Nurses, hospital OK with overtime rules

GREENFIELD — Baystate Franklin Medical Center, like other hospitals across the state, will have the authority to force its nurses to work overtime during special “emergency situations,” a state agency decided last month.

But the hospital cannot use this power as a staffing mechanism and must first make a “good faith effort” to have overtime covered on a voluntary basis, according to the state’s Health Policy Commission.

Both Baystate Franklin hospital officials and the Massachusetts Nurses Association said they were pleased with the regulations. Overtime, and how nurses are paid for it, has been the central topic of debate between the hospital and its local nurses union during the past 22 months.

The state Legislature banned mandatory overtime last year in order to reduce medical errors, which state officials say sometimes occur when nurses are tired and working beyond eight- or 12-hour shifts.

The law allows for an exception to the ban during an “emergency situation,” which the Health Policy Commission has defined as three possible scenarios: a government-declared emergency, a catastrophic event (like a chemical spill or natural disaster) and a “hospital emergency” that could impact patient care.

The third item has the most leeway, because it can be anything that the chief hospital executive feels could affect patient care and safety, such as forcing a nurse to continue working during a complex surgical procedure.

It can’t be, however, a routine staffing problem such as a hole in a nursing schedule caused by approved sick time, vacation, holidays or personal leaves of absence.

And the regulations outline a number of alternatives the hospital must first consider before forcing a nurse to work overtime.

The health policy commission suggested that hospitals ask for volunteers among staff working at the time, contact employees who made themselves available to work extra time, seek the use of off-duty per diem and part-time nurses, seek personnel from a contracted temp agency and determine whether coverage is available from other units in the hospital.

It also advises hospitals to take precautions by maintaining a “float pool,” creating and posting schedules a month in advance, taking actions to fill vacancies before shifts occur, establishing an “on-call” list of nurses, convening daily “pre-shift huddles” to determine staffing requirements and ensure that a hospital’s “disaster plan” provides for staffing assignments during emergency situations.

The agency’s executive director David Seltz said that the guidelines were formed after months of hearing from the public, reviewing best practices in other states and deliberating on the issue.

“As a result, our guidelines are balanced, reasonable and some of the strongest in the nation,” he said. “Above all, they protect patient safety, ensure mandatory overtime is not a hospital staffing strategy and strictly limit the practice to exceptional circumstances.”

Baystate Franklin Medical Center president Chuck Gijanto said the rules are “fair and appropriate (and) really within the framework of what we’ve done all along.”

And MNA spokesman David Schildmeier said that the union is comfortable with the regulations. Even though the hospital executive has the authority to mandate overtime, the facts that there must be a good faith effort to first find volunteers should prevent abuse of the power, he said.

Still, the MNA is asking nurses to notify the union on all instances of mandatory overtime. The hospital is also required to log the information and send it to the state’s department of public health.

There are no fines or penalties in place, in part because the law never asked the Health Policy Commission to define any. But the agency will review reports about the use of mandatory overtime and can revisit the issue at a future time, if necessary.

You can reach Chris Shores at:
or 413-772-0261, ext. 264

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