Nurse Overtime and Patient Safety Act of 2024
This bill requires certain providers, as a condition of Medicare participation, to limit mandatory overtime for nurses.
Specifically, the bill prohibits hospitals, ambulatory surgical centers, home health agencies, rural health clinics, federally qualified health centers, and other specified providers from requiring nurses to work (1) more than a previously scheduled shift, 48 hours in a workweek, or 12 consecutive hours in a 24-hour period; or (2) during the 10 hours immediately following the 12th hour worked in a shift during a 24-hour period.
Qualifying work hours include time spent in training, on call, and on standby. The bill's provisions do not apply during declared emergencies or disasters, subject to specified conditions, and do not preclude voluntary overtime.
The bill also establishes (1) certain protections for nurses who file complaints against providers, (2) documentation and notice requirements for providers, and (3) potential civil penalties for violations.
[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7546 Introduced in House (IH)]
<DOC>
118th CONGRESS
2d Session
H. R. 7546
To amend title XVIII of the Social Security Act to provide for patient
protection by limiting the number of mandatory overtime hours a nurse
may be required to work in certain providers of services to which
payments are made under the Medicare Program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 5, 2024
Ms. Matsui (for herself and Mrs. Kiggans of Virginia) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committee on Ways and Means, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for patient
protection by limiting the number of mandatory overtime hours a nurse
may be required to work in certain providers of services to which
payments are made under the Medicare Program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Nurse Overtime and Patient Safety
Act of 2024''.
SEC. 2. FINDINGS.
Congress finds as follows:
(1) The Federal Government has a substantial interest in
assuring that the delivery of health care services to patients
in health care facilities is adequate and safe.
(2) Research, including a study published in the Health
Services Research in October 2014 and a 2019 study from New
York University, document the following:
(A) Limits on work hours have long been found in
high-risk occupational settings where long work hours
can adversely affect safety and performance as well as
job satisfaction and quality of life.
(B) Regulations limiting work hours were first
instituted in the 1930s.
(C) Adoption of work hour regulations has been
slower in the health care sector.
(D) A review of the current literature indicates
that despite potential pitfalls of discontinuity in
care, regulated work hours for nurses improve
occupational and patient safety.
(E) The work year for registered nurses is
substantially longer than the national average by 200
work hours.
(F) When nurses with more than one position of
employment are taken into account, total nurse work
hours may be greater than the estimate above.
(G) Furthermore, because nurses frequently work
under a 12-hour shift schedule, they not only work
extended hours but also return to work often without
sufficient time for rest.
(H) Newly licensed nurses work an average of 39.4
hours a week, predominantly in 12-hour shifts.
(I) More than 13 percent of newly licensed nurses
report having a second paid job.
(J) New nurses prefer working the day shift, and
the preferred shift length is 12 hours.
(K) Twelve percent of nurses report working
mandatory overtime, and nearly half work voluntary
overtime at an average of three hours in a workweek.
(3) Nurses working long hours often experience fatigue,
poor sleep quality, impaired vigilance, and lack of alertness,
which contributes to medical errors and results in other
consequences that compromise patient safety, even after
controlling for staffing levels and hospital characteristics.
(4) 18 States have passed legislation or promulgated
regulations restricting mandatory overtime for nurses.
SEC. 3. LIMITATIONS ON MANDATORY OVERTIME FOR NURSES.
(a) Provider Agreements.--Section 1866 of the Social Security Act
(42 U.S.C. 1395cc) is amended--
(1) in subsection (a)(1)--
(A) in subparagraph (X), by striking ``and'' at the
end;
(B) in subparagraph (Y), by striking the period and
inserting ``, and''; and
(C) by inserting after subparagraph (Y) the
following new subparagraph:
``(Z) to comply with the requirements of subsection (l)
(relating to limitations on mandatory overtime for nurses).'';
and
(2) by adding at the end the following new subsection:
``(l) Limitations on Mandatory Overtime for Nurses.--For purposes
of subsection (a)(1)(Z), the requirements of this subsection are the
following:
``(1) Prohibition on mandatory overtime.--
``(A) In general.--Except as provided in this
subsection, a provider of services shall not, directly
or indirectly, require a nurse to work--
``(i) in excess of--
``(I) a previously scheduled work
shift or duty period of the nurse,
regardless of the length of the shift;
``(II) 48 hours in any workweek (as
defined in section 778.105 of title 29,
Code of Federal Regulations, or any
successor regulation); or
``(III) 12 consecutive hours in a
24-hour period; or
``(ii) during the 10-hour period
immediately following the 12th hour worked in a
shift or duty period during a 24-hour period.
``(B) Hours worked.--For purposes of subparagraph
(A), time spent by a nurse in the following shall be
included as hours worked:
``(i) Required meetings or while receiving
education or training.
``(ii) On call or on standby when the nurse
is required to be at the provider of services.
