Mandatory overtime has been the hot-button issue in every hospital-union conflict for the last decade, and the current contract dispute at Memorial Hospital of Rhode Island is no different.

The issue remains so persistent and prominent because it arises from basic struggles in health care today. Economic pressures have forced hospitals to discharge patients as soon as they are no longer acutely ill. As a result, all hospitalized patients are very sick, requiring great attention from nurses.

Hospitals' patient loads fluctuate unpredictably, making staffing difficult. Hospitals can't afford to have nurses standing idle. Nor can they let unexpected patients go uncared-for.

Meanwhile, there is a nationwide shortage of nurses -- exacerbated, some nurses say, by the demanding nature of hospital work and the constant threat that nurses will be required to work beyond their scheduled shifts. Mandatory overtime, union officials say, disrupts nurses' lives and puts patients at risk of errors caused by exhaustion.

Hospital officials say mandatory overtime is a last resort, very rarely used.

Over the course of a year, mandatory overtime accounts for about one-half of 1 percent of the hours that nurses work, rising to no more than 1 percent or 2 percent in peak seasons, according to Edward J. Quinlan, president of the Hospital Association of Rhode Island. Meanwhile, Quinlan said, voluntary overtime represents about 10 percent of nursing hours.

"Mandatory overtime is extremely expensive. No hospital or nursing-home facility would ever plan mandatory overtime," Quinlan said. "It's an option you reluctantly use in order to be able to care for your patients."

During labor disputes unions tend to draw more attention to mandatory overtime than to wages and benefits, even though "the data simply doesn't support the significance of it," Quinlan said.

But Linda McDonald, regional president of United Nurses and Allied Professionals, the union that represents nurses at Memorial and several other hospitals, said that the emphasis on mandatory overtime reflects nurses' genuine concerns and is "not a negotiating ploy." She noted that the union has been pushing for a state law banning mandatory overtime in every legislative session for the past several years, even when no contract negotiations were going on.

The union disputes the hospital figures on overtime. But regardless, McDonald said, no one denies that mandatory overtime does occur -- and she believes it shouldn't happen at all.

"Is it on every day, every shift? No," she said. "But are nurses and other health-care workers constantly worried about it? Yes. If you have one mandatory shift on your unit every week, you're still jeopardizing patient care on that shift. There are other ways to take care of patients."

Hospitals find mandating overtime "an easy solution," rather than resorting to more creative alternatives, McDonald asserted. In states that have banned mandatory overtime, McDonald said, "those hospitals figure out other ways to staff."

Donna Policastro, executive director of the Rhode Island State Nurses Association, said that hospitals "use mandatory overtime as a staffing tool." The association is a professional organization, not a union, but Policastro said that if there is a strike at Memorial, RISNA will join the picket line -- because it considers mandatory overtime a public-safety issue. "Nurses who work more than 12 hours a day are unsafe," Policastro said.

"If you have safe patient staffing, then you don't need mandatory overtime," Policastro said. "What we like nurses to do is be in charge of staffing their own unit."

That's essentially what happens at Newport Hospital, according to Cathy E. Duquette, vice president of nursing and patient care services. Duquette said that Newport Hospital, whose nurses are not unionized, has a "wonderful work environment" in which nurses have control over their scheduling and there are few vacancies.

As a result, Newport does not resort to mandatory overtime except for "one or two instances of a true emergency," Duquette said. Duquette relies on a "float pool" of nurses who are not assigned to units but go where they're needed, and on per-diem nurses who come in only when called.

Duquette, a former hospital association executive who opposes banning mandatory overtime, said the practice will always be a possibility given the current nursing work force -- and as nurses age and retire, the problem will only get worse. "There just won't be [enough] people out there no matter how good it gets," she said.

ffreyer@projo.com / (401) 277-7397