Mandatory Overtime For Nurses Banned In Pennsylvania
Story from Pittsburgh Post-Gazette

There were no parades or fireworks Wednesday, but July 1 was the independence day that so many nurses and hospital caregivers had hoped and battled for. Among those many was Lois Cusick of Mt. Lebanon, who has worked at UPMC's Western Psychiatric Institute & Clinic for 26 years.

She, and all other nurses and caregivers in the state, are now largely immune from management requests to work "mandatory overtime," the extra hours, nurses say, that frequently were tacked on the end of already long hospital shifts, jeopardizing patient care and making it tough to keep quality nurses.

"This is a huge win. I've been a nurse for 30 years. I raised three children doing in-patient nursing," Ms. Cusick said. "There were so many times I couldn't go home at the end of my work shift."

Every year, the unpredictable overtime hours, compounded by lack of staffing, are high on the list of issues that push nurses out of the health-care industry

For much of the decade, nurses and the Service Employees International Union, and overtime lawyer have been lobbying for a change in state law that would restrict hospitals' ability to force nurses and support staff to work overtime hours. Fourteen other states have similar laws and regulations on the books.

Pennsylvania's law was signed by the governor last fall, and went into effect on Wednesday. "Seven years we've been fighting for this," said Deb Bonn, director of the Nurse Alliance of SEIU Pennsylvania

Now, "when they go to work in the morning, they know what time they are getting out."

It's not just a vague quality-of-life issue -- uncertainty over hours is a major reason that nurses leave the field, many say. In Pennsylvania, nurses must re-register for nursing licenses every two years, and each time they do so, they must fill out a survey that asks about job satisfaction (and dissatisfaction). Every year, the unpredictable overtime hours, compounded by lack of staffing, are high on the list of issues that push nurses out of the health-care industry.

"It's critical," said Cathy Stoddard, a longtime nurse at Allegheny General Hospital, which hasn't imposed mandatory overtime upon its union workforce for six years. "You don't want the person taking care of you to be so exhausted that they're making mistakes."

Even though the SEIU was one of the groups pushing hardest for this change, the new law actually may have a greater effect on non-union personnel. That's because, in some cases across the state, nurses and other support staff already represented by unions have negotiated limits on the number of overtime mandates that can be issued each month.

Non-union nurses and support staff -- including nursing home workers, radiology aides, lab workers, phlebotomists, surgical technicians -- are more likely to see an immediate change in the workplace.

The new overtime law doesn't mean that nurses and caregivers will never work any overtime. They can still volunteer for extra hours, for example. And there are certain "last resort" events that would trigger a hospital's ability to require its employees to work overtime -- a major accident, or a natural disaster, or any other national, state or municipal emergency.

Chronic understaffing is not considered an "unforeseeable emergent circumstance" by the law, and thus isn't a circumstance that would allow for mandatory overtime.

The state Department of Labor and Industry is charged with making sure hospitals and other care institutions are meeting the new guidelines, and seeing to it that "an employer [does] not retaliate against an employee who refuses to work overtime."

If that happens, hospitals may be subject to fines or other corrective measures for any facility that breaks the law, known as Act 102.

What will hospitals and care homes do now that the state has put the kibosh on forced overtime? Hire more nurses and support staff, for one thing. Employers also can borrow nurses from employee banks.

Nurses Unions Square Off Over Workers

Two of the nation's biggest nurses' unions are engaged in a slugfest over workers, seeking to spoil each others' organizing drives with tactics normally used against employers, including ad campaigns, lawsuits and infiltrating job sites.

The fight between the giant Service Employees International Union and a smaller union, the California Nurses Association, began in Ohio and has spread in recent weeks to Texas, Nevada and New York. Last week, SEIU filed suit against CNA in Iowa District Court in Johnson County, alleging that CNA illegally acquired a confidential mailing list of SEIU members it used to send promotional flyers critical of SEIU.

Both unions are trying to boost membership in a fast-growing sector of the economy. Last year, 7.5% of the private-sector work force belonged to unions, down from 17% 25 years ago, according to the Labor Department.

CNA says nurses would be better represented by a registered-nurses-only union that could focus on issues including nurse-to-patient staffing ratios. The union represents 80,000 registered nurses, mostly in California, but also in Maine, Illinois and Nevada.

SEIU, which represents 85,000 registered nurses out of its 1.7 million members, says nurses are better off in a bigger union that would also fight for other hospital workers and improve hospital-wide standards.

