Written Opponent Testimony - Ohio Hospital Association and Ohio Chamber on HB 163 (April 21, 2021)

Summary

Written opponent testimony of the Ohio Hospital Association and the Ohio Chamber of Commerce to the House Commerce and Labor Committee, dated April 21, 2021, on House Bill 163, which would prohibit mandatory nurse overtime in hospitals. The testimony states that HB 163 seeks to address a problem that has not been quantified and that no data or specific references to hospitals have been provided to suggest the practice is occurring. It names focused collaboration as an effective alternative. It also points to ORC 3727.51, which it says already holds hospitals accountable for safe staffing plans, and says hospitals offer voluntary overtime hours to nurses.

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               Ohio Hospital Association and Ohio Chamber of Commerce
         Written Opponent Testimony to House Commerce and Labor Committee
                                     April 21, 2021


Chairman Stein, Vice Chair Johnson, Ranking Member Lepore-Hagan and members of the
House Commerce and Labor Committee, on behalf of the Ohio Hospital Association and the
Ohio Chamber of Commerce, we appreciate the opportunity to share our perspectives on House
Bill 163 which would prohibit mandatory nurse overtime in hospitals.
With respect to the need of for this legislation, HB 163 seeks to address a problem that has not
been quantified. Despite reasonable requests for specific data to substantiate the allegation of
widespread use of mandated overtime, no data or specific references to hospitals have been
provided to suggest that this practice is occurring. Instead, subjective accounts have been
provided. Legislation to address an alleged issue without quantification is not necessary. An
effective alternative to this legislation would be focused collaboration to address any potential or
actual areas of concern, whether widespread or limited.

Regarding safe hospital staffing, hospitals have no desire to utilize overtime as a routine staffing
strategy, for many reasons. Patient care staffing is based upon patient care needs. Patient care
needs are based upon patient condition that legislation is not able to predict or control. Since
patient care needs continually fluctuate, hospital staffing needs also fluctuate in response to those
needs. Hospitals must adequately and safely address those patient care needs, especially when
the timing of patient care is of the essence. To ensure that patient care is safe and adequate,
staffing is continually assessed throughout a 24-hour period, not simply daily. To cite merely a
few, examples of continuously fluctuating staffing considerations based upon patient needs
include patient admissions, patient discharges, patient transfers, patient surgical cases,
emergency department patient volume and acuity, and community disasters. Continual
assessment of considerations such as these examples are critical to ensure safe care to the
patients and communities served by hospitals. Some hospitals may need to contract with agency
nurses to safely and adequately staff a shift due to last minute call-offs. Safe and timely patient
care is the ultimate priority.
The need for overtime may result from several complex factors such as the number of call-offs in
a shift, the RN turnover rate in a quarter or the number of competent nurses required in a
Ohio Hospital Association and Ohio Chamber of Commerce
Opponent Testimony
Page 2

specialty care area that are away on a leave of absence, to cite merely a few. For example, when
three call-offs occur within one hour of the beginning of an oncoming shift, a nursing leader is
accountable for ensuring safe, timely patient care is rendered. That situation, not uncommon,
may be addressed by asking for nurses to voluntarily add hours to their pre-scheduled time. This
is NOT a staffing plan, but rather one way to address the issue of call-offs with limited time to
secure replacement staff.
Hospitals DO offer voluntary overtime hours to nurses. Frequently, hospitals also offer
incentives to nurses for electing to voluntarily add hours to their scheduled time. Nurses often
choose to add these hours to their pre-scheduled time on duty and this bill allows the nurse to
continue to do so. Supporters of this bill have cited safety concerns as a justification for their
position. Hospitals are focused upon staff and patient safety as well, using existing fitness-for-
duty policies and procedures to ensure patient and staff safety when nurses choose to voluntarily
add hours on duty.
With respect to existing measures, ORC 3727.51 already exists and holds hospitals accountable
for safe staffing plans with specifications including 50% staff nurse representation on each
hospital’s safe staffing committee and its development of consideration criteria including, but not
limited to patient acuity, nurse competency, and the need to increase staffing. These plans must
be submitted to the Ohio Department of Health as well as made publicly available upon request.
In addition, numerous safety standards and measurable elements of performance already exist to
hold hospitals accountable for patient and staff safety, further making HB163 unnecessary.
Hospitals engage in rigorous cyclical accreditation processes, seek specialty certifications, and
designations for levels of care they provide to the patients and communities they serve. Each
process possesses specific requirements and standards for safety and staffing, as well.
We want to convey our deep respect for the profession and practice of nursing. Further, we have
immeasurable gratitude and appreciation for the nurses who form the very foundation of hospital
operations. The COVID-19 pandemic has underscored the tireless and dedicated service of our
hospitals’ nurses, without whom we could not serve the many needs of our communities.
To that end, we would also like to acknowledge the immense toll the pandemic has taken on all
caregivers. Ohio hospitals are addressing this challenge by retaining employee wellness
(including mental and emotional wellbeing) as a top priority. There are several initiatives
currently in place to address the needs of hospital employees and we have included an article that
recently appeared in the Columbus Dispatch highlighting just a few.
Further, the Ohio Organization for Nursing Leadership (OONL), an affiliate society of OHA, has
included the development of a leadership strategy to improve the workplace environment by
promoting care of body, mind and spirit of nursing professionals as one of their strategic
priorities. As part of this work, OONL is partnering with the Ohio State University on clinician
wellbeing strategies, working to potentially implement some of the recommendations laid out in
a policy brief titled A Call to Action: Clinician Wellbeing and Patient Care and Safety that was
produced by the Health Policy Institute of Ohio in collaboration with the OSU College of
Ohio Hospital Association and Ohio Chamber of Commerce
Opponent Testimony
Page 3

