Health OT costs rise $5m in one year; Audit

By Stanley Tromp and Elaine O’Connor, The Province [Vancouver, B.C.], 28 Nov. 2013



Fraser Health spent $43.3 million on overtime this past year, up nearly $5 million from the previous year.

The findings come from an internal audit on OT for the health region, which has been lambasted by Health Minister Terry Lake for failing to meet its budget three years in a row despite funding increases that outpace its population growth.

The audit showed that two staffers were found to have worked astonishing amounts of overtime: one employee worked 1,358 hours of OT, the other, 1,075 hours, so each worked more than 3,000 hours a year total.

The auditors recommended management "should consider setting limits on overtime that employees may work to reduce patient-care risks and reduce (staff ) sick time," and also put "anti-fatigue" work policies in place.

The audit revealed "there is currently no policy that limits the amount of overtime that an employee may work."

Units with the highest levels of OT included emergency departments at both Royal Columbian and Surrey Memorial hospitals, Abbotsford Regional Hospital and Cancer Centre, and the hemo-dialysis unit at Royal Columbian.

The audit reviewed nurse, careaide and technician staffing at the four facilities. Payroll data revealed in 2011-12 that 30 employees accrued an average of 653 overtime hours - more than a third of their annual regular work hours.

Vivian Giglio, Fraser Health's vicepresident of clinical operations, attributed the rise in OT to staff pay increases over time and the hiring of 1,000 new nursing positions in the past few years.

Giglio said the health authority has made reducing overtime a priority since the audit.

"We are concerned about the wellbeing of our staff and do recognize that working too much overtime is not in their best interest," she said.

However, OT caps weren't on the table. Instead, the health authority requests management pay more attention to overtime, and is working on recruiting staff and training existing workers to cover in the ER.

"Overtime will always be a part of health care because of the nature of the care we provide," Giglio said.

B.C. Nurses Union vice-president Christine Sorensen countered that overuse of OT was due to bad management and that overworked nurses were at risk of injury, of making errors and ultimately of suffering burnout and leaving the profession.

Sorensen challenged the idea there were no nurses for hire - B.C. graduates about 1,000 new nurses a year. But she explained there are few fulltime openings for general nurses: what is needed is for the health system to train established nurses in specialties to make room for new hires to help relieve the pressure on staff.

"At the end of the day it is about health-care mismanagement and the failure to invest early on in prevention strategies to avoid overtime costs," Sorensen said.

Sabrina Wong, University of B.C. associate professor of nursing, said extensive OT among nursing and care staff could impact patient care.

"Clearly, there are concerns about things like patient safety and medication errors," said Wong of the university's Centre for Health Services and Policy Research.

The audit noted Fraser Health has been working to reduce overtime, providing managers with scheduling guidelines and conducting a staffing systems review. These measures have helped reduce costs 15 per cent, or $553,000, this year over last.


Some B.C. nurses' OT pay rival a doctor's paycheque

By David Carrigg, The Province [Vancouver, B.C.], July 7, 2014


Shocking overtime figures released under the Freedom of Information Act reveal Vancouver Coastal Health paid nearly $600,000 to three nurses over a 27-month period to April this year.

The top overtime-earning nurse, Jinu Joseph, netted a whopping $210,594 in overtime between January 2012, and April 2014 for 2,565 hours of work. That's an average 95 hours a month, on top of a required workload of 150 hours a month. Joseph earned $190,395 in total income for the financial year ending March 2013.

That puts Joseph's earnings on par with those of some doctors.

The second and third big overtime earners in VCH for the same period were Rose Avisa Wamunga at $195,517 and Irene Queh at $182,981.

B.C. Nurses Union president Debra McPherson said the overtime load highlights the shortage of specialty nurses in the province. Examples of specialty nurses are those who work in intensive-care units, operating rooms and trauma and cardiac wards.

"Right now we have a shortage of specialty nurses," McPherson said. "Staffing levels are low so they have to go to overtime."

She said specialty nurses are often called once or twice a day on their days off, and sometimes when they are at work, to fill shifts.

"It's not something we encourage. Fatigue builds up, which can lead to error," McPherson said.

Health authority spokeswoman Anna Marie D'Angelo confirmed all three workers were specialized nurses.

She said the authority could not speak about the individuals mentioned in this news article, but confirmed the three "worked in multiple hospital units and worked on their days off."

"Managers approve overtime and managers are responsible for their budgets," D'Angelo said. "There are many reasons to ask for overtime, but overall it's to meet the operating needs of each unit."

The health authority's director of public affairs, Gavin Wilson, said overtime comprises straight time, followed by a premium that is time and a half or double time.

Wilson said the most senior nurses are offered overtime first and emphasized that overtime cannot be stopped.

"It's important to remember that in a health care setting, if someone calls in sick, they have to be replaced to meet mandated staffing levels and ensure patient safety is maintained," Wilson said in a prepared statement.

"And that often requires asking a co-worker to stay and work an additional shift."

