Testimony - Lisa Ochs, Ohio Nurses Association, House Bill 163 Nurse Overtime (March 24, 2021)

Summary

A letter dated March 24, 2021, to the Ohio House Commerce & Labor Committee and Chairman Dick Stein, RE: House Bill 163 – Nurse Overtime, from Lisa Ochs, Chief Executive Officer of the Ohio Nurses Association. The written testimony says that unsafe nurse staffing and nurse fatigue top the issues in the association's surveys of nurses, and describes them as two consequences of nurse mandatory overtime. It says some employers threaten a nurse with termination and sometimes a referral to the Ohio Board of Nursing, and it refers to House Bill 346 in 2008. The closing speaks on behalf of ONA and over 210,000 Ohio registered nurses and asks that all facilities not use mandatory overtime.

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Full text

March 24, 2021
Ohio House Commerce & Labor Committee
Chairman Dick Stein
Ohio Statehouse
1 Capitol Square
Columbus, OH 43215

RE: House Bill 163 – Nurse Overtime

Dear Chairman Stein, Vice Chair Johnson, Ranking Member Lepore-Hagan, and members of the House
Commerce & Labor Committee:

My name is Lisa Ochs and I am the Chief Executive Officer of the Ohio Nurses Association. I am providing
written testimony today to make you aware of an issue of grave concern to registered nurses and patients
across the state, but more importantly I am offering a solution that will help make care safer. If you survey
nurses on the issues that concern them most, which ONA regularly does, the issues that top the list time
and time again are unsafe nurse staffing and nurse fatigue – two consequences of nurse mandatory
overtime.
Mandatory overtime is a straightforward concept; but what does it mean in healthcare? When a registered
nurse who has a predetermined schedule, but then is ordered to work additional hours before or after
their predetermined schedule, the safety of nurses and the patients in their care are often compromised.
In order to ensure nurses comply with an order to work additional unscheduled hours, some employers
will threaten a nurse with termination and, sometimes, even a referral to the Ohio Board of Nursing for
patient abandonment. Given these threats to nurses’ personal and professional livelihood, it is easy to see
why they feel coerced into accepting additional hours even though they may feel incapable of safely
delivering care. Systemically, nurses compelled to work additional hours lack the ability to stand up for
themselves and for their patients when they feel unsafe to continue delivering high quality care.
When ONA advocated for passage of nurse-staffing legislation - House Bill 346 - in 2008, it was understood
that this was a foundation to build upon. Some Ohio hospitals are mindful of the dangers of nurse fatigue
when constructing nurse staffing patterns. It’s important to note that since its enactment, ONA has
remained engaged with Ohio’s nurses to gauge the effectiveness of the 2008 law on nurse staffing. We
have found that safe nurse staffing continues to be the top concern for Ohio’s nurses, both as a patient
safety and a workplace issue. Our members have conveyed this repeatedly, and comments on social media
only reinforce this reality.
To be clear, there are a small number of hospitals in the state that have staffing plans that limit the number
of hours a nurse can work in a 24-hour period. And ONA has negotiated provisions in collective bargaining
agreements that do the same. Unfortunately, though, there are many facilities who lack detailed nurse
staffing plans. And most of the nurses we hear from report that their staffing plans are not followed, and
that their hospital employers knowingly create schedules with staffing gaps. The plan to fill these gaps
includes coercing nurses into mandatory work beyond a scheduled shift.

