Ban on mandatory nursing overtime starts; impact on Baystate Franklin uncertain
GREENFIELD — Baystate Franklin Medical Center administrators and nurses are watching closely as Massachusetts’ new health care reform law goes into effect Monday — especially one piece of the law that bans mandatory overtime for nurses. Signed into law by Gov. Deval Patrick on Aug. 6, the act contains a number of measures designed to rein in the state’s ever-increasing health care costs.
Section 226, which prevents a hospital from forcing its nurses to work overtime, was included to reduce medical errors — which state officials say sometimes occur when nurses are tired and working beyond eight- or 12-hour shifts.
The law does not impact voluntary overtime, other than to limit the consecutive hours a nurse can work to 16 hours. The two sides’ contract debate on overtime pay will remain a major topic in negotiations between the hospital and its nurses.
The ban goes into effect Monday, but it may not be truly effective for some time — because of uncertainty surrounding the law’s language and intent.
The law states that there is an exception to the ban: “an emergency situation where the safety of the patient requires its use and when there is no reasonable alternative.”
But the state has not yet determined what these “emergency situation(s)” will be.
A health policy commission, now being formed by the state, will ultimately make this decision. During hearings to be held in the near future, the commission will gather public input on the matter, state officials said Friday.
BFMC administrators said they use mandatory overtime as a last resort, after they have put out a call for volunteers. The most common scenarios for overtime exist when there are nurse absences or when there is an unexpected increase in the number of patients, they said.
During flu season, for instance, there will be times when patient levels surge, administrators said. They wonder if such a time would count as an “emergency situation,” or if the state would restrict the definition to disaster scenarios like a hurricane or a train crash.
“Both sides (hospital officials and nurses) have so far been wanting to get into compliance with the new regulations,” said Kerry Damon, director of human resources, who added that the topic was discussed during the hospital’s monthly meeting with union representatives.
“The largest clarification needed ... (is the) question of what defines an emergency,” she said. “The union is equally interested in finding more out about that. As we learn more about this, we’re going to have to come back together and really talk about the effect.”
Nurses union co-chair Donna Stern said that the change will force the hospital to re-evaluate its staffing procedures.
She said that Baystate Health corporate leaders have limited the Greenfield hospital’s resources. This has put BFMC managers in a difficult situation of having to use overtime as a necessary staffing mechanism, she said.
“(The hospital is) operating on such skeletal levels that they put the schedule out with holes,” said Stern. “It puts nurses in a situation where if someone calls in sick you get mandated to work.”
Hospital officials have denied that they post schedules with holes and said that overtime is only used as a last possible resort.
They said that overtime — about 3.2 percent of all hours — has decreased from 2011 levels, when it made up 4 percent of total hours.
And officials said that they can mandate nurses to only work up to 16 total hours of overtime throughout the calendar year. Through 10 months of this year, only 4 percent of all the nurses on staff have been forced to work all of those 16 hours, they said.
Still, Damon said the hospital will continue its push to explore alternatives to overtime.
“We both agree that this new regulation is providing us a platform to partner together so that we can address staffing issues together as they occur,” she said.
The law states that the hospital must report any mandated overtime hours, along with the reasons for the overtime, to the Department of Public Health.
State officials said that there are currently no other enforcement methods or penalties — things that will ultimately be determined by the still-forming health policy commission.
In the meantime, Damon said that the two sides will just have to work together and evaluate situations as they occur.
If nurses are forced to work overtime, Stern said they will not abandon their posts but will file a complaint report to the department of public health.
And because the law does not limit voluntary overtime, it does not impact the two sides’ policies on overtime pay — a major sticking point of an ongoing 13-month contract negotiation dispute.
As long as nurses keep working overtime voluntarily, the issue won’t go away, said Stern. Nurses who choose to work beyond their regular hours should be paid time and a half, she said.
Hospital officials, citing a need to make difficult but necessary cost-savings decisions, want to change the overtime policy to a weekly model. Nurses would only be paid time-and-a-half after working their 41st hour in a week.
Administrators proposed a “bonus pay” compromise for any overtime hours. The union has dismissed this offer, saying it is not worth considering because it is too small an amount.