In a profession facing a shortage of workers, overtime pay is a constant concern. Nurses are keeping a close eye on two pieces of federal legislation - one dealing with mandatory overtime and the other with overtime pay regulations - that are being debated in Congress.

The Safe Nursing and Patient Care Act of 2003 (HB 745; SB 373) would strictly limit mandatory overtime for nurses. The bill would prohibit requirements that a nurse work more than 12 hours in a 24-hour period or 80 hours in a consecutive 14-day period. The act would also provide whistleblower protection to nurses who protest mandatory overtime.

The act underscores the findings of a new study published in the July/August issue of Health Affairs magazine.

"This study is more evidence that patient safety is closely linked to nurses' working conditions," said Barbara Blakeney, MS, APRN, BC, ANP, American Nurses Association president.

The study found that the risk of errors greatly increased when nurses worked shifts longer than 12 hours or when they worked more than 40 hours a week. It also reinforced the findings of the 2003 Institute of Medicine report that said long working hours by nurses can pose a serious threat to patient safety.

"Right now we have 107 co-sponsors for the Safe Nursing and Patient Care Act, and it is unlikely this will pass," said Chris Donnellan, ANA associate director of government affairs. "Unfortunately, a lot of people see this as an employee-employer issue, while we regard it is a patient safety issue.

"We hear stories from across the country where people are being forced to work overtime," Donnellan said. "I have 5,000 nurses who are leaving [the profession] not because of the pay, but because of the working conditions."

But there's not a consensus on limiting voluntary overtime, Donnellan said. "Nurses also like the flexibility of 12-hour shifts, and even go so far as to take on additional shifts at other hospitals after their fourday week is done."

"We found about 7 percent of nurses were working mandatory overtime," said Dr. Myra Carmon, president of the Georgia Nurses Association. All other overtime "was voluntary overtime - nurses were working two full-time jobs.

"Nurses don't like the idea of having restrictions on their overtime, but we have to think of patient safety also," Carmon added. "There has been discussion of limiting the number of hours between practices (shifts), much like the airlines do with pilots."

New overtime pay rules
While there's no consensus on limiting overtime hours, there is a consensus on getting paid for working them.

Revised Department of Labor regulations set to take effect on Aug. 23 guarantee overtime protection for workers who earn less than $23,660 per year - or $455 per week. What worries some nurses is determining who is exempt from overtime protection.

While the new regulations don't change the status of salaried nurses who currently don't receive overtime pay, there is fear that overtime pay for nonsalaried professionals, such as contract workers who make more than $455 a week, would be eliminated, Donnellan said.

Both issues are causing the phones to ring at the ANA headquarters in Washington as nurses seek clarification, Donnellan said.

An amendment proposed by Sen. Tom Harkin (DIowa) that would protect overtime pay for workers who currently receive it passed the Senate in May.

"The issue is being debated in Congress," Carmon said. "[We believe] that if the Harkin amendment is not passed [in the House], some nurses will not be protected. Nurses must contact their legislators to make sure the Harkin amendment passes."

For information on both issues, go to www.anapoliticalpower.org.