The Journal Gazette
Thursday, December 03, 2015 4:34 am

Extra demands on nurses

Sherry Slater | The Journal Gazette

Some local nurses are being asked or assigned to work longer than their scheduled 12-hour shifts – contrary to recommended practice, but hospitals say it is rare and happens only when there is no other solution.

A national nursing association says any nursing shift longer than 12 hours is too long. But Parkview Health and Lutheran Health Network sometimes ask their registered nurses to remain on duty beyond scheduled 12-hour shifts. 

The health care providers said such extended shifts don’t occur often but sometimes are necessary. Patient and staff safety remain top priorities, they said.

Critics say assigning nurses to continue caring for patients immediately after finishing 12-hour shifts could be putting exhausted workers in charge of dispensing prescription drugs, responding to patients in cardiac arrest and making other life-and-death decisions. 

Nurses who make mistakes while working impaired can lose their professional licenses, and without licenses, they can’t get new nursing jobs. Fatigue is considered an impairment.

Even if local nurses wanted to file a complaint about their hours, it’s unclear whom they would contact. The Indiana State Department of Health referred questions to the U.S. Department of Labor Wage and Hour Division. A Labor Department spokesman said that agency doesn’t collect complaints from fatigued nurses concerned about patient safety.

Growing demand

State and national nursing shortages have left many hospitals, including those operated by Parkview and Lutheran, with numerous unfilled positions. 

Hiring is ongoing at both local health care organizations, but it hasn’t kept up with demand for nursing care. Officials declined to be specific about how many openings they have.

In hospitals, registered nurses typically are scheduled to work three consecutive 12-hour days for a 36-hour week, which is considered full time, or four consecutive 10-hour days. 

Nurses tend to like that schedule because it allows them more days off to do other things, said Pam Cipriano, president of the American Nurses Association. 

But with holes in their nursing schedules, Lutheran and Parkview resort to various methods to fill them. 

Parkview, a Fort Wayne-based nonprofit, refers to the practice of asking nurses to stay on the job beyond a scheduled shift as up-staffing, spokesman Eric Clabaugh said.

"When a need to up-staff is identified, the first step is to seek out volunteers who may be able to come in on their day off or stay over their regularly scheduled shift," he said. 

"Parkview also works to identify areas where there may be a need to up-staff, well in advance of the actual need, and then use a variety of methods like offering extra compensation to nurses willing to switch or pick up shifts to help avoid the need to up-staff."

If enough volunteers can’t be found, Clabaugh said, supervisors resort to drafting nurses to stay on a rotating basis.

But the person at the top of the list isn’t always ready and willing to stay. Supervisors deal with that, Clabaugh said.

"Parkview’s culture is very supportive, and when a nurse is unable to stay beyond their normally scheduled shift due to family needs or other circumstances, it is not unusual for another nurse from within the same department, another department or even another hospital to fill the role and meet the need," he wrote. 

"Even if none of those options is possible – which is a rarity," he said, "nursing leadership will find a solution to support the nurse who is unable to up-staff." 

Volunteers sought

When Parkview nurses are asked to work beyond 12-hour shifts, it’s typically for two hours or a maximum of four hours, Clabaugh said. 

"And it doesn’t happen very often," he added. 

Clabaugh said Parkview payroll records show mandatory overtime has accounted for only 0.5 percent of the almost 1.5 million nursing hours worked so far this year, which would be 7,500 hours.

Lutheran officials offered fewer specifics but acknowledged that nurses are sometimes asked to work beyond 12 hours at a time. 

"Our employees are our most valuable assets, and Lutheran Health Network facilities do everything they can to prevent worker fatigue situations," Lutheran spokesman Geoff Thomas said in an email.

Both local health care providers said nurses have a choice in the matter. They said nurses are not fired if they refuse to work beyond 12 consecutive hours.

A former Parkview nurse, who contacted The Journal Gazette to complain about "mandatory" overtime, declined to be identified in print for fear that speaking out would lead to trouble finding a nursing job in the future.

Because Indiana is an at-will work state, workers are correct in believing that employers can fire them at any time without citing failure to work an extended shift as the official reason, said Alan VerPlanck, a Fort Wayne attorney and partner with Eilbacher Fletcher. 

If nurses believe employers would take that step, he said, it creates an atmosphere where employees believe they can’t say no without risking their jobs. 

Workplace concerns have bubbled up before with local nurses, said VerPlanck, who has met with local labor leaders and nurses in years past to discuss options.

"We’ve tried to unionize nurses a couple of times, and it just fizzles," he said, attributing part of the challenge to varied nursing schedules that make it difficult for nurses to know – and build trust with – their peers.

Four other nurses contacted for this story either immediately declined to be interviewed, citing fear of losing their jobs, or initially agreed but then failed to return repeated phone messages – despite the fact that all were promised they wouldn’t be identified by name. 


Asking nurses to work more than 12 consecutive hours is not a staffing solution, said Cipriano, of the American Nurses Association. "Every organization really has a responsibility to ensure they have adequate staffing," she said, adding that "adequate" refers to the number of nurses and to the specialty training each nursing assignment calls for, such as cardiac or intensive care.

Blayne Miley, director of policy and advocacy for the Indiana State Nurses Association, said the Indianapolis-based organization tries to promote and share best practices in staffing. Using those practices makes financial sense, he said.

Drawbacks of extending 12-hour shifts include greater nurse burnout, which leads to increased nurse turnover and higher training costs for replacement nurses, Miley said. 

The concern, of course, is that a nurse will be too tired to do the job correctly.

The American Nurses Association’s 16-page policy paper on nurse fatigue says "registered nurses are accountable for their practice and have an ethical responsibility to address fatigue and sleepiness in the workplace that may result in harm and prevent optimal patient care."

The Washington-based association’s professional issue panel on nurse fatigue spent more than a year drafting the position statement, which replaced two statements that addressed nurses and employers separately. 

In it, the professional association stresses that nurses and employers have a responsibility to ensure that mentally and physically tired nurses are not asked to care for patients. 

Nurses’ responsibilities include getting adequate sleep before reporting to work, taking meal and rest breaks during work shifts and using "fatigue countermeasures to maintain alertness." Those measures could include ingesting appropriate amounts of caffeine and taking scheduled nap breaks.  

The policy paper goes on to say: "Registered nurses are responsible for negotiating or even rejecting a work assignment that compromises the availability of sufficient sleep and recovery from work."

Under employers’ responsibilities, the nurses’ association includes limiting work shifts "to a maximum of 12 hours in 24 hours. Those limitations include on-call hours in addition to actual work hours."

But even if working overtime wouldn’t put a nurse in the position of exceeding 12 hours on the job, the association said, he or she should be allowed to decline the additional hours without penalty.


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