Nurses in Alaska are joining a movement in states across the nation to limit forced overtime at hospitals, a practice they contend is dangerous for both them and their patients.
Nurses at state-run health care facilities, such as the Alaska Psychiatric Institute in Anchorage and the state's six Pioneer Homes for seniors, and at health clinics in rural areas often work 12- or 16-hour shifts to help fill holes in round-the-clock schedules.
Dianne O'Connell of the Alaska Nurses Association said nurses sometimes are called in two or three times a week to work double shifts.
They feel obligated to fill the empty shifts over fear of retribution or the possibility of losing their nursing license for abandoning their patients, O'Connell said.
API nursing director Jane Barnes said nurses who leave their posts irresponsibly without alerting other staff could be reported to the Alaska Board of Nursing.
"But we haven't had nurses do that irresponsibly," she said.
She said it is unlikely that nurses would be reported or have their licenses revoked for declining a mandatory overtime shift because of fatigue.
She said API takes the circumstances of each situation into account and has tried to work with nurses to accommodate their needs.
Nurses who refuse mandatory overtime shifts without good reason, though, would be subject to disciplinary action, Barnes said. She said any potential disciplinary action would be made known up front before a nurse decides whether or not to work the shift.
O'Connell said the mandatory overtime issue has been a problem at the Psychiatric Institute for years because the facility does not have enough nurses on staff.
"If somebody calls in sick, they don't have a pool of people to call upon," she said.
There are 8,670 licensed nurses in Alaska.
The Alaska State Employees Association, which represents about 90 nurses statewide, and the Alaska Nurses Association are pushing Alaska lawmakers to approve a bill that would prevent hospitals from requiring nurses to accept overtime hours if they believe it would jeopardize their safety or the safety of their patients. The bill by Rep. Peggy Wilson, R-Wrangell, would not apply in emergency situations.
Nurses would not be allowed to work more than 12 hours without an eight-hour break. Health care facilities that violate the law would have to pay nurses three times their regular pay for the mandatory overtime hours worked. A second offense within 12 months would result in a fine of $500, and a third violation within a year would mean a fine of $2,500 to $5,000.
J.W. Pound, a nurse who has worked at API for 14 years, said nurses at the hospital are attacked by patients on a regular basis. Many of the patients admitted to the institute are straight out of jail, Pound said.
"You have to be on your guard all the time," he said. "You have people who are pretty paranoid. A lot of them are angry and delusional."
Pound, 55, said he works the night shift when attacks are more common.
He said nurses at API often sign up for scheduled overtime shifts to get their names removed from a list of mandatory overtime shifts that can be required if other nurses are sick or unable to work.
He said some of the overtime shifts can make for 16-hour days at the hospital.
ASEA Business Agent Doug Carson said the assaults can become more of a safety issue for nurses after they've worked double shifts.
"If you're tired, you make yourself more vulnerable," he said.
API director and CEO Ron Adler, said the hospital does not compromise its workers' or patients' safety.
"There is a noted incongruence between the data and staff perceptions," Adler said.
Adler said the quality improvement program at the hospital monitors staff safety, which he said is demonstrating a trend of fewer employee and patient injuries.
He said mandatory overtime is a "lightning-rod issue" and the hospital is implementing a nursing management software program that will help identify peak times of the year when mandatory overtime shifts increase.
"It really gives us data and information to staff the hospital in a more precise way than we're doing," he said. "I think we can staff up with seasonal, part-time and on-call employees."
He said the hospital wants to accommodate employees and give them the time off to spend with their families.
Carson said ASEA filed a grievance against the hospital earlier this year, arguing that API cannot call nurses in on their days off. He said the grievance is pending.
Adler declined to comment on the grievance, directing questions to state labor negotiator Art Chance. Chance did not return phone calls requesting an interview.
The Legislature does not meet again until January, but Wilson, who also serves as chairman of the House Health, Education and Social Services Committee, said she plans to hold hearings sometime later this year.
Wilson, who has worked as a nurse for 32 years, said she has never had to work mandatory overtime shifts but wants to give those who have a chance to discuss the issue in a public forum.
She said the issue also is a problem for nurses at state corrections facilities.
"I think what hospitals are going to have to do is start paying nurses more," she said, noting that state health care facilities pay nurses significantly less than private facilities, which makes it difficult to retain employees.
Carol Cooke, a spokeswoman for the American Nurses Association, said the move to establish laws limiting mandatory overtime is playing out in states across the nation as well as in Congress.
She said nine states have passed laws limiting the practice and another 23 have introduced their own legislation.
A bill by U.S. Rep. Pete Stark, D-California, and U.S. Rep. Steven LaTourette, R-Ohio, would limit mandatory overtime to emergency situations and gives the U.S. Department of Health and Human Services the authority to issue $10,000 fines to health care facilities that are in violation. A companion bill in the U.S. Senate has been introduced by Sen. Ted Kennedy, D-Mass.
Adler acknowledged the trend and said API is hoping to move away from mandatory overtime with its new scheduling system and seasonal and part-time employees.
The bill is House Bill 271.