Mandatory OT bans for nurses edge toward long term care.

After several years of watching state and federal lawmakers consider legislation banning or limiting mandatory overtime for hospital nurses, their long term care counterparts are beginning to get their due.

Pennsylvania lawmakers are mulling a bill that would limit work schedules of nurses and other patient caregivers to 80 hours in a two-week period, except in emergencies or by voluntary consent. The legislation as currently written would apply to health care workers in nursing homes and hospitals, according to Neil Cashman, legislative director for the bill's author, Sen. Christine Tartaglione.

In February, New Jersey became the first state to implement a nursing home-applicable version of a law banning mandatory overtime, according to Jeanne Otersen, director of public policy for the state's largest nurse's union, Health Professionals and Allied Employees in Emerson, N.J.

A similar bill directed at Wisconsin nursing homes, assisted living facilities, retirement centers and hospitals failed in March. The legislation would have prevented facilities from requiring nurses and nursing assistants to work more than 40 hours per week without the workers' consent, except in cases of "unforeseeable emergencies," according to the legislation text.

A law that took effect in May banning mandatory overtime in West Virginia hospitals is considered a precursor to long term care-related legislation to be introduced later this year or next year, according to Mike Hay, director of government affairs for the West Virginia Health Care Association in Charleston, W.Va.

Anyone wanting a view of where the legislation is headed in long term care can look at what's happened with hospital-based versions written during the past few years, Cashman noted.

Under existing laws in most states, health care workers, particularly nurses, can be required to work overtime if a facility is unexpectedly shorthanded, Cashman said. This has generated concerns about employee fatigue and patient safety due to possible medical errors, as well as fear of liability issues.

"Many hospitals admit they don't use mandatory overtime because they realize the risks," Cashman said. "They go out of their way to make sure they have adequate staffing levels and reserve people on notice to call on in case of a shortage. The main concern we're trying to address are those facilities that say, 'You'll work this extra shift or we'll fire or demote you.'"

Since 2000, 10 states have passed laws limiting mandatory overtime for nurses in some fashion, and in some cases established minimum nurse-to-patient ratios in hospitals, according to the American Nurses Association. Washington, New Jersey and West Virginia passed laws actually banning the practice. Two dozen other states currently have or have had similar legislation under consideration, the association reported. Federal lawmakers have Senate and House versions of "The Safe Nursing and Patient Care Act" under consideration.

In Washington, it's been fairly quiet on the medical front--a far cry from the "gloom and doom" forecasts of the hospital industry when the state passed the nation's first ban on mandatory overtime for nurses in 2002, according to Anne Piazza, a spokesperson for the Washington State Nurses Association in Seattle.

The centerpiece of arguments against the law, then and now, tends to be on how already labor-short facilities will keep enough personnel on the floor if overtime is not an option, she said.

But healthcare association members say a greater focus should be placed on finding ways to recruit more people into the caregiving industry--then enticing them to stay there.

In Washington, for example, one in five nurses leaves the workplace every year due to poor working conditions, according to Piazza. "What they need is to work on improving the workplace environment instead of simply plugging holes through mandatory on-calls and overtime," she said.

Alan G. Rosenbloom's long term care organization, The Pennsylvania Health Care Association in Harrisburg, Pa., does not support the state's proposed overtime ban. But the association president agrees that employee recruitment and retention are major factors toward reducing the industry's I dependence on overtime.

TO IMPROVE EMPLOYEE RETENTION

It's no surprise that turnover is a big problem. According to a 2002 survey by the American Health Care Association, turnover rates for staff RNs, LPNs and Directors of Nursing positions were estimated at 50 percent, while the turnover rate is estimated at more than 71 percent for CNAs. But there are some inexpensive management tactics to combat this problem, according to Ronald E. Retzke, Ph, D., president of Retzke & Associates Inc. in Milwaukee, who provides consultation services in Staff retention and training.

1. TRAIN MANAGERS, Schedule 15 to 20 minutes each week to train supervisors on the basic skills of Supervising. Begin the meeting by asking what challenges they might have with any employees. It has been noted that people leave a job primarily due to their immediate supervisor.

2. KEEP EMPLOYEE SURVEYS SHORT AND FREQUENT. Limit the survey to five or six questions and conduct it monthly Ask questions such as Do we treat you with respect, Do we communicate with you about what is going on in the company? Then, take that information to the supervisor's meeting each month.

3. SCHEDULE TIME TO SOLVE EMPLOYEE CONCERNS. Conduct listening sessions with employees by bringing pizza into the break room. Always act on the information. Take it back into the training session with the supervisors and ask what needs to be changed in terms of supervisor behavior to meet that request.

Health Care Management Educator Quint Studer author of "Hardwiring Excellence: Purpose Worthwhile Work Making a Difference," (Fire Starter Publishing, April 2004, $28) preaches the creation of a solid workplace culture to retain quality employees.

4. GET TO KNOW YOUR EMPLOYEES. Go beyond token efforts. Make talking to them an integral part of your job, and do it on their turf. Studer suggests CEOs make daily rounds and ask employees specific questions about what they need to do their jobs. Be sincere. (People can always tell when you're faking it.) When someone shares a problem, do something about it.

5. MANAGE UP. Position people well and pass along posture comments to people, and spread good news. This is an invaluable tool for getting buy-in for goals and creating more autonomy. When you consistently look for the positive and communicate it, you create a culture where people want to work.