Wilson said the authority is having some success cutting back on overtime costs. He attributed that to an attendance wellness program to reduce sick time, and a 37 1/2-hour work week schedule implemented last year as part of the new collective agreement.

"We have also hired for vacation relief positions to avoid staff working overtime to cover their co-workers' shifts," he said. "We've also recently added an electronic scheduling and timekeeping system that's helped managers get better access to real-time information to help inform decisions about scheduling. That has reduced overtime as well."

The authority also has a policy that ensures an employee has a day off after working an overtime shift to limit excessive numbers of shifts in a row.

The B.C. Nurses Union is currently negotiating another collective agreement with the provincial government after its previous agreement expired in March.

Joseph and Queh could not be reached for comment and Wamunga did not return The Province's calls.

With files from Stanley Tromp


 The five top overtime earners

Vancouver Coastal Health Authority top overtime earners, Jan. 6, 2012 to April 10, 2014:

1. Jinu Joseph - 2,565 hours, earned $210,594.

2. Rose Avisa Wamunga - 2,385 hours, earned $195,517.

3. Irene Queh - 2,236 hours, earned $182,981.

4. Gwendolyn Farrell - 2,084 hours, earned $170,791.

5. Barbara Janus - 1,832 hours, earned $149,768.

Nurses in B.C. currently earn between $31.71 an hour and $50.21 an hour, depending on experience. Nurses are paid a premium for working nights and public holidays.


Nurses rack up $70m in OT; Specialists in Short Supply

By Susan Lazaruk, The Province [Vancouver, B.C.], 26 Aug. 2015


A chronic shortage of specially trained nurses kept overtime costs for B.C.'s two largest health authorities at more than $70 million a year, with the two hardest-working nurses taking home an astounding $125,000 in overtime pay.

"The health care system is running on nursing overtime, it depends on nurses working the overtime," B.C. Nurses Union president Gayle Duteil said. "Sixteen-hour shifts are the new norm."

Data provided by Vancouver Coastal Health listing the top 10 overtime earners showed employee Peggy Holton worked an additional 1,541 hours and was paid, at $81 an hour on average, $124,865 in overtime pay for 2014.

Staffers Francis Tiuseco, who worked 1,172 additional hours at $84 an hour and took home $98,512 in extra pay, and Mary Hooi, who worked 1,117 hours of overtime to earn an extra $91,989 at $82 an hour, were the other top two earners.

The top earners for Fraser Health for the 2014-2015 fiscal year were Minecar Li, who had 1,469 hours of overtime at $124,078, Irene Queh, who worked 1,021 hours for an extra $85,820, and Mary Morishita, with 959 hours for $79,740 OT pay.

The six staffers would also have worked about 2,000 hours at their regular shifts at an average wage of $30 to $50 an hour. Median pay for a Vancouver registered nurse is $75,000 a year, according to

Duteil said the staff shortage isn't confined to big city hospitals, with specialty nurses in particularly short supply in Fraser Health, Interior Health and the Provincial Health Services authorities.

"I just got back from Kelowna emergency where the hospital is regularly posting five shifts of overtime a day," Duteil said.

She knows of two nurses in Vancouver long-term care residences who worked 20-hour shifts last week.

"We're concerned about (burnout and sickness for) the nurses, but we're also concerned about the safety of the patients," Duteil said.

And the money paid for overtime could be used to hire an additional 1,000 nurses, she said.

Most of the shortages involve specially trained nurses in intensive care and critical care units, as well as emergency and operating rooms, Duteil said.

BCIT trains 400 nurses for those specialty positions every year and the BCNU negotiated with the health ministry for $5 million for an extra 60 seats for this year. But the nurses on training will be taken out of rotation for six months, to be replaced by nurses working overtime, then will be mentored into positions, she said.

"It's not a quick fix."

She blamed poor forecasting by health authorities for the shortages.

She said policies to limit overtime don't always work to limit shifts because nurses don't want to say no and leave co-workers in the lurch.

"We are concerned about any staff member working high numbers of overtime hours," Vancouver Coastal Health spokeswoman Anna Marie D'Angelo said in an email.

VCH limits the number of consecutive shifts under its Reducing Consecutive Shifts to Minimize Fatigue, Errors and Injuries Policy, but can't cap hours because of the union contract.

D'Angelo said the average number of OT hours worked in a year by 4,400 full-and part-time RNs in VCH is 511/2, about four hours a month.

The overall staff overtime costs for FHA were up six per cent to $43.5 million for the 2014-15 year from the previous fiscal year. The overall staff OT rate fell 21/2per cent to $30.2 million for VCH for the 2014 calendar year.

At VCH, "less than 21/2per cent of hours worked" is paid at overtime rates, D'Angelo said.

FHA spokeswoman Tasleem Juma said the OT total was up, but because of several new hires for Surrey Memorial's new emergency department and critical care tower, the percentage of overtime paid out in relation to worked hours remained stable, at 2.7 per cent.

Both VCH and FHA said they are hiring more staff.