Nursing Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and
Healthcare.
HB 163 proposes government mandates that interfere with the employment relationship between
an employer and employee. Government mandates and regulations on any employment
relationship is problematic and can hinder both employers and employees because they prevent
companies and their employees from crafting tailored solutions that work best for all parties.
Specifically, this legislation adds another layer of regulation on the employment practices of
hospitals who are already subjected to the requirement to create and implement government
mandated staffing plans for their nurses.

We believe that hospitals should be free from burdensome government regulations or mandates
on their employment practices that fail to consider what is practical or makes sense for each
individual hospital. Likewise, we believe employment practices are best addressed in labor
negotiations between individual companies and their employees instead of using a one size fits
all legislative mandate. We fundamentally disagree with government regulation and intervention
in private employer decisions.

In closing, HB 163 creates government mandates that dictate the relationship between employers
and employees and represents legislation that seeks to over-regulate Ohio employers which can
hinder the state’s economic competitiveness. Rather, an effective alternative to this legislation
would be focused collaboration to address any potential or actual areas of concern, whether
widespread or limited.

It is for these reasons that the Ohio Hospital Association and Ohio Chamber of Commerce have
taken an opposition stance on HB163.
We appreciate the committee’s time and consideration.




James Guliano, MSN, RN, NPD-BC, FACHE
Vice President, Quality Programs
Ohio Hospital Association




Kevin Shimp
Director of Labor and Legal Affairs for the Ohio Chamber of Commerce
Ohio Chamber of Commerce
Ohio Hospital Association and Ohio Chamber of Commerce
Opponent Testimony
Page 4

About OHA:
Established in 1915, OHA is the nation’s first state-level hospital association. OHA exists to
collaborate with member hospitals and health systems to ensure a healthy Ohio. OHA currently
represents 240 hospitals and 14 health systems throughout Ohio. OHA members hospitals in
2020 include: 189 acute care hospitals, 23 long-term acute care facilities, 28 psychiatric,
rehabilitation, and specialty surgical hospitals, and 10 children’s hospitals. Members include 33
critical access hospitals and 51 teaching hospitals. The association is governed by a 20-member
Board of Trustees with representation from small and large hospitals, teaching facilities and
health care systems with a committee and task force structure.

About the Ohio Chamber:
The Ohio Chamber of Commerce is the state’s leading business advocate, and we represent over
8,000 companies that do business in Ohio. Our mission is to aggressively champion free
enterprise, economic competitiveness and growth for the benefit of all Ohioans. With members
ranging from small businesses to international companies, the Ohio Chamber of Commerce
represents Ohio's business voice. Founded in 1893, the Ohio Chamber is one of the state's oldest
business organizations. The Ohio Chamber is led by a volunteer board of directors that consists
of 66 business leaders from all over the state. Our staff of 19 people includes lobbyists, political
experts, membership specialists and knowledgeable support staff. The Ohio Chamber staff
promotes the chamber's pro-business agenda with Ohio's elected officials and manages
membership services that help Ohio chamber members run their businesses.


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