Editor's Note: These Seachange Bulletins and articles of special interest to
nursing, labor and health care activists are archived on 'Sandy's Links'
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BILL WOULD BAN MANDATORY OVERTIME FOR HEALTH CARE EMPLOYEES
Nurses Applaud Federal Proposal, Saying Public Safety at Issue
CONTACT: Michael Byrne (202) 331-3700
WASHINGTON - Mandatory overtime for licensed health care employees (excluding
physicians) would be prohibited under a bill introduced in the U.S. House of
Representatives Thursday by U.S. Reps. Tom Lantos (D-Calif.) and James
McGovern (D-Mass.). The legislation recognizes the growing danger to patient
safety posed by forced overtime practices in hospitals nationwide.
"Hospitals across the nation are requiring nurses to work overtime on a
regular basis," said Jill Furillo, RN, national outreach coordinator for the
California Nurses Association. "Nurses frequently complain that at the end of
their shift, they no longer have the stamina and mental alertness to deliver
the quality of care patients need."
At least 1,720 hospital patients have been accidentally killed and 9,584
other injured since 1995 because of the actions or inaction of registered
nurses across the country, according to an investigative report by the
Chicago Tribune, which attributed the problem to cuts in staff and other
belt-tightening in U.S. hospitals.
In recent months, mandatory overtime has been a major factor in lengthy,
high-profile nurses' strikes in Massachusetts, California and New York, and
has been a rallying cry for exhausted RNs and other health care workers
across the nation.
"Forced overtime is a prescription for disaster," said Teri Evans, RN,
president of the Pennsylvania Association of Staff Nurses and Allied
Professionals. "Patients are placed at greater risk when the professionals
caring for them are exhausted and not sufficiently alert. Increased
medication errors and errors in judgment result."
The Lantos-McGovern bill amends the Fair Labor Standards Act to bar mandatory
overtime beyond 8 hours in a work day or 80 hours in any 14 day work period,
except in the case of a natural disaster or in the event of a declaration of
emergency by federal, state or local government officials. Voluntary overtime
is also exempted."Our bill would give nurses the relief they need," Lantos
said. "America's nurses put their hearts and souls into caring for
individuals and their families. We need to ensure that they have time to care
for their families as well. It's inhumane the way hospitals treat nurses."
McGovern pointed to a recent 49-day strike at St. Vincent/Worcester Medical
Center in Massachusetts, where mandatory overtime was the primary issue that
led more than 600 nurses to walk out. "Health care professionals have drawn
the line against mandatory overtime, and for good reason," he said. "No one
should be asked to work the kind of hours that jeopardizes patient care."
"No patient deserves a nurse in her fifteenth or sixteenth hour working,
especially after she has said 'I can't do this,' " said Sandy Ellis, RN, of
the Massachusetts Nurses Association, who was among those who struck St.
Vincent. "If you are forced to do it, your license is not protected and
you've been mandated to put your patients at risk."
Rosalind Hunter, RN, a Contra Costa County (Calif.) Regional Medical Center
nurse, points to the "horrible staffing situations" and the "abuse of
mandatory overtime" by California hospitals. "If this (ban on mandatory
overtime) becomes law, I predict it will be a real lifesaver for both nurses
and patients."
Mandatory overtime actually has contributed to the national nursing shortage,
Furillo added, pointing to surveys and anecdotal reports showing that nurses
are refusing to work in hospitals with unsafe conditions, including when they
are forced to work unplanned overtime hours. "Without a curb on this reckless
practice, more nurses will leave the profession and we will experience a
deeper and longer-term nursing shortage," Furillo said.
This bill was initiated by the following nursing organizations:
California Nurses Association
Massachusetts Nurses Association
Maine State Nurses Association
Pennsylvania Association of Staff Nurses and Allied Professionals
Already signing on in support of this bill are:
Congressman Robert Brady (Democrat, Pennsylvania)
Congressman Luis Gutierrez (Democrat, Illinois)
Congressman Moakley (Democrat, Massachusetts)
Congresswoman Grace Napolitano (Democrat, California)
Congressman Barney Frank (Democrat, Massachusetts)
Congressman Bob Filner (Democrat, California)
Congresswoman Juanita Millender-McDonald (Democrat, California)
Interviews with members of the California Nurses Association, Massachusetts
Nurses Association, Maine State Nurses Association and Pennsylvania
Association of Staff Nurses and Allied Professionals are available by
contacting Tamil Perry or Suzanne DeMass at (202) 331-3700.
