1. Foley, Mary MS, RN


Mandatory overtime can become a thing of the past.


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Inadequate nurse staffing in U.S. hospitals has resulted in a public health care crisis. A three-part series of articles published in the Chicago Tribune last fall sparked a firestorm when it reported that inadequate nurse staffing and training led to thousands of deaths and injuries each year. The series placed most of the blame on "hospitals that sacrifice patient safety for the bottom line." FIGURE

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Many nurses were infuriated by the report, with its inflammatory headline and narrow focus on a handful of "problem" nurses. I'm angry too. But not with the newspaper, which brought much-needed publicity to the plight of overworked nurses and their patients. No, my anger is directed at the shortsightedness of providing inadequate health care funding and at cost-cutting decisions that place profits before adequate and appropriate nurse staffing. I'm angry with those who impose mandatory overtime requirements as a temporary though inadequate solution to the problem of short staffing that results from profit-driven decision making. I'm angry that the real health care experts-registered nurses-aren't the decision makers in issues such as patient care, health and safety, and professional practice.


My anger is shared by nurses in California, Massachusetts, New York, and, most recently, Washington, DC, where nurses have gone on strike to protest inadequate staffing and rampant imposition of mandatory overtime requirements in their hospitals. Additionally, nurses in New York and Minnesota have rallied to alert the public to the dangers patients face when nurses are overworked and required to work longer shifts.


Organized nursing is also continuing to sound the alarm. In May, the American Nurses Association released a study showing that patients experience fewer complications and are discharged sooner from hospital facilities with more nurses providing direct patient care. In June, the ANA's policymaking House of Delegates issued a statement opposing mandatory overtime under all circumstances, giving strong support to what nurses have been saying nationwide-that they will no longer work in settings where the importance of adequate and appropriate RN staffing is devalued.


They're being heard. As a result of the strikes, nurses in Massachusetts, New York, and Washington, DC, have secured contractual limits on mandatory overtime. At hospitals in Ohio, Minnesota, and Washington State, nurses have successfully negotiated prohibitions of mandatory overtime. And nurses have effected federal action by working on the introduction of a bill in Congress in mid-September that would restrict mandatory overtime for health care providers. The ANA will be pursuing this initiative in the next federal legislative session. In addition, the ANA will be leading the way with a health and safety research initiative to establish safety limits for both mandatory and voluntary overtime.


Although these gains constitute a change in the health care environment, this isn't the end of the matter. That's why the ANA has developed resources, including its Principles for Nurse Staffing, to provide more immediate assistance in the tackling of day-to-day staffing problems. And the ANA continues to promote the American Nurses Credentialing Center's Magnet Nursing Services Recognition Program, which provides a model for all institutions. Good facilities do exist, and nursing practice does thrive in some settings. We want to spread the word so that the best practices become common practices.


The ANA is committed to improving the workplaces of all nurses to ensure that safe, high-quality patient care is provided. But it can't do this alone. We need you to join us to give professional nursing a more powerful voice in the media, on Capitol Hill, in state legislatures, and in hospitals and other health care facilities. Only through a unified effort can we relegate mandatory overtime to the past and ensure appropriate staffing.


To learn more about how the ANA is addressing nurse staffing issues, or to join your state nurses association, go tohttp://www.nursingworld.orgor call (800) 274-4ANA.