In the spring of 2021, as the national COVID-19 vaccine rollout promised to lift the burden of overwhelmed hospitals, nurses at the University of Michigan were working harder than ever. Understaffing has been a problem for University of Michigan nurses since the 1980s, but it worsened during the pandemic, as patient surges met with hospital-wide cost containment measures that further thinned staff and resources.

Over the first year of the pandemic, University of Michigan nurses filled gaps in staffing mainly by volunteering for overtime. As elective procedures resumed, management turned to mandatory overtime — a mechanism written into the union’s 2018 contract as an emergency measure — to staff the hospital. If a unit was short-staffed, supervisors called off-duty nurses. If one of these nurses picked up the phone, they could be mandated to work. Others were told to stay on after the end of their shifts. Nurses who declined mandates could be accused of patient abandonment.

Supervisors also used a “pre-mandating” system to continually adjust mandate schedules, creating an uncompensated on-call system. With the expanded use of mandatory overtime, the hospital began depending on this fail-safe as a routine strategy to resolve the patient-care deficits caused by chronic understaffing.