In Ohio, SEIU spent three years trying to organize 8,000 nurses at a Catholic health-care system and was hoping to use the Ohio union as a springboard to organize Catholic hospitals in other states. Before a mid-March SEIU vote, CNA sent representatives to Ohio hospitals to distribute promotional flyers saying SEIU had reached a back-door deal with the employer.

Susan Horne, 48 years old, a registered nurse in Cincinnati, said CNA organizers posed as Pizza Hut delivery workers to gain access to her nurse's unit. Ms. Horne, an SEIU supporter, said, "I told them, 'You have not been here for three years yet you come here five days before the election and try to sabotage our vote.' "

CNA's interference incensed SEIU, and the vote was canceled. "Their distortions and holier-than-thou statements are nothing more than a flimsy cover for out-and-out union busting," said SEIU President Andy Stern.

Orest Holubec, spokesman for Catholic Healthcare Partners, said management agreed to the election and a two-week period without pressure from SEIU or management so that employees could choose whether they wanted to join the union. He said CNA organizers entered restricted areas in hospitals and "engaged in the exact type of tactics we were trying to avoid." He said the health-care system, which employs 37,000 people in Ohio and four other states, won't agree to another vote "until the unions work out their turf wars."

Rose Ann DeMoro, the head of CNA, argues that while SEIU and the employer reached an agreement to hold the election, nurses didn't widely support SEIU. "Nurses didn't really have a choice," she said. She called allegations that CNA organizers posed as delivery workers "outrageous lies."

A month after the Ohio election was scuttled, SEIU sent six busloads of organizers to a labor conference where Ms. DeMoro was scheduled to speak. A scuffle broke out. An SEIU protester had a heart attack on the scene and later died. Another attendee went to the hospital for stitches. The action was broadly criticized within the labor movement. CNA has since boosted security at its headquarters, Ms. DeMoro said, installing security cameras and posting guards.

Mr. Stern has urged John Sweeney, the head of the AFL-CIO, to condemn CNA, which belongs to the federation, saying it is flouting AFL-CIO antiraiding rules.

Instead Mr. Sweeney asked Mr. Stern and Ms. DeMoro to resolve their dispute through mediation, to avoid damaging labor's influence during the presidential campaign. Unions "simply cannot afford to see their political, legislative and policy agendas derailed by the escalation of these disputes," Mr. Sweeney wrote to Mr. Stern recently.

Both unions have run ads attacking each other on progressive sites such as Daily Kos and Talking Points Memo. CNA sent mailers to SEIU members, which included a form to decertify the SEIU, while SEIU hired a company to poll CNA members. In an audio recording of a 13-minute call reviewed by The Wall Street Journal, the person conducting the poll asks a CNA member to respond to statements, including CNA is "wasting members' dues" and "acting like CEO union-busters."

Meanwhile, students earning their nursing degrees, health-care employers and their consultants are watching from the sidelines. "We love it," says Bill Adams, a labor-relations consultant in Fort Wright, Ky., who works with hospitals but isn't involved in the Ohio dispute. "You're guided by the principle, 'The enemy of my enemy is my friend.' "

By: Kris Maher
Wall Street Journal; May 19, 2008

Slowdown's Side Effect: More Nurses

Economy's Woes Prod many Who Left Field to Return; Brushing Up on Anatomy

The ailing economy is helping to ease the nursing shortage.

With house prices falling and the cost of gasoline and food rising, many nurses are going back to work, in some cases to make up for the income of a spouse who has lost a job. Hospitals say part-time nurses are taking on extra shifts. And nursing schools are seeing an increase in people applying for refresher courses on the ins and outs of modern hospitals. Some older nurses are putting off a planned retirement.

"We are seeing a temporary lessening of the nursing shortage," says Jane Llewellyn, vice president of clinical nursing affairs at Rush University Medical Center in Chicago. But, she says, "as soon as the economy turns up we'll see them staying home again."

It's a familiar pattern during economic slowdowns. For years, the high demand for nurses has allowed them to design work schedules that suit their financial and family needs. Many start off working full time on difficult shifts and then reduce their hours when they have a family -- the profession is more than 90% female -- or as they approach retirement. But when the economy goes sour, many nurses go back to work full time.

Dana Goodin, a nurse at Chicago's Rush University, worked three evening shifts a week for nearly two decades, giving her time to raise her four children. But after her husband, a carpenter, was laid off late last year, Ms. Goodin began working four days a week to boost the family's income and to qualify for cheaper health benefits. Although her husband has since found a new job at a retail warehouse, he makes just half of his former salary, and Ms. Goodin is looking for another shift to push her above full time.

