The bitter cold did not deter a group of more than 20 nurses from holding signs that read "Exhausted nurses = unsafe care," "End mandatory overtime," and "When nurses float, patient safety sinks," at the corner of Palmer Avenue and Ter Heun Drive in an informational picketing on the morning of Thursday, December 11. Donning hats and mittens to guard against the off-and-on raindrops and snow flurries, the group waved and smiled to passersby at the intersection located steps away from their workplace, Falmouth Hospital.

"It's not about wages," said Judy Apone, a registered nurse for the hospital and the negotiating committee co-chairman for Falmouth's chapter of the Massachusetts Nurses Association (MNA). "We're looking to end mandatory overtime."

The group has been engaged in negotiations since its contract expired in September 2013, with the goal of addressing two key issues—mandatory overtime and the practice of "floating" nurses between units.

Ms. Apone said that Cape Cod Healthcare, the parent company of Falmouth Hospital and Cape Cod Hospital in Hyannis, implements the highest level of mandatory overtime statewide. Cases at Falmouth are not quite as high as Hyannis, though; at a meeting attended by Cape Cod Hospital staff, representatives of the Massachusetts Nurses Association learned that 16 nurses in one department had been mandated to work overtime in a period of a few months.

"You can't take someone calling out sick as a reason to mandate overtime," she said.

Her colleague and co-chairman, nurse Phyllis A. Peterson, said that nurses are proud of their hospital but have experienced issues with management.

"The hospital refuses to engage us in any dialogue," she said in a phone interview prior to the picketing.

Nurses are willing to step up in the case of an emergency, but mandatory overtime is unsafe for them and for patients—and it is not an effective way to staff a hospital, Ms. Peterson said.

"[A nurse] is more likely to make a mistake after 12, 13 hours," she said.

In addition to mandatory overtime, requiring nurses trained in specific specialties to "float" between departments puts patients at risk. For example, Ms. Peterson said that asking an ICU nurse, who is trained to care for patients in highly critical condition, to work on the surgical floor is comparable to "asking a hockey coach to coach basketball."

"[ICU nurses] are highly skilled but don't have the skill or the knowledge to manage five or six patients at a time," she said.

However, Peter J. Kane, senior vice president of communications and business development for Cape Cod Healthcare, said that regular staffing is based on the historical patient census—the number of patients and nurses the hospitals have needed in each department in recent years—and the float pool is only used in special cases.

"We have a procedure in place to be able to add nurses in the event that we have something other than regular staffing patterns," he said.

As for overtime, Mr. Kane said, nurses are seldom mandated to work beyond their regular hours. He said that total nursing hours at the hospitals comprise less than one percent of mandatory overtime, stressing that the company is in full compliance with the Massachusetts overtime law brokered between the state government, the Massachusetts Hospital Association and the MNA.

Picketers have raised the issue of patient safety, he said, but the company's quality speaks for itself. Mr. Kane pointed out the numerous accolades Cape Cod Healthcare has received from third-party sources. Last year, it was named one of the top 15 healthcare systems in the country.

A third issue raised by staff, a proposal to have medical-surgical nurses "on call" in the summertime, or out of the building but available to work if needed, was taken off the table on Tuesday.

Mr. Kane described negotiations with nurses as civil and friendly, like "any typical negotiation."

"We're very grateful to them... and we're working very hard to know that in the end, the winners are the people of Cape Cod whom we take care of," he said.