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Nurses struggle with overtime rule, safety issue


Quality of health care and access to care are major issues in the presidential election campaign this year, as they are in most elections. This time, in the midst of a heated campaign, Congress passed a bill that might limit overtime pay for some nurses.

The American Nurses Association believes the federal regulations that took effect Aug. 23 will allow employers to increase forced overtime for nurses. This is because salaried employees are not required to be compensated at time-and-a-half. The result? Many nurses will be hit by a double whammy as they’re called upon to work more hours but not rewarded for their extra effort the same way other workers are.

Most news accounts have said that hospitals and long-term-care agencies will continue to pay overtime to nurses because there is a shortage of personnel, a shortage that will continue to spiral upward until 2020 when there will be a 20 percent vacancy rate in the profession. Access to and quality of health care will both be affected by the severe deficit of professional staff.

Even today, in order to provide patients access to nursing care, employers are asking nurses to work more and more overtime. Some employers mandate overtime, while others encourage the practice and reward volunteers with lucrative hourly earnings. Nurses can boost their income significantly by working overtime.

But do we really want nurses working those added hours?

A recent study of 393 registered nurses led by researcher Ann Rogers at the University of Pennsylvania found that the number of mistakes nurses made multiplied as they worked beyond a 12-hour shift. Nurses who worked an average of between eight- and 12-hour shifts committed errors in 12 of 771 shifts or 1.6 percent of the time. Nurses who worked an average of 12.5 hours committed errors in 103 of 2,057 shifts or 5 percent of the time.

That finding does not surprise exhausted nurses. “Joe” works in an intensive care unit in the Des Moines area. He could work extra shifts almost every day should he volunteer. He is in his 20s, physically fit and has no children. He is far younger than the 48-year-old average working R.N. in this country, yet he tells me he’s weary.

Given the skills required to monitor acutely ill patients — everything from the ability to recognize subtle changes in a patient’s color to adeptness in changing intravenous medication dosage when blood pressure plummets — patients’ lives literally are in nurses’ hands. Federal regulations limit how many hours airline pilots can be in the air. Truck drivers are also very closely monitored for hours logged on the road. Falling asleep in the cockpit or at the wheel is not good. Neither is giving the patient the wrong dose of medication or missing an erratic heartbeat because one’s attention span wanes.

So the problem becomes less about paying nurses for overtime, which I believe most institutions must continue to do, and more about patient safety.

Health-care policy decisions at the state and federal levels need to include further discussions about limiting the number of hours nurses work per week. This dialogue will be difficult given the 24-hour staffing that is needed in hospitals and long-term-care centers. Staff nurses need to be included and asked for input into possible solutions.

Would you want an exhausted nurse bending over your or your loved one’s bedside? I wouldn’t.

Jean Logan is a registered nurse and a professor in the division of nursing at Grand View College.

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