Time and Again: Overtime in State Facilities

Report #231, April 2016
Time and Again: Overtime in State Facilities

Full Report

Executive Summary

Press Release

FOR IMMEDIATE RELEASE
April 5, 2016

For Additional Information Contact:
Carole D’Elia, Executive Director
(916) 445-2125

Commission Urges State to Set Goal to Reduce Excess Overtime in State Health Care Facilities

Last year, nursing staff working in state facilities clocked 3.75 million hours of overtime at a cost of $179 million, the Little Hoover Commission stated in a report released Tuesday calling for policymakers to cut that overtime use in half.

The bipartisan citizens commission, in a new letter report, Time and Again: Overtime in State Facilities, found the state’s overtime is four times the national average – 18 percent of state nursing staff pay is for overtime as compared to an average of four percent nationally for registered nurses and health care workers.

Most of that overtime for the nurses and psychiatric technicians working in state facilities was voluntary, some 80 percent, but staff was forced to work 417,226 hours of overtime, an archaic staffing solution all but abandoned in the private and other public health care facilities.

The Commission study stemmed from a 2015 request by Assemblymember Sebastian Ridley-Thomas, who also serves as a Commission member, to look at mandatory overtime. Assemblymember Ridley-Thomas has a bill (AB 840) under consideration by the Legislature that would ban mandatory overtime for nurses working in state facilities.

“The Commission began this review with a focus on mandatory overtime – the state’s practice of forcing its nursing staff to work back-to-back shifts to meet required nursepatient staffing ratios when there are vacancies or workers out on leave – but we soon realized this was a symptom of a much bigger problem,” said Commission Chair Pedro Nava. “Clocking 3.75 million hours of overtime in one year is a clear signal that the state is not adequately scheduling and staffing its facilities providing health care.”

These state facilities include prisons, state hospitals, developmental centers and veterans homes. Hiring nursing staff can be challenging in the best of circumstances but even more so when the patients are convicted felons and those deemed too mentally ill to stand trial. These facilities also are often in remote corners of the state, making recruitment even more difficult. The potential worker pool thins even more with the possibility that the state can force an employee to work back-to-back shifts, often with little advance notice.

In a public hearing last year, the Commission heard from state officials who manage these facilities and whose hands are often tied by budget and civil service restrictions and use overtime to meet regulated staffing requirements. The Commission also heard from nurses and psychiatric technicians who came from all over the state to provide first-hand stories of harrowing drives home from work after back-to-back shifts and collegeagues whose lives had been cut short by the stress of working long hours.

Study after study has concluded that working long hours in a health care setting is unsafe for patients and for staff. Error rates increase as does the risk of injury.

In this letter report, the Commission recommends reducing all overtime, which would reduce or possibly eliminate forced overtime and should reduce risks for errors and on-the-job injuries.

In its letter to the Governor and Legislature, the Commission recommends:

  • Set a target to reduce overtime by 50 percent by 2018 and use mandatory overtime only in well-defined emergencies.
     
  • Continue to reform civil service procedures to make it easier to hire and retain qualified staff.
     
  • Provide managers with appropriate flexibility in scheduling and structuring staff and then hold management accountable for reducing overtime.
     
  • Assess trends in patient health care and staffing needs to safely and cost-effectively provide health care in state facilities. Based on that assessment, authorize adequate staff to reduce overtime.
     

The Little Hoover Commission is an independent state agency charged with recommending ways to improve the efficiency and effectiveness of state programs. The Commission’s recommendations are submitted to the Governor and the Legislature for their consideration and action. The letter report is available at www.lhc.ca.gov.

Fact Sheet

Study Description

For this study, the Commission reviewed mandatory overtime for state employees who work in state government facilities. This review was requested by Commissioner and Assemblymember Ridley-Thomas in a May 12, 2015, request letter to the Commission.

The primary focus of this study was on mandatory overtime for nurses and psychiatric technicians who work in state hospitals, prisons and developmental centers, as well as nurses who work in veterans homes. 

