After many sessions of negotiation, nurses at Baystate Franklin Medical Center in Massachusetts are poised for a strike: the issue – overtime. The management has proposed that nurses receive overtime for hours worked over 40 per week. The hospital claims it pays $180,000 a year in overtime.

The union is fighting to maintain the current practice: nurses who work more than their scheduled 8- or 10-hour shift would receive overtime for that shift, regardless of how many hours they worked during the week.

Overtime occurs because of an inability to complete all of the care within a scheduled shift. Unexpected admissions or emergencies can throw off the typical work patterns. Overtime also occurs because a nurse on the next shift comes in late or not at all.

The supervisor, staffing office or nurse manager try to convince another employee to come in to fill the spot. Caller ID has made it a simple matter for nurses to recognize a call from their employer. While these calls are being made, nurses who have already finished their shift are asked to stay longer.

Nurses who favor the current system argue that switching to a 40-hour week as the basis for calculating overtime removes the financial disincentives for asking or forcing a nurse to stay longer.

The hospital argues that it could save $80,000, or roughly the equivalent of one full time nursing salary, by reducing the cost of overtime based on a 40-hour work week.

As the Joint Commission says, “The link between health care worker fatigue and adverse events is well documented, with a substantial number of studies indicating that the practice of extended work hours contributes to high levels of worker fatigue and reduced productivity.

These studies and others show that fatigue increases the risk of adverse events, compromises patient safety, and increases risk to personal safety and well-being.” The Joint Commission issued a Sentinel Event Alert about this issue. Get it here: Sentinel Event Alert

In my opinion, not looking at the costs to patients from medical errors made by fatigued nurses is short sighted. The overtired nurse may make a minor or a major error. The cost of litigation that may ensue from a major error will easily over strip the $80,000 in savings. The Baystate nurses are right: patient safety comes first.

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