The nursing profession also is attracting greater interest among new recruits, drawn by expanding job opportunities and rising wages in some places. Nursing school enrollment surged in the wake of the Sept. 11, 2001, terrorist attacks and the economic slowdown that followed. Enrollment continues to grow apace, though at a reduced rate, and schools are turning away thousands of qualified applicants for lack of faculty. Even so, nursing experts predict shortages will grow in future years as demand for nursing services outpaces the number of professionals entering the field.

For hospitals, the renewed interest in nursing is a relief. Shawn Tyrrell, chief nursing officer at Rush-Copley Medical Center in Aurora, Ill., says that until last year the hospital used outside employment agencies when it didn't have enough nurses to cover the shifts. Now, despite an increase in patient volume, the hospital's own nurses want extra hours, so it doesn't need the agencies. "We've been able to handle that volume increase through our own staff members," she says.

The nursing shortage began in the 1990s as older nurses started retiring and there were fewer newcomers to take their place. The crunch got worse as baby boomers got older and demand for health care increased. By 2001, there were 126,000 vacant nursing positions in the U.S., according to the American Hospital Association. That means about 13% of all nursing jobs were unfilled.

Beefing Up Recruiting

To attract nurses, hospitals have increased wages and beefed up recruiting, including from overseas, and have offered potential hires signing bonuses of cash or even new cars. Hospitals have also taken steps to keep older nurses in the work force by making their jobs easier, including replacing hand cranks used to lift beds with automated lift devices, bringing in lift teams so nurses don't strain themselves picking up patients, or putting supplies closer to patients' rooms to cut down on walking. By the end of 2006, the nurse vacancy rate had fallen to 8.1%.

Of course, nurses who haven't been working for some time can't just jump back into the job. Nurse-education requirements vary from state to state, but in general the longer the nurse has been out of the work force the more likely it is he or she will have to complete a refresher course to be relicensed. The Mount Carmel College of Nursing in Columbus, Ohio, for instance, offers a refresher program for $700 plus the cost of textbooks that includes 230 hours of online courses, covering such topics as anatomy, new medications and privacy regulations. Students also log 100 hours working in a clinical setting such as a nursing home or a hospital.

Economic Indicator

For the past few decades, nursing has been a kind of reverse economic indicator. In periods of economic weakness or recession -- including in the early 1980s, the early 1990s and earlier this decade following the technology-company bust and the Sept. 11 attacks -- the number of full-time nurses grew at an average annual rate of 3.5%. By contrast, in times of healthy economic expansion, the increase has averaged just 2.4%, according to an analysis of government data in "The Future of the Nursing Workforce in the U.S.," a book by Peter Buerhaus, director of the Center for Interdisciplinary Health Workforce Studies at Vanderbilt University Medical Center, Douglas Staiger, a Dartmouth College economics professor, and David Auerbach, a principal analyst in the Health and Human Resources Division of the Congressional Budget Office.

Last year, there was a net increase of about 113,000 nurses in the work force, the largest increase since 2002, and most of the added nurses were over 50 years old, according to the Census Bureau. The pattern has continued this year. Although the U.S. economy lost 20,000 jobs in April, the fourth monthly decline in a row, health-care employment rose by 37,000 and is up 365,000 jobs over the past 12 months, according to Labor Department data released last week.

"In bust periods, unemployment is rising, which means there is a lot of pressure on married RNs to be working," says Mr. Buerhaus.

Jennifer Schlesser, a 57-year-old Ellicott City, Md., resident, says she worked as a nurse for 27 years before leaving the profession a decade ago, feeling overworked and underpaid. She went to work in the mortgage-lending industry, but the housing slowdown has forced her to change employers and has cut into her commissions.

Refresher Courses

Ms. Schlesser is currently enrolled in an online refresher course for nursing and she expects to be relicensed by next month. She plans to work part time in both nursing and mortgage lending. "Whatever works out best," she says.

But over the long term the nursing shortage is expected to continue and eventually worsen, as retiring baby boomers ramp up demand for care. In their book, Messrs. Buerhaus, Staiger and Auerbach use Census data to project that the nursing work force will plateau in 2015. By 2025, they estimate there will be a shortage of almost 500,000 nurses, representing a vacancy rate of 40% or higher.

By: Conor Dougherty
Wall Street Journal; May 7, 2008