Currently, it is not uncommon for nursing staff in state facilities to be required to work two eight-hour shifts in one day, with little or no notice. As a result, it is very difficult to recruit and retain staff, exacerbating the problem for those employees who do work in these positions.  Additionally, there are public safety issues. Research has shown that prolonged work hours and fatigue affect worker performance. A 2002 study examining the effects of working conditions on patient safety found that nurses with shift durations that exceeded 
12 consecutive hours had significantly higher error rates. As a result of these and other findings, the U.S. Institute of Medicine Committee on the Work Environment for Nurses and Patient Safety recommended that in order to reduce error-producing fatigue, nursing staff should be prohibited from providing patient care in excess of 12 hours in any given 24-hour period and in excess of 60 hours per seven-day work period.

In addition to patient safety being compromised by mandatory overtime, errors in state hospitals and prisons also put nursing staff at risk.  Many of the patients have been convicted of serious or violent crimes or have been deemed mentally incompetent to stand trial. 

A wage order adopted in 2001, provides that employers can propose an alternative workweek schedule, and if the agreement is approved by at least two-thirds of affected employees, it will go into effect. Many health care facilities in California have adopted an alternative workweek with 12-hour shifts. The wage order also limits work hours for nurses in California to no more than 12 hours in a 24-hour period except in a healthcare emergency. This wage order, however, does not apply to nursing staff working in state facilities.  Nurses and psychiatric technicians who work for the state have been unsuccessful at negotiating an agreement to limit work hours in a specific time period. 

A bill that would eliminate mandatory overtime in state facilities, AB 2155, was enacted by the Legislature in 2014 but vetoed by Governor Brown. In his veto message, Governor Brown indicated this issue would best be resolved through the collective bargaining process.  Similar legislation in 2005 was vetoed by Governor Schwarzenegger with a similar veto message. Two bills currently under consideration by the Legislature, AB 840, and SB 780, would prohibit mandatory overtime for nurses and psychiatric technicians who work in state facilities. 

As part of this review, the Commission examined options for better balancing staffing needs and managing costs in state facilities and other opportunities to improve patient care and working conditions.

Agenda

Overview

In this report, the Commission urges the state to reduce excess overtime in state health care facilities by 50 percent by 2018.

During its review, the Commission found that nursing staff working in state facilities clocked 3.75 million hours of overtime – at a cost of $179 million. The state’s overtime is four times the national average – 18 percent of state nursing staff pay is for overtime as compared to an average of four percent nationally for registered nurses and health care workers. The Commission also found that working long hours in a health care setting is unsafe for patients and staff.

The Commission recommends cutting all overtime, which would reduce or possibly eliminate forced overtime and should reduce risks for errors and on-the-job injuries.

This review was requested by Commissioner and Assemblyemember Sebastian Ridley-Thomas in a May 12, 2015, request letter to the Commission. 

Print 
			Agenda
  • August 27
    2015
    Mandatory Overtime
    9:00 a.m., State Capitol, Room 437, Sacramento, CA
    Public Hearing
    Agenda

    AGENDA

    Public Hearing on Mandatory Overtime
    Thursday, August 27, 2015, at 9:00 a.m.
    State Capitol, Room 437
    Sacramento, CA 


    Opening Remarks 

    Nurses Perspective

    1. Margarita Maldonado, Vice President for Bargaining, SEIU Local 1000 (Written Testimony)
      Luisa Luema, Licensed Vocational Nurse, California Department of Corrections and Rehabilitation, California Correctional Health Care Services and member of SEIU Local 1000 Psychiatric Technician Perspective (Written Testimony, Attachment)
       
    2. Coby Pizzotti, Consultant, California Association of Psychiatric Technicians (CAPT), Eric Soto, CAPT Chapter President and Psychiatric Technician, Metropolitan State Hospital, City of Norwalk (Written Testimony)
      ​​​Lessie Moore, CAPT Chapter Vice President and Psychiatric Technician, Patton State Hospital, City of San Bernardino (Written Testimony)