Rep. Lantos may be contacted at (202) 225-3531. Rep. McGovern is available at
(202) 225-6101.
-------------------------------------------------
American Nurses Association Applauds Overtime Restriction
U.S. Newswire
15 September 2000
American Nurses Association Applauds Introduction of Bill to Restrict
Overtime for Nurses and Other Health Care Workers
To: National Desk
Contact: Joan Meehan-Hurwitz, 202-651-7020, or Cindy Price, 202-651-7038,
both of the American Nurses Association; http://www.nursingworld.org/rnrealnews/
WASHINGTON, Sept. 15 /U.S. Newswire/ -- Calling it a step toward ending the
unsafe practice of mandatory overtime, the American Nurses Association (ANA)
applauded the introduction of a bill yesterday in the U.S. House of
Representatives that would limit the number of hours licensed health care
workers, including registered nurses (RNs), are forced to work. The bill,
H.R. 5179, the "Registered Nurses and Patients Protection Act,"introduced by
Rep. Tom Lantos (D-Calif.), would amend the Fair Labor Standards Act so that
no RN would be required to work beyond eight hours in any workday or 80 hours
in any 14-day work period.
Every day, nurses in hospitals across the country are forced to work up to
16-hour shifts, thus putting themselves and their patients at increased risk
of error and injury. In the case of nurses, mandatory overtime is a
calculated business practice used by hospital administrators as a quick fix
to a nurse staffing shortage that ANA contends has been brought on in large
part due to hostile working conditions for nurses.
The problem of inappropriate nurse staffing was driven home this week by a
three-part series in the Chicago Tribune (Sept. 10-12), which explored the
deplorable state of nurse staffing in our nation's hospitals, a situation ANA
has called a "public health crisis." The article also noted that hospitals,
driven by the bottom line, are imposing cost-cutting measures, such as
reducing nursing staff, to save money. This practice leads to safety
concerns, such as chronic under-staffing, which, when remedied by use of
mandatory overtime, creates an environment where mistakes are more likely to
occur.
As patient advocates, the members of the ANA and its labor arm, the United
American Nurses, have taken strong positions opposing mandatory overtime and
want the public to know the negative impact mandatory overtime is having on
patient safety.
Testifying on staffing issues at a daylong National Summit on Medical Errors
and Patient Safety Research in Washington, D.C., on Sept. 11, ANA First
Vice-President Patricia Underwood, Ph.D., RN, stated that because of
cost-containment measures, nurses, physicians and others are asked to do more
with less. "As hospitals have reorganized and put fewer nurses at the
bedside, and as more and more hospitals have come to rely on use of overtime
as a 'solution' to inadequate staffing, the most common complaint we hear
from our members is their belief and concern that these changes are putting
patients at risk," she said.
The summit was held as part of the federal government's response to last
year's Institute of Medicine report, which noted that up to 98,000 patients
are killed each year from medical errors. But missing from the report's
findings, Underwood noted, is an examination of the "full range of staffing
issues," including the alarming incidence of mandatory overtime currently
being used to fill gaps in staffing.
"Don't we know enough about the impact of fatigue on human judgment, and on
cognitive abilities, to recognize that having a 47-year-old nurse working
16-hour shifts for three or four days in a row is dangerous?" she testified.
(Editor's Note: Reportedly the AFL-CIO has also joined ANA in endorsing this
legislative initiative of CNA, MNA, MSNA & PASNAP. -- SE)
__________________________
Massachusetts Nurses Association Board Takes Stand on Independence
September 15, 2000
The Board of Directors of the Massachusetts Nurses Association today voted
7-5 to support the proposed bylaw amendment to effect MNA's disaffiliation
from the ANA federation, while pledging to continue to foster open discussion
and dialogue on this vital issue. The MNA Board joins the MNA Cabinet for
Labor Relations, Congress on Health and Safety, the District 2 Board of
Directors, the Executive Board of MNA's State Chapter of Health Care
Professionals, and a rapidly growing roster of MNA members who have
constituted themselves as the Pro-MNA Campaign. Every MNA member in good
standing has the right to speak and vote at the MNA's annual business meeting
to be held in Boston on November 9th. A two-thirds majority of those present
and voting is required to pass a bylaw amendment.