``(iii) On call or on standby when the
nurse is not required to be at the provider of
services.
``(C) Clarification regarding voluntary overtime.--
Nothing in this subsection shall be construed to
preclude a nurse from volunteering to work overtime.
``(2) Exceptions.--
``(A) In general.--Subject to subparagraph (B), the
requirements of paragraph (1) shall not apply to a
provider of services during a declared emergency or
disaster (as defined in paragraph (9)(E)) if the
provider is requested, or otherwise is expected, to
provide an exceptional level of emergency or other
medical services to the community.
``(B) Limitations.--With respect to a provider of
services to which subparagraph (A) applies, a nurse may
only be required to work for periods in excess of the
periods described in paragraph (1) if--
``(i) the provider has made reasonable
efforts to fill the immediate staffing needs of
the provider through alternative means;
``(ii) the duration of the work requirement
does not extend past the earlier of--
``(I) the date on which the
declared emergency or disaster ends; or
``(II) the date on which the
provider's direct role in responding to
the medical needs resulting from the
declared emergency or disaster ends;
``(iii) a staff vacancy for the next shift
becomes known at the end of the current shift;
and
``(iv) there is potential harm to an
assigned patient if the nursing staff member
leaves the assignment or transfers care to
another nursing staff member.
``(3) Whistleblower protections for nurses.--
``(A) Right to report.--
``(i) In general.--A nurse may file a
complaint with the Secretary against a provider
of services who violates the provisions of this
subsection.
``(ii) Procedure.--The Secretary shall
establish a procedure under which a nurse may
file a complaint under clause (i).
``(B) Investigation of complaint.--The Secretary
shall investigate complaints of violations filed by a
nurse under subparagraph (A).
``(C) Actions.--If the Secretary determines that a
provider of services has violated the provisions of
this subsection, the Secretary shall require the
provider to establish a plan of action to eliminate the
occurrence of such violation, and may seek civil money
penalties under paragraph (7).
``(4) Nurse nondiscrimination protections.--
``(A) In general.--A provider of services shall not
terminate or propose to terminate, penalize,
discriminate, or retaliate in any manner with respect
to any aspect of employment, including discharge,
promotion, compensation, or terms, conditions, or
privileges of employment, against a nurse who refuses
to work mandatory overtime or who in good faith,
individually or in conjunction with another person or
persons--
``(i) reports a violation or suspected
violation of this subsection to a public
regulatory agency, a private accreditation
body, or the management personnel of the
provider of services;
``(ii) initiates, cooperates, or otherwise
participates in an investigation or proceeding
brought by a regulatory agency or private
accreditation body concerning matters covered
by this subsection; or
``(iii) informs or discusses with other
employees, with representatives of those
employees, or with representatives of
associations of health care professionals,
violations or suspected violations of this
subsection.
``(B) Retaliatory reporting.--A provider of
services may not file a complaint or a report against a
nurse with the appropriate State professional
disciplinary agency because the nurse refused to comply
with a request to work mandatory overtime.
``(C) Good faith.--For purposes of this paragraph,
a nurse is deemed to be acting in good faith if the
nurse reasonably believes--
``(i) that the information reported or
disclosed is true; and
``(ii) that a violation has occurred or may
occur.
``(5) Notice policy and requirements.--
``(A) Requirement to develop a policy and
procedure.--Each provider of services shall develop a
policy and have in place procedures to ensure, at a
minimum, that--
``(i) mandatory overtime, when required as
described in paragraph (2)(B), is documented in
writing; and
``(ii) mandatory overtime policies and
procedures are clearly written, provided to all
new nursing staff and readily available to all
nursing staff.
``(B) Requirement to post notice.--Each provider of
services shall post conspicuously in an appropriate
location a sign (in a form specified by the Secretary)
specifying rights of nurses under this subsection.
``(C) Right to file complaint.--Such sign shall
include a statement that a nurse may file a complaint
with the Secretary against a provider of services who
violates the provisions of this subsection and
information with respect to the manner of filing such a
complaint.
``(6) Posting of nurse schedules.--A provider of services
shall regularly post in a conspicuous manner the nurse
schedules (for such periods of time that the Secretary
determines appropriate by type or class of provider of
services) for the department or unit involved, and shall make
available upon request to nurses assigned to the department or
unit the daily nurse schedule for such department or unit.
``(7) Civil money penalty.--
``(A) In general.--The Secretary may impose a civil
money penalty of not more than $10,000 for each knowing
violation of the provisions of this subsection
committed by a provider of services.
``(B) Patterns of violations.--Notwithstanding
subparagraph (A), the Secretary shall provide for the
imposition of more severe civil money penalties under
this paragraph for providers of services that establish
patterns of repeated violations of such provisions.