    Mandatory Overtime in State Correctional Facilities

    1. Cheryl Schutt, Statewide Chief Nurse Executive and Joyce Hayhoe, Director of Legislation and Communications, California Correctional Health Care Services (Written Testimony)

    Attachment 1 - FY 14/15 Statewide Voluntary and Involuntary OT Hours

    Attachment 2 - FY 14/15 Voluntary and Involuntary OT Hours by Institution

    Attachment 3 - FY 14/15 Vacancies

    Attachment 4 - FY 14/15 Temporary Separations Nursing

    1. Kelly Harrington, Director, Division of Adult Institutions, California Department of Corrections and Rehabilitation (Written Testimony)

    Attachment 1 - Bargaining Unit 17 (Registered Nurse) Agreement 

    Attachment 2 - Bargaining Unit 18 (Psychiatric Technician) Agreement


    State Hospitals, Developmental Centers and Veterans Homes

    1. Lupe Alonzo-Diaz, Deputy Director of Administrative Services, California Department of State Hospitals (Written Testimony)
       
    2. Dwayne LaFon, Deputy Director (A), Developmental Centers Division, California Department of Developmental Services (Written Testimony)
       
    3. Beth Muszynski, Chief of Research and Program Review, Veterans Homes Division, California Department of Veterans Affairs (Written Testimony)
       

    Public Comments

    Public Notice

    PUBLIC NOTICE

    FOR IMMEDIATE RELEASE
    August 14, 2015

    For Additional Information Contact:
    Carole D’Elia, Executive Director
    (916) 445-2125

    Notice of Meeting

    On Thursday, August 27, 2015, the Little Hoover Commission will conduct a public hearing on mandatory overtime for nurses and psychiatric technicians who work in state prisons, state hospitals and developmental centers, as well as nurses who work in California veterans homes. The hearing will begin at 9 a.m. in Room 437 of the State Capitol in Sacramento.

    As part of this review, the Commission will examine options for better balancing staffing needs and managing costs in state facilities and other opportunities to improve patient care and working conditions.

    At this hearing the Commission will hear from the unions that represent the nurses and psychiatric technicians, as well as nurses and psychiatric technicians who work in state facilities. These employees and their union representatives will describe the challenges they face and safety issues that arise when they work mandatory overtime shifts. The Commission also will hear from a panel of representatives from California Correctional Health Care Services, the receiver appointed by the courts in the longstanding lawsuit over prison medical treatment, and the California Department of Corrections and Rehabilitation. Another panel will include representatives from the Department of State Hospitals, the Department of Developmental Services and the Department of Veterans Affairs. Each department leader will describe the scheduling and resource challenges that have led to mandatory overtime being used as a general staffing tool. They also will present opportunities for operational improvements that could maintain patient care and patient and staff safety while reducing the need for mandatory overtime.

    There will be an opportunity for public comment at the end of the hearing. The Commission also encourages written comments. Immediately following the hearing, the Commission will hold a business meeting in the legislative counsel conference room located on the lower level of 925 L Street in Sacramento.

    All public notices for meetings are on the Commission’s website, www.lhc.ca.gov. If you need reasonable accommodation due to a disability, please contact Commission Executive Director Carole D’Elia at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, August 20, 2015.

