Imagine nurses finishing an eight-hour shift only to be informed they have to work another one, or becoming so tired on the way home from a double shift that they fall asleep at the wheel. As mandatory overtime is demanded increasingly from nurses nationwide, horror stories like these have become anthems for nursing advocacy groups. And at Penn's Nursing School, students and faculty are keenly aware of the effects mandatory overtime -- a symptom of a national shortage of nurses -- may have on health care. The issue of mandatory overtime gained national attention last September, when an investigation by The Chicago Tribune exposed medical errors by hospital nurses. According to the study, at least 1,720 patients have been killed and nearly 10,000 injured by nurse error. The Tribune investigation linked the deaths to undertrained, overworked and overwhelmed nurses working mandatory extended and double shifts due to a widespread shortage of nurses. Since then, mandatory overtime has become a key issue in a number of recent rallies and strikes. The largest strike involved 12,000 nurses at the Washington Hospital Center in Washington D.C., who ended a nine-week strike in November. "It's an environment that just breeds mistakes. You've got nurses that have been up sometimes over 24 hours, making life and death decisions," said Teri Evans, president of the Pennsylvania Association of Staff Nurses and Allied Professionals, a newly formed nursing advocacy group. "It's very much a top priority issue that we need to start addressing legislatively," Evans added. Mandatory overtime is just one of the working conditions that faces nurses. Most of these conditions result from a national nursing shortage so severe that the American Nurses Association has declared it a "public health crisis." Working in a hospital is just one option for Penn Nursing students, and some have echoed the sentiment that poor working conditions have turned them away from hospitals. "Issues like mandatory overtime have affected my decision of what to do with my nursing career, and my decision not to work in a hospital right now," Nursing Masters student Julianne Glancy said. Mandatory overtime is a practice that has been used in extreme cases of emergency, but while some hospitals address their staffing shortages by requiring nurses to work extra shifts, not all hospitals resort to this practice. Hospitals avoid mandatory overtime by offering benefits to part-time nurses who will work full time, as well as offering bonuses to nurses who voluntarily work overtime. The Hospital of the University of Pennsylvania, for example, has chosen to close beds rather than subject their nurses and patients to unsafe conditions, according to Nursing Professor Kathy McCauley. Nursing doctoral candidate Diane Graff has worked mostly in private practice, but said she would not encourage her own children to go into nursing. "I think the hours are outrageous, I think the salaries are terrible overall for the amount of work that's put in," Graff said. But Graff, who has friends in hospital administration positions, said that options are not much better for hospitals that are currently experiencing drastic budget cuts. "Nursing is the labor force that's the most expensive single entity of running a hospital," Graff said. Still, many experts maintain that this issue is just a symptom of a greater malady within the nursing profession. "Making mandatory overtime against the law is one solution to a very complex problem, but it's not the only thing that needs to be done," McCauley said. According to McCauley, such legislation is "like putting a band aid over the greater issues." The solution to the problem, she says, is to attract people to the field of nursing -- even those with degrees in other fields -- by offering scholarships to nursing schools. "If you want to be a nurse, you shouldn't have to pay any tuition," McCauley said. Nursing groups like the American Nurses Association are increasingly advocating this approach. A bill announced on Tuesday by California state Sen. Deborah Oritz would allow nursing students to apply for loans that would be forgiven if they work in understaffed areas. And advocacy groups such as PASNAP have spotlighted the issue of mandatory overtime in an attempt to create legislation against mandatory overtime and other effects of the nursing shortage. Last September, the New Jersey State Nurses Association succeeded in getting a law banning mandatory overtime in the New Jersey state Congress, making New Jersey the first state to examine the mandatory overtime issue. The law was ultimately vetoed by New Jersey Gov. Christine Whitman. That same month, a bill was introduced to the U.S. House of Representatives by Rep. Tom Lantos (D-Calif.) that would make it illegal for hospitals to force nurses to work more than eight hours in a day.
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