significantly associated
with increased errors among nurses.”3
A 2004 study by University of Pennsylvania Researcher Ann Rogers found that the risk
of errors increased when nurses worked overtime or worked more than 40 hours
per week. In fact, the risk of error was 3 times higher when a nurse worked 12.5 hour
shift or longer.4
Mandatory Overtime Hurts Caregivers and their Families
Mandatory overtime is also dangerous for the health care worker.
Consider the nurse working in a prison infirmary who exhausted near the end of a mandated
second shift and is accidentally stuck with an HIV-infected needle while helping a combative
inmate; or the nursing assistant in a nursing home who suffers a back injury after lifting residents
for over 12 hours; and the single mother who falls asleep at the wheel on her drive home after a
Mandatory overtime has real life consequences for health caregivers and their families.
Not surprisingly, in a 2004 report by the Legislative Budget and Finance Committee of the
General Assembly, job dissatisfaction was cited as a major contributing factor to the problems of
recruiting and retaining nurses. Mandatory overtime is among the key factors identified by
various studies as contributing to job dissatisfaction among nurses.
Mandatory Overtime Contributes to the Health Care Staffing Crisis
The dangerous practice of mandatory overtime is contributing to what the federal Health
Resources and Services Administration predicts will be a shortage of over one million nurses
nationwide by the year 2020.5
Fewer nurses are willing to work in health care under the current conditions, and fewer young
people are attracted to nursing as a profession. In the Commonwealth’s most recent published
surveys of registered nurses renewing their licenses, 13.6% of respondents (more than 1 out of 8)
reported having worked mandatory overtime within the prior two weeks. Nurses who reported
such mandatory overtime were nearly twice as likely to express dissatisfaction with their jobs.6
Even with ever-increasing recruitment campaigns and hiring bonuses, one out of five licensed
registered nurses in Pennsylvania has left bedside nursing and is not currently working in health
What will bring nurses back? Ending mandatory overtime is one step in the right direction.
Mandatory Overtime is Not Just a Nurse Issue
The risks to patients, health care workers, and the industry are not limited to registered nurses.
Every direct patient caregiver who is forced to work past their point of safety puts patients at
Technicians, such as those that work in radiology, are making critical calculations and decisions
that have a significant impact on patient safety. In fact, US Pharmacopoeia reported in 2006 that
errors in radiology were more dangerous and more costly than other medication errors.8
The health care staffing crisis is as severe in nursing homes as in hospitals. Nursing home work
has always been difficult and undervalued, and nursing assistants in nursing homes have the
third-most hazardous job in private industry, with a higher risk of workplace injuries than coal
miners, construction and warehouse workers, or truck drivers.9 Turnover for certified nursing
assistants (CNAs) in Pennsylvania nursing homes is 50.4%10 on average and considerably higher
in individual nursing homes.
Pennsylvania’s Health Care Union, SEIU 1199P supports
legislation that would:
Protect patients by prohibiting health care employers from forcing direct patient
caregivers to work past their predetermined and agreed to regularly-scheduled shift. This
would do nothing to prohibit employees from volunteering to work overtime.
Allow employees to be mandated in the event of an unforeseen declared emergency or
catastrophic event that increases the need for health care services, but only as a last
Cover all direct care workers.
Institute of Medicine, To Err Is Human: Building a Safer Health System. Linda T. Kohn, Janet M. Corrigan, and
Molla S. Donaldson, editors. Washington, 2000, 26.
DR Gold, R Rogacz, N Bock, TD Tosteson, TM Baum, FE Speizer and CA Czeisler, “Rotating shift work, sleep,
and accidents related to sleepiness in hospital nurses,” American Journal of Public Health, Volume 82, Issue 7
(July 1992), 1011-1014.
Institute of Medicine, Keeping Patients Safe: Transforming the Work Environment of Nurses. Ann Page, editor.
November 2003, 43-44.
Ann E. Rogers, Wei-Ting Hwang, Linda D. Scott, Linda H. Aiken, and David F. Dinges, “The Working Hours of
Hospital Staff Nurses and Patient Safety,” HealthAffairs, Volume 23, Number 4 (July/August 2004), 202-12.
U.S. Department of Health and Human Services, Health Resources and Services Administration, What Is Behind
HRSA’s Projected Supply, Demand, and Shortage of Registered Nurses, April 2006.
Pennsylvania Department of Health, Special Report On The Characteristics of the Registered Nurse Population in
Pennsylvania, Volume 2, August 2006, 52-3.
Pennsylvania Department of Health, 2.
U.S. Pharmacopeia, MEDMARX Data Report: A Chartbook of 2000-04 Findings from Intensive Care Units and
Radiological Services, 2006.
Paraprofessional Healthcare Institute, Direct-Care Health Workers: The Unnecessary Crisis in Long-Term Care,
New York, September 2000.
American Health Care Association, Survey of Nursing Staff Vacancy and Turnover in Nursing Homes, 2002.