    Video
Print 
		Agenda
  • August 27
    2015
    Mandatory Overtime
    9:00 a.m., State Capitol, Room 437, Sacramento, CA
    Public Hearing
    Agenda

    AGENDA

    Public Hearing on Mandatory Overtime
    Thursday, August 27, 2015, at 9:00 a.m.
    State Capitol, Room 437
    Sacramento, CA 


    Opening Remarks 

    Nurses Perspective

    1. Margarita Maldonado, Vice President for Bargaining, SEIU Local 1000 (Written Testimony)
      Luisa Luema, Licensed Vocational Nurse, California Department of Corrections and Rehabilitation, California Correctional Health Care Services and member of SEIU Local 1000 Psychiatric Technician Perspective (Written Testimony, Attachment)
       
    2. Coby Pizzotti, Consultant, California Association of Psychiatric Technicians (CAPT), Eric Soto, CAPT Chapter President and Psychiatric Technician, Metropolitan State Hospital, City of Norwalk (Written Testimony)
      ​​​Lessie Moore, CAPT Chapter Vice President and Psychiatric Technician, Patton State Hospital, City of San Bernardino (Written Testimony)


    Mandatory Overtime in State Correctional Facilities

    1. Cheryl Schutt, Statewide Chief Nurse Executive and Joyce Hayhoe, Director of Legislation and Communications, California Correctional Health Care Services (Written Testimony)

    Attachment 1 - FY 14/15 Statewide Voluntary and Involuntary OT Hours

    Attachment 2 - FY 14/15 Voluntary and Involuntary OT Hours by Institution

    Attachment 3 - FY 14/15 Vacancies

    Attachment 4 - FY 14/15 Temporary Separations Nursing

    1. Kelly Harrington, Director, Division of Adult Institutions, California Department of Corrections and Rehabilitation (Written Testimony)

    Attachment 1 - Bargaining Unit 17 (Registered Nurse) Agreement 

    Attachment 2 - Bargaining Unit 18 (Psychiatric Technician) Agreement


    State Hospitals, Developmental Centers and Veterans Homes

    1. Lupe Alonzo-Diaz, Deputy Director of Administrative Services, California Department of State Hospitals (Written Testimony)
       
    2. Dwayne LaFon, Deputy Director (A), Developmental Centers Division, California Department of Developmental Services (Written Testimony)
       
    3. Beth Muszynski, Chief of Research and Program Review, Veterans Homes Division, California Department of Veterans Affairs (Written Testimony)
       

    Public Comments

    Public Notice

    PUBLIC NOTICE

    FOR IMMEDIATE RELEASE
    August 14, 2015

    For Additional Information Contact:
    Carole D’Elia, Executive Director
    (916) 445-2125

    Notice of Meeting

    On Thursday, August 27, 2015, the Little Hoover Commission will conduct a public hearing on mandatory overtime for nurses and psychiatric technicians who work in state prisons, state hospitals and developmental centers, as well as nurses who work in California veterans homes. The hearing will begin at 9 a.m. in Room 437 of the State Capitol in Sacramento.

    As part of this review, the Commission will examine options for better balancing staffing needs and managing costs in state facilities and other opportunities to improve patient care and working conditions.

    At this hearing the Commission will hear from the unions that represent the nurses and psychiatric technicians, as well as nurses and psychiatric technicians who work in state facilities. These employees and their union representatives will describe the challenges they face and safety issues that arise when they work mandatory overtime shifts. The Commission also will hear from a panel of representatives from California Correctional Health Care Services, the receiver appointed by the courts in the longstanding lawsuit over prison medical treatment, and the California Department of Corrections and Rehabilitation. Another panel will include representatives from the Department of State Hospitals, the Department of Developmental Services and the Department of Veterans Affairs. Each department leader will describe the scheduling and resource challenges that have led to mandatory overtime being used as a general staffing tool. They also will present opportunities for operational improvements that could maintain patient care and patient and staff safety while reducing the need for mandatory overtime.

    There will be an opportunity for public comment at the end of the hearing. The Commission also encourages written comments. Immediately following the hearing, the Commission will hold a business meeting in the legislative counsel conference room located on the lower level of 925 L Street in Sacramento.

    All public notices for meetings are on the Commission’s website, www.lhc.ca.gov. If you need reasonable accommodation due to a disability, please contact Commission Executive Director Carole D’Elia at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, August 20, 2015.

    Video