The amendment itself was proposed in March by the Cabinet for Labor Relations
and the Congress on Health and Safety. It consists of two parts: the deletion
of Article I, Section 5, which defines the MNA's status as a constituent membe
r of the ANA, and all other explicit references to ANA. The rationale offered
for this change runs as follows:
"To liberate the MNA during this time of assault on nursing and patient care,
freeing our resources to focus on actions and activities that unify nurses
around these core values:
* Protect and promote the profession of nursing.
* Enhance the knowledge and promote the education of nurses fostering
clinical expertise and activism on behalf of their patients and practice.
* Accept and embrace the nurse's role as patient advocate.
* Promote the access to quality healthcare for all.
* Protect the health and safety of nurses in all work settings.
* Enhance and promote the economic, health and general welfare of nurses.
* Provide and respect workplace democracy for all eligible nurses who
desire to exercise this right.
* Work toward solidarity with any and all nurses who share these core
values for the survival of nursing."
The other language proposal would amend Article II, Section 5, Paragraph b to
read: "The dues previously paid to the ANA shall be automatically retained as
MNA annual dues." The rationale furnished for this is:
"Current MNA dues include dues paid as a 'per cap' assessment that the MNA
must pay as a condition of membership in the ANA federation. The 'dues
previously paid' refers to this per cap assessment of $85 per full-time
member. By retaining this assessment at the state level the MNA, without
altering its current dues level, can provide greater resources to the benefit
of its membership in addressing their issues as directed on the state and
national level."
(Editor's Note: Thorough discussion of the debate within MNA can be found on
the MNA web site <http://www.massnurses.org>. -- SE)
------------------------------------------------
Message from Teana Gilinson, RN, written is response to her attendance at the
third of twelve 'town meetings' being held this fall across Massachusetts to
stimulate grassroots discussion of the issues posed by the bylaw change
initiative to create a strong, independent MNA:
After the Town Meeting last night, I thought I would put together a list of
Frequently Asked Questions. I intend to use this as a hand-out. If there are
any other questions that need to be answered, please let me know and I will
add them. If you have any corrections to make, please send them to me. If you
wish to use this for your own purposes, you have my permission. I'll attach a
file version of this for print downloading, but the text of it follows.
FAQs on Disaffiliation
1. If we separate from ANA, won't we lose our "national voice?"
The voice of ANA is not loud enough to deal with the current crisis in
nursing and health care. Last November, Madge Kaplan, a noted national media
powerhouse from NPR, was invited to address the fellow of the American
Academy of Nursing (FAAN). She commented on the absence of nursing's national
visibility and lack of influence in national health care issues. After an
informal survey of health care journalists around the country, Kaplan said
that "Reporters don't seem to know which nursing groups to pay attention to,
or who the important leaders are." She added, "Nurses don't seem to be
playing an important role in the larger health care debates and policy
developments, especially at the national level."
In 1998, the ANA hired an independent consulting group to analyze their
budget and financial problems (Lang Report). In its conclusion, the report
states: "A single issue came up time and time again ... it appears to be an
underlying cause to many problems. That issue is the lack of a clearly
communicated vision as to what ANA is."
Therefore, we must conclude that we will not lose our national voice,
because none exists. Instead, by leaving the ANA and aligning ourselves with
other like-minded nursing groups, we have a new opportunity to make our
voices heard.
2. Without help from ANA, will we diminish our ability to impact the current
national staffing crisis?
In its FY2000 budget, the ANA lists nurse staffing as one of its core
issues and a priority for the year. The stated goal for this issue is for
the ANA to "demonstrate its impact on improved nurse staffing in clinical
sites (acute care and community care) in at least 15 cases utilizing both
collective bargaining and workplace advocacy strategies by January 2001."
We cannot wait around to see if any hospitals in Massachusetts will be
among the lucky 15. We must advocate for ourselves to improve staffing in
our own state, and cooperate with others by sharing ideas and strategies, so
that other states might benefit as well.
3. Isn't the money we send to ANA well spent if it furthers the national
agenda of nursing?
