Pennsylvania Health Care and Work Schedules

Compressed work schedules are increasingly viewed as a perk in the health-care field. In fact, in Philadelphia, some nursing jobs boast 12 hour shifts, including one job that involves acute nursing care for the elderly! Another describes a weekend nursing job that consists of 12 hour shifts, 7 p.m. to 7 a.m., 36 hours bi-weekly.

But is this a good thing? Pennsylvania is still wrestling with this issue in the context of mandatory overtime and health-care employees.

Unfortunately, “a glacial pace” moves faster nowadays than the Pennsylvania Senate. May 23, 2008 will mark the one year anniversary since HB834 – banning mandatory overtime for health-care employees – was sent to the Pennsylvania Senate. Not only have supporters rallied in Harrisburg, but bill boards have even been purchased around the state demanding action by the Senate…and yet nothing has changed.

Even before the bill was sent to the Senate, however, the evidence has been piling up that hours worked beyond a certain point were dangerous to the health of both patients and the health-care workers. Anecdotal evidence of fatigue was reported by such entities as the California Nurses Association in 2003 where a nurse described how it felt to work a mandatory 16 hour double shift in the following way:

By 4 a.m., I was so exhausted that I would stop between going from one baby to the next and completely forget why I was going to the other bedside.

A study funded by the Agency for Healthcare Research and Quality in 2002 focused on full-time hospital staff nurses and the relationship between hours worked and errors and near errors. Significantly, the study found that a 12 hour shift does not always end after 12 hours. The data indicated that almost half of the shifts worked actually exceeded 12 hours and 25 percent exceeded 12 hours and 50 minutes. The importance of this rests with the fact that error rates increased by a statistically significant amount when a shift exceeded 12 hours, although the rate was lower when the overtime was voluntary.

A month before HB834 was sent to languish in the Pennsylvania Senate, the American Journal of Nursing published the results of a study on the topic. The study was part of a Nurses Worklife and Health Study which found that more than 25 percent of the nurses responding worked 12 or more hours per day. More recently, as reported by the American Academy of Sleep Medicine in December 2007, a study in Sleep found that the risk of a motor vehicle crash doubled among nurses when they drove following shifts that exceeded 12.5 hours.

Will HB834 resolve problems inherent in overtime? Yes and no. On the one hand, except for emergencies and procedures-in-progress, according to the bill, employees of health care facilities cannot be forced “to work in excess of an agreed to, predetermined and regularly scheduled daily work shift”. In addition, employees who do work over 12 consecutive hours are entitled to ten consecutive hours of off-duty time.

BUT…on the other hand, under the bill, employees can STILL volunteer to work additional hours and employees can WAIVE the right to the ten hours of off-duty time. So the question remains is this a substantive gain for patient safety advocates or merely lip service?