When a nurse is pregnant and in labor but is ordered to work overtime--giving birth the next day--then something is wrong, says Federation of Nurses/United Federation of Teachers leader Anne Goldman.

Goldman, a Federation of Nurses and Health Professionals program and policy council (FNHP PPC) member, spoke at the council meeting in early February to start a discussion about some real solutions to the problem of mandatory overtime. Being forced to work back-to-back 16-hour shifts with no time off in between is becoming chronic and unconscionable. "Our staff had more flu than our patients this winter," Goldman said of her New York City members. "[However] even those who were pregnant were working 16 hours three times a week."

It's so bad, notes Goldman, that the union has engaged attorneys to do research on injunctive relief for overworked and overtired health professionals. Employers should be penalized for using mandatory overtime as the solution for staffing and other problems that exist in hospitals today.

Some employers resort to quick fixes like paying bonuses for overtime work. But it can't make up for the worsening problem of being chronically understaffed and overworked. "You can throw money at it, but the fact remains that they're dead tired, don't want to work anymore and are unsafe," says FNHP PPC chair Candice Owley.

"The real problem has to be addressed legislatively," said Goldman. "We have double-time [pay], we have bonuses, but the marketplace is not generating the type of work force that is ready to serve the kind of patient needs that are out there."

"We need a better plan," said Goldman. "We need to do something to generate nursing enrollment."

Grievances among nursing staff are proliferating, she added. There are more violent incidents against members than ever before, more injuries, hepatitis infection is up and employers are getting waivers not to use safe needle devices. Mergers are going sour and top management is turning to the union nursing staff to help them with inadequate middle managers, she said.

"Fortune--at the jewelry counter--has more staff than I do on intensive care units," said Goldman.

At the same time, home health care units, which are beginning to proliferate to absorb the multitudes of patients who are released from hospitals still needing nursing care, are regularly coming into union ranks.

That doesn't mean they're staffed properly, however, says Jim Doelling, FNHP PPC member from the Federation of Visiting Nurses and Health Professionals in Warwick, R.I. "There are not enough nurses," said Doelling, who added that there have been five positions open in his home care group that they can't fill. "If you call in sick, the patients don't get seen."

The union solution
Having a union, fortunately, means that health care professionals have a way to deal with these problems, FNHP PPC members agreed. Through contracts, through legislation, through community involvement, through organizing already unionized members into focused committees and task forces, the problems in today's health care systems are being taken on one by one.

The Health Professionals and Allied Employees, which is part of the Coalition for Patient Care--with patients, families, community members and other unions--just oversaw the passage of a safe needle bill in the New Jersey Legislature. "We're one state of five to have this, said HPAE president and FNHP PPC vice chair Ann Twomey. The coalition also got a bill on staffing requirements introduced and legislators have agreed to hold hearings on the issue this Spring.

Developing a basis on which to make an even greater impact in the legislature and on bargaining better and safer staffing conditions is a big concern for health care professionals. Jack Needleman, Ph.D., assistant professor from the Harvard School of Public Health visited the FNHP program and policy council at its February meeting to describe the studies being conducted to analyze data on hospital staffing and its impact.

Needleman looked at ongoing studies on hospital restructuring, nurse staffing and patient outcomes. "Why study staffing?" he asked. "Because of complaints from the field about understaffing, patients' safety being put at risk and staff safety and health being put at risk."

Some studies that have already been completed may show a relationship between reduced staffing and poor patient outcomes, but many of the studies are limited or not duplicable or tainted in other ways.

"We see more professional nurses replaced by aides and technicians, and this is not good for patient care, but studies have to be done to prove it," said Needleman. "The key assertion is that things are getting worse, but it can't be documented."

While hard data proving causal relationships will certainly be helpful in the long run, FNHP PPC chair Candice Owley noted: "We can't wait until the studies come out, because nurses have already reached their limit on how bad things can become without the kind of staffing levels and help they need to do things right.... We can't sit back and wait for the data."