In truth, the ANA is in serious financial trouble, and there is no
"national agenda." The Lang report identified two major problems within the
organization - "The absence of strong financial leadership, and the lack of a
clearly defined vision for the Association." For the years 1995 - 1997, the
ANA had a negative cash flow and poor budget planning that resulted in a $5.8
million deficit. The Lang report recommended that the ANA "contract" before
it "expands," citing a need to cut programs and activities. They also
provided ANA with the steps and procedures that are needed to restore it to
financial health. The ANA claims to have met all of the steps and implemented
the processes. However, one of the biggest issues was the lack of strong
financial leadership. Given the structure and make-up of the ANA, making the
necessary changes here would be like replacing all of our national
legislators at the same time.
By retaining the money we send to ANA, we can focus on the needs of our
own nurses and work to strengthen our practice and our profession.
4. If we disaffiliate, will we lose future grant money from the ANA?
Yes, we will. Over the last 9 years, the ANA has given the MNA
approximately $500,000. By disaffiliating we will retain over one million
dollars in the first year alone.
5. Will we lose our ability to provide CEUs?
No. MNA will still be an approved provider of CEUs. We will be able to
conduct programs and award educational credits. We will, however, lose our
vendor status. Hospitals, organizations and educational companies will no
longer be able to come to us to receive approval for their programs. This
will result in the loss of some revenue for the MNA.
6. Without the ANA, will we become a labor-only organization?
NO! The structure of the MNA will not change. There will still be the
Congress on Nursing Practice, the Congress on Health Policy and Legislation,
and the Congress on Health & Safety. The Center for Ethics and Human Rights
will still exist. There will be no change in the committees, task forces or
role and issue groups. The Districts will remain intact. Anyone who is
currently involved with MNA will be encouraged to stay. Their participation
has, and will be, valued. We will continue to benefit from the diversity of
our membership.
HMOs plan to spend as much as $4 million to fight a universal health care
ballot measure that comes before voters Nov. 7, even as they impose
double-digit rate hikes on customers and complain of chronic losses.
Major HMO managers said this week they will be seeking average rate increases
of 7 to 14 percent.
Premiums will climb even higher if the ballot measure passes, says a
spokesman for the group fighting the initiative.
``At the end of the day, what we're talking about is an extremely costly and
unwieldy ballot measure that doesn't contain costs,'' said Larry Rasky,
spokesman for the No on 5 coalition.
Business and industry insiders say the state's big HMOs want to raise $4
million and are looking for another $1 million from businesses to fight the
measure.
Already the group has amassed nearly $1 million, state records show.
That kind of spending is why the ballot initiative is needed, supporters say.
``We strongly believe insurance companies should be spending their money on
patient care,'' said Andre Guillemin, campaign director for Yes on 5.
``In order to have a healthy and productive health care system in this state,
we have to direct dollars to patient care and not to advertising and
marketing.''
Supporters dispute that the measure will push up costs. They are also raising
money, but so far have just under $5,000, state records show.
Paul Ling, a psychologist who supports the ballot measure said he believes
HMO leaders are concerned about a provision that would give patients more
freedom in choosing a doctor.
``I also think (HMO leaders) are very much threatened by a provision that
would limit their spending on administration and bonuses to 10 percent of
their total budgets,'' he said.
Opponents of the ballot measure predict health care rates will raise 20 to 60
percent within weeks if the ballot initiative passes. They say a universal
health care system could cost $17 billion a year, citing a study by the
Legislature's Joint Committee on Health Care.
Nearly everyone would be hit by the increases, HMO leaders say. Although many
business will have rates set, most contracts let HMOs raise their rates if
there are substantial changes in state or federal law.
This week, Blue Cross and Blue Shield of Massachusetts said it is raising
rates 10 to 14 percent while Harvard Pilgrim is looking at 7 to 9 percent
increases and Tufts Health Plan, 9 to 12 percent.
Some will see even higher increases.
Opponents are still determining how much money they need to fight the
initiative, Rasky said.
``We have a variety of scenarios depending on how much public education is
needed,'' he said.
Editor's Note: Two years ago twins studies on the impact of a single-payer
universal health care system in Massachusetts were completed. These studies
were commissioned by the Massachusetts Medical Society and the Senate Ways
and Means Committee, and conducted by Solutions for Progress and the Lewin
Group. They both showed considerable savings in a single-payer system here,
enough to cover all currently uninsured and underinsured. For more
information, go to the web site of the Massachusetts Campaign for Single
Payer Health Care <http://www.masscare.org>.
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