A few months before Sarah Sheehan quit her full-time nursing job in October, her colleagues handed her a trophy. “Most mandated RN,” it said, in recognition of the number of times she had been forced to work past her scheduled shift. It was shaped like a toilet.
In the year before Sheehan quit, her 12-hour shifts in the emergency department of Leominster’s UMass Memorial HealthAlliance - Clinton Hospital had repeatedly stretched to 16 hours. So exhausted, she would sometimes duck into a room to cry. She was missing activities with her four children, including soccer games and time with them before and after school.
The pressure became so great that Sheehan decided to switch to a part time, per diem role at the same hospital.
“It takes a toll mentally,” she said. “That’s why I Ieft when I did. I was in a bad spot. I was burnt out. It affected every other aspect of my life.”
With staffing shortages plaguing every part of the health care system, nurses say some hospitals have turned to controversial methods to stretch their existing personnel, from mandating on-call shifts to increasing the number of days nurses must work. According to reports filed with the Department of Public Health, several hospitals have turned to mandatory overtime, which requires nurses to stay beyond their scheduled shift. The practice is prohibited under state law except in cases of emergency.
“There is a law, but it has no teeth. There are no consequences,” said Katie Murphy, president of the Massachusetts Nurses Association.
Some suggest the methods may backfire by causing more burnout and driving more nurses to quit. A recent survey by the Massachusetts Nurses Association found that nearly a fifth of nurses in Massachusetts plan to leave the field in two years or less.
For their part, hospitals say they are doing their best to manage a staffing crisis that has plagued every part of the health care system, but there are no quick solutions. In a statement, Patricia Pistone, a spokeswoman for Clinton Hospital, said the hospital mandated overtime for some of its nurses to ensure safe and continuous patient care and that the move was in compliance with state law.
“Since 2021, HealthAlliance-Clinton has taken several important steps to mitigate staffing challenges, most notably collaborating with the nurses’ union on new collective bargaining language that increased pay and benefits for nurses,” Pistone said. “In addition, the hospital invested heavily in temporary traveler staff as well as created a new grad nurse program – all of which have led to greater retention and recruitment.”
Hospitals across the state have spent considerably to bring in outside staff to deal with gaps. In the fiscal year that ended in September, hospitals collectively spent $1.5 billion on temporary clinical staff, 77 percent of which were temporary nurses, according to the Massachusetts Health & Hospital Association.
But even those strategies sometimes fall short. Officials from Cape Cod Healthcare said last summer they couldn’t hire enough travelers, prompting the use of mandatory overtime. They have since greatly reduced the use of mandatory overtime by hiring more travelers and are working on recruitment efforts, such as collaborating with Cape Cod Community College to hire new grads.
According to state guidance, hospitals should only impose mandatory overtime after they’ve made a good faith effort to find voluntary coverage, including seeking per-diem and off-duty nurses, temporary labor, or nurses from other units in the hospital.
“Mandatory overtime is not a routine practice and is viewed as a final measure taken to preserve safe patient care when other options have been exhausted,” said Michael Sroczynski, senior vice president and general counsel for MHA. “Hospitals are closely following the law set more than a decade ago, including reporting all instances of its use to the Department of Public Health.”
According to data compiled by the Globe, about a dozen hospitals reported more than 350 instances of mandatory overtime between June 2022 and February 2023. That represented a decrease from the same period the previous year, when there were over 600 instances reported from approximately two dozen hospitals.
Murphy, with the nurses’ union, said the use of mandatory overtime has become less a function of unexpected emergencies, as is allowed under law, but rather poor staffing practices such as hospitals not assigning enough nurses to shifts to begin with, or failing to anticipate the normal call-outs that occur when employees get sick or have to take care of family. The guidelines developed around the law specifically prohibit mandatory overtime to compensate for routine staffing shortages. DPH records, which require a description of why mandatory overtime was needed, show some hospitals classified the use of mandatory overtime as a hospital emergency and described the reason as employees calling out sick.
However the law does allow mandatory overtime in the case of a government declaration of emergency. Former governor Charlie Baker declared a state of emergency, including a public health emergency, in March 2020. In May 2021 he ended the state of emergency, effective that June, and also declared a modified public health emergency. Governor Maura Healey announced the modified public health emergency would end in May.
Nurse groups contest that the state of emergency has ended. As proof, Murphy pointed to the fact that the state is now forcing hospitals to comply with nurse-to-patient ratios in their ICUs -- a regulation that it had held off on enforcing during the pandemic. Hospitals say the emergency is ongoing.
Other staffing practices are also putting stress on front-line workers. Meg Pilato, an ambulatory surgical nurse at St. Luke’s Hospital in New Bedford, said she has repeatedly been called in for extra shifts for routine surgeries — something that, before COVID, only happened when patients had an emergency.
“I can’t get what I need to do for my home life done because I’m at work six days a week,” she said. “The 12-hour shift on Saturday is more than my usual eight-hour shift Monday through Friday. It’s insane, and out of control ... I’m exhausted.”
Public records also show the hospital has used mandatory overtime.
In a statement, Shawn Badgley, public information officer for Southcoast Health, the parent company of St. Luke’s said the health system has used mandatory overtime on an emergency basis to deal with high patient volume amid a staffing crisis.
Other nurses have had their schedules involuntarily scrambled. Ana Echavarri, an operating room nurse at Brigham and Women’s Hospital, said the hospital had shifted her schedule from four 10-hour shifts to five eight-hour shifts a week. Other people who had worked weekends, many for child-care reasons, had been taken off weekend shifts. Employees also were being given additional on-call shifts.
“I’m able to work around it. But I’ve already had roughly 10 of my friends leave, or they’re on their way out within the next couple of weeks to pursue other jobs because they have children or other commitments, [like] elder care, that they’re not able to perform because they’re going to be here,” she said in a picket line the nurses held outside of the Brigham in February to protest working conditions.
“BWH does occasionally adjust staffing schedules to ensure continuity of patient care and every effort is made to accommodate the needs of our staff whenever possible,” said Mike Morrison, a spokesman for Mass General Brigham, in a statement.
Despite the pressures, many affected nurses say they still feel a call to the profession.
Sheehan herself found a new job working for the hospital at home program through UMass in October, which allows her to deliver nursing care in people’s homes, in addition to working per diem in the ER. She said she is one of at least seven colleagues who have left full-time work in the emergency department for the hospital at home program. Work is no longer consuming her life.
“It restored my faith in nursing,” she said.