Policy Statement on Mandatory Overtime by rmf16317


									                                Policy Statement on
                                Mandatory Overtime

             (Approved by the AONE Board of Directors, December 2003)

Statement of the Issue                         Overtime has been defined as the hours
In its groundbreaking publication,             worked in excess of an agreed-upon,
Perspectives on the Nursing Shortage: A        predetermined, regularly scheduled full-
Blueprint for Action (AONE, 2000), the         time or part-time work schedule, as
American Organization of Nurse Executives      determined by contract, established work
(AONE) recognized early on the potential       scheduling practices, policies or
impacts of the nursing shortage. In the        procedures. The Institute of Medicine
last three years, the nursing shortage has     report, Keeping Patients Safe:
become more acute. Shortages have been         Transforming the Work Environment of
documented in countless studies and have       Nurses (IOM, 2003), cautioned that long
become a critical factor in the access to      work hours of some nurses represented
and the provision of timely patient care       one of the most serious threats to patient
services. The Division of Nursing at the       safety. The Fair Labor Standards Act
Health Resources and Services                  (FLSA) has defined mandatory overtime as
Administration projects the need for one       hours worked over 40 per week or over 80
million nurses by 2010. Barring aggressive     for a two-week period. Mandatory
intervention, the supply of nurses will fall   overtime does not include those overtime
by 29 percent below what is required by        hours for which workers have volunteered,
the year 2020.                                 but the nurse manager must consider the
                                               total number of hours a nurse has worked
A majority of the states have reported         and the effects of fatigue on human
professional nurse vacancy rates from 12       performance when making assignments.
to over 20 percent. To deal with the
professional nurse shortages, health care      In the view of AONE, declining a patient
institutions have closed beds, reduced the     assignment after completion of a regularly
volume of elective surgeries, and placed       scheduled shift will not be deemed as
emergency rooms on diversion to attempt        patient abandonment, be grounds for
to deal with rising nurse vacancies. In        disciplinary action, or result in actions
many cases, institutions have initiated        against the nurse. AONE does not consider
mandatory overtime or asked staff to           mandatory overtime to include “staffing
remain voluntarily on patient care units       up” for unseen emergencies, such as mass
after the completion of a scheduled tour of    causalities or snowstorms, or scheduled
duty. Surveys have indicated that the          “on call” time when a nurse may be paged
practice of using mandatory overtime is        to come into work as defined in his or her
widespread; however, at times, the stories     job description.
have been overblown. The use of
mandatory overtime has contributed to a
negative image of the nursing profession       Policy Position
and the characterization of the hospital       It is the view of AONE that mandatory
work environment as overly stressful and       overtime is the staffing vehicle of last
unsafe for patients.                           resort, limited to crisis situations that
                                               would put patients in danger of not
receiving the basic requirements of the       physical, mental and emotional state, to
safe care that they require.                  either accept or decline extra hours as a
                                              competent and safe care provider at the
AONE believes that all health care delivery   patient side.
organizations, working in conjunction with
the nurse executive and his or her nurse      AONE is opposed to legislation prohibiting
managers, are responsible for the             the use of mandatory overtime at both the
monitoring of staffing as it relates to       state and federal level with regard to the
patient safety, actual or potential patient   registered professional nurse. It is the
outcomes, and the quality of the work         view of AONE that the issue is best
environment. Every effort must be made        addressed within the institutional setting.
on the part of these organizations and the    Mandatory overtime is but one aspect of
nurse management team to develop              the nursing shortage and its usage should
staffing plans based on the consideration     be monitored and tracked.
of such factors as patient acuity and
volume, the experience level of the nursing
staff, the layout of the unit, the            References
relationships and availability of physician
staff and the needs of the patients and the   American Organization of Nurse
nursing staff.                                Executives. 2000. Perspectives on the
                                              Nursing Shortage: A Blueprint for Action.
Ultimately, it is the individual nurse who    Chicago, IL: AONE.
must be accountable to assess his or her
ability, within the parameters of one’s       Institute of Medicine. 2003. Keeping
                                              Patients Safe: Transforming the Work
                                              Environment of Nurses. Washington, DC:
                                              National Academies Press.

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