               The Recognized Leader and Advocate for Professional Nursing in Ohio
   3760 Ridge Mill Drive  Hilliard, OH 43026  614-969-3800  Fax 614-969-3888  www.ohnurses.org
                      In 2015, hundreds of Ohio nurses joined together and voted to commit our
                      organization to combatting the epidemic of unsafe nurse staffing and nurse fatigue
                      through the elimination of unsafe practices, like mandatory overtime. Make no
mistake: safe nurse staffing is not simply a goal for addressing unsatisfactory working conditions in
hospitals. Research has shown an inextricable link between safe nurse staffing and the safety and quality
of care patients receive in a hospital. This is a public safety issue.
Nurses in our state are commonly mandated to work hours far in excess of what has been deemed safe
for patient care, and fatigue-associated drops in performance are critical when a nurse is charged with the
care of human beings. Fatigue has been proven to result in risk factors, like increased likelihood of errors,
decline in memory, reduced ability to learn, and impaired communication skills. Even the most competent
nurse can make a mistake when exhausted, a condition that can only contribute to data showing that
medical errors are the third leading cause of preventable deaths in the United States.
Nurse fatigue presents a danger to nurses themselves, as well as to others once they venture outside the
healthcare setting. One study showed impairment due to fatigue contributed to auto-accidents due to
impaired eye-hand coordination, impaired balance and coordination, meaning a heightened risk for
workplace injury- in a setting where injury rates are among the highest across all occupations. In fact,
research has compared the impact of fatigue on performance to that of someone that is impaired due to
high blood alcohol content. Studies also link fatigue to the tendency to nod off behind the wheel, and
show that even routine activities, like driving home from work can be life-threatening.
ONA recognizes, as much as anyone, the intricacies of nurse staffing in a hospital. Hospitals are complex,
fast-moving environments operating under tremendous economic and environmental pressures. We also
know that adverse events and serious harm can result for patients when the stage isn’t set for safe practice
and clinical decision. Sound nurse staffing patterns are built upon the premise that patients are safe when
nurses are safe; and nurses aren’t safe when they are worked to the point of exhaustion. By design,
standard shift lengths for nurses are a foundational and structural component of patient care in the
hospital industry.
Though the title of this bill is ‘Prohibit mandatory nurse overtime”, I want to make it clear that nurses will
still have the ability to work additional hours if they feel safe to do so. We believe that overtime decisions
need to take place as a conversation between highly-skilled and dedicated healthcare professionals.
Nurses enter this profession devoted to helping others and it’s never an easy decision to leave patients.
However, nurses are ethically bound to assess their ability to care for patients and, in fact, the Ohio Nurse
Practice Act also requires nurses by law to provide a safe environment for patient care. The Ohio Board of
Nursing states:
     “Working under conditions of fatigue may not be safe for the nurse or the patient. A nurse who
     fails to demonstrate competence or does not provide consistent performance within his or her
     nursing practice as a result of excessive work hours, or for any other reason, will not have met
     standards of safe practice.”
Too many Ohio nurses lack the ability to refuse unsafe situations, like being forced to work in an unsafe
and fatigued state. Some employers allow nurses to fill out Assignment Despite Objection forms – which
are pieces of paper where a nurse (usually covered by the protection of a union contract) documents an
unsafe situation that he or she was forced to be part of, even when they expressed concerns to their
employer. There are hundreds of these, and these only represent a small percentage of the situations that


               The Recognized Leader and Advocate for Professional Nursing in Ohio
   3760 Ridge Mill Drive  Hilliard, OH 43026  614-969-3800  Fax 614-969-3888  www.ohnurses.org
                      occur across our state because most nurses don’t have access to Assignment Despite
                      Objection forms or really any recourse at all when they are forced to work when they
                      are fatigued.
House Bill 163 will allow all bedside nurses to have a real conversation with their employer about whether
they are in a condition that is safe to continue providing care to the patients who depend on them to be
alert and attuned to their health needs. If the nurse feels safe to continue to provide care, he or she may
do so. If the nurse does not feel safe providing care, House Bill 163 would provide that nurse the right to
decline additional hours, therefore allowing the nurse to uphold her ethical obligation and to abide by the
Ohio Nurse Practice Act without fear.
As previously mentioned, patient quality and outcomes can be linked to nurse staffing practices in a
hospital. Studies and empirical evidence demonstrate that non-overtime nurse staffing decreases the odds
of readmission rates in medical and surgical patients by approximately 50 percent and also reduces post-
discharge emergency department visits. Additionally, a 2019 report performed by the Ohio Auditor of State
showed through a detailed analysis of staffing models for six state psychiatric hospitals currently mandate
nurses and other direct care employees and that if hospitals were to eliminate mandatory overtime, the
hospitals would save the state money:
     “[The] detailed analysis of the staffing model developed by OMHAS Hospital Services found that
     the model should be adjusted to reflect historical operational needs. Do so, in addition to
     updating scheduling practices, would reduce mandated overtime and help save OMHAS up to
     nearly $1 million annually.”
Moreover, between 210,000 and 440,000 patients per year suffer from preventable harm that contributes
to their death. Tragically 44,000 to 98,000 patient deaths per year are directly attributed to medical errors,
equivalent to a Boeing 747 jet going down every single day.
Incredibly, medical errors are the third leading cause of death in the United States. A hospital’s reliance
on mandatory overtime and other unsafe staffing practices place patients at increased risk of harm, and
even death. We believe adoption of this proposal would go a long way toward mitigating those risks.
We believe it is time for Ohio to join 18 other states, including Texas, West Virginia, and Pennsylvania, in
working toward combating nurse fatigue by prohibiting mandatory overtime. Additionally, this legislation
would protect nurses from feeling coerced into working additional hours, beyond their regular shift,
through the threat of termination or licensure sanction in non-emergency situations.
There are Ohio hospitals that do not use mandatory overtime as a tool to meet staffing needs and they
are successful meeting the needs of their patients. Let’s work together to ensure that ALL facilities do not
use mandatory overtime.
On behalf of ONA and over 210,000 Ohio registered nurses, I want to thank you for the critically important
work that you do. I am eager to provide additional information and would be happy to answer any
questions you might have on this issue.



Lisa Ochs, Chief Executive Officer
Ohio Nurses Association

               The Recognized Leader and Advocate for Professional Nursing in Ohio
   3760 Ridge Mill Drive  Hilliard, OH 43026  614-969-3800  Fax 614-969-3888  www.ohnurses.org


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