``(C) Administration of penalties.--The provisions
of section 1128A (other than subsections (a) and (b))
shall apply to a civil money penalty under this
paragraph in the same manner as such provisions apply
to a penalty or proceeding under section 1128A(a).
The Secretary shall publish on the Internet site of the
Department of Health and Human Services the names of providers
of services against which civil money penalties have been
imposed under this paragraph, the violation for which the
penalty was imposed, and such additional information as the
Secretary determines appropriate. With respect to a provider of
services that has had a change in ownership, as determined by
the Secretary, penalties imposed on the provider of services
while under previous ownership shall no longer be published by
the Secretary on such internet site after the 1-year period
beginning on the date of change in ownership.
``(8) Rule of construction regarding other rights,
remedies, and procedures.--Nothing in this subsection shall be
construed to alter or otherwise affect the rights, remedies,
and procedures affords to nurses under Federal, State, or local
laws or under the terms of collective bargaining agreements,
memorandums of understanding, or other agreements between such
employees and their employers.
``(9) Definitions.--In this subsection:
``(A) Mandatory overtime.--The term `mandatory
overtime' means hours worked in excess of the periods
of time described in paragraph (1), except as provided
in paragraph (2), pursuant to any request made by a
provider of services to a nurse which, if refused or
declined by the nurse involved, may result in an
adverse employment consequence to the nurse, including
discharge, discipline, loss of promotion, or
retaliatory reporting of the nurse to the State
professional disciplinary agency involved.
``(B) Overtime.--The term `overtime' means time
worked in excess of the periods of time described in
paragraph (1).
``(C) Nurse.--The term `nurse' means a registered
nurse or a licensed practical nurse.
``(D) Provider of services.--The term `provider of
services' means--
``(i) a hospital (as defined in section
1861(e));
``(ii) a psychiatric hospital (as defined
in section 1861(f));
``(iii) a hospital outpatient department;
``(iv) a critical access hospital (as
defined in section 1861(mm)(1));
``(v) an ambulatory surgical center;
``(vi) a home health agency (as defined in
section 1861(o));
``(vii) a rehabilitation agency;
``(viii) a clinic, including a rural health
clinic (as defined in section 1861(aa)(2)); or
``(ix) a Federally qualified health center
(as defined in section 1861(aa)(4)).
``(E) Declared emergency or disaster.--The term
`declared emergency or disaster' means a major disaster
or an emergency (as those terms are defined in section
102 of the Robert T. Stafford Disaster Relief and
Emergency Assistance Act (42 U.S.C. 5122)), or an
emergency or disaster as declared by a Governor of any
State or Indian Tribal government, but does not include
an emergency that results from a labor dispute in the
health care industry or consistent understaffing.
``(F) Standards of safe patient care.--The term
`standards of safe patient care' means the recognized
professional standards governing the profession of the
nurse involved.
``(10) Relationship to state law.--Nothing in this
subsection shall be construed to preempt any State law that
provides greater protections with respect to mandatory overtime
for nurses.''.
(b) Effective Date.--The amendments made by this section shall take
effect 1 year after the date of enactment of this Act.
SEC. 4. REPORTS.
(a) Standards on Safe Working Hours for Nurses.--
(1) Study.--The Secretary of Health and Human Services,
acting through the Director of the Agency for Healthcare
Research and Quality, shall conduct a study to establish
appropriate standards for the maximum number of hours that a
nurse who furnishes health care to patients may work without
compromising the safety of such patients. Such standards may
vary by provider of service and by department within a provider
of services, by duties or functions carried out by nurses, by
shift, and by other factors that the Director determines
appropriate. The Director may contract with an eligible entity
or organization to carry out the study under this paragraph.
(2) Report.--Not later than 2 years after the date of the
enactment of this Act, the Secretary shall submit to Congress a
report on the study conducted under paragraph (1) and shall
include recommendations for such appropriate standards of
maximum work hours.
(b) Report on Mandatory Overtime in Federally Operated Medical
Facilities.--
(1) Study.--
(A) In general.--The Director of the Office of
Management and Budget shall conduct a study to
determine the extent to which federally operated
medical facilities have in effect practices and
policies with respect to overtime requirements for
nurses that are inconsistent with the provisions of
section 1866(l) of the Social Security Act, as added by
section 3.
(B) Federally operated medical facilities
defined.--In this subsection, the term ``federally
operated medical facilities'' means acute care
hospitals, freestanding clinics, and home health care
clinics that are operated by the Department of Veterans
Affairs, the Department of Defense, or any other
department or agency of the United States.
(2) Report.--Not later than 6 months after the date of the
enactment of this Act, the Director of the Office of Management
and Budget shall submit to Congress a report on the study
conducted under paragraph (1) and shall include recommendations
for the implementation of policies within federally operated
medical facilities with respect to overtime requirements for
nurses that are consistent with such section 1866(l), as so
added.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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