Nurses today claim that they are overworked and underpaid, and patients are suffering because of it. According to the Chicago Tribune, as many as 1,720 hospital patients have been killed and 9,584 injured because of nursing-related errors since 1995. As workloads for nurses increase significantly — along with mandatory overtime — patients who require supervision are being left without care, and nurses have claimed that their own health is suffering.

Questions of mandatory overtime has led to nurses' strikes across the country, most recently in Massachusetts and New York state. On September 21, 1,200 nurses walked off their jobs at the Washington Hospital Center to protest mandatory overtime. This is the first major nurses' strike in the D.C. area since a similar protest in 1978, which lasted 31 days. Washington Hospital Center has hired 625 temporary replacements through the U.S. Nursing Corporation. According to union officials, there is no immediate end to the strike in sight. Nurses at WHC collect between $15-$24 an hour depending on experience, with benefits included. The hospital claims that it has offered nurses a contract, which would provide for a 16.5 percent raise and a limit on overtime to two shifts every two weeks.

Nurses unions claim that the increase in wages is a secondary concern for the strikers. Oftentimes, nurses endure frequent 12-hour shifts without breaks. As insurance companies push for shorter stays in the hospital and outpatient treatment, unions say, nurses now are being left with the most critically ill and seriously injured patients to treat. These patients require round-the-clock treatment that current nurse to patient ratios won't treat. According to Nurses United, a study in Scotland indicates that treatment in overworked intensive care units can double the odds of patients dying.

Nursing unions have formed in the states of Colorado, while existing nursing unions have won significant victories in Massachusetts and New York. In June this year, New Jersey legislators voted to ban mandatory overtime in hospitals. In California, a law has been passed which discourages mandatory overtime by requiring specific nurse-patient ratios. Early this September, U.S. Representative Tom Lantos (D-Calif.) introduced a bill to limit mandatory overtime for nurses in hospitals and medical facilities. The bill has eight cosponsors in the house.

Nobody denies that as baby boomers grow older, there will be a serious nursing shortage. The pay scale for RNs is lower than it is for other stressful jobs. The current average age for nurses is 42; it will increase to 45 over the next ten years. According to Peter Buerhaus of the Vanderbilt University School of Nursing, that could mean a shortage of 400,000 RNs within the decade. Hospitals claim that it's the only way to adjust to the shortage in the work force. Nurses unions, however, say that they're doing it the wrong way: by forcing nurses to work overtime in a profession where overwork is life-threatening. Should the government step in and place controls on mandatory overtime for nurses?

On One Hand...

The current "shortage" of nurses is a direct result of the transformation of hospitals into moneymaking operations. In the mid-90s, many US hospitals cut back on their nursing staff in response to pressure from HMOs and other private concerns. By downsizing they left more work in the hands of fewer people, and over the last decade nursing has become a high-pressure, 12 hour/day job with low-pressure salary. It should come as no surprise that fewer people than ever are willing to take up this grueling, unrewarding position, where are treated without the respect that they get in other mid-level jobs. Not only is it unjust that nurses are expected to compensate for this shortage by working mandatory extra hours. It also makes the job less attractive than it already is, at a time when the number of nurses is already at a critically low level. The federal government needs to step in and put a limit on mandatory overtime for nurses.

On the Other Hand...

Overtime should not be limited in the nursing profession. When a critically wounded patient is wheeled into the ICU, that patient needs care. If a nurse simply walks off the job because he or she has a date, there has to be a replacement. It's the basic right of any patient, and if a nurse is unwilling to stay a few hours to provide that care, he or she is probably in the wrong profession. The same code applies to doctors as well as to other essential services. Unfortunately, at this point, the numbers of nurses has been reduced, while critically ill patients remain. Clearly, times have changed, and something has to be done to make the profession more attractive. But placing a federal cap on mandatory overtime would endanger the lives of patients by ignoring the short-term truth: you can't just walk out on a patient whose life is in danger when there's no one to take the job.

• Dr. Richard Anderson, an executive at Doctor's Company, a malpractice insurer covering 18,000 doctors, says the RN shortage could be fuelling the number of patients dissatisfied with the quality of their care and more eager to sue their doctors and hospitals.

• A survey conducted by the California Board of Registered Nursing in 1997 reported that the average nursing salary in the state was $45,073.

• Hospital system executives say unionized nurses will drive up costs by demanding higher pay and exacerbate staffing shortages by taking resources needed to recruit new nurses.

• Under the expired contract, the average nurse at the Washington Hospital Center earns $60,626 a year, including base pay, bonuses, and overtime.

Financial Times; Nurses United; Business Journal.com; Washington Post