,,ii #aafth ,,congress #b;d ,session ,s4 #deda ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,september #h1 #bjbj,mr4 ,merkley introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,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 ,program4 #a4 ,short title ,this ,act may be cited as the ,nurse ,overtime and ,patient ,safety ,act of #bjbj4 #b4 ,findings ,congress finds as follows3 7#a7 ,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 safe4 7#b7 ,research1 including a study published in the ,health ,services ,research in ,october #bjad and a #bjai study from ,new ,york ,university1 document the following3 7,a7 ,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 life4 7,b7 ,regulations limiting work hours were first instituted in the #aicjs4 7,c7 ,adoption of work hour regulations has been slower in the health care sector4 7,d7 ,a review of the current literature indicates that despite potential pitfalls of discontinuity in care1 regulated work hours for nurses improve occupational and patient safety4 7,e7 ,the work year for registered nurses is substantially longer than the national average by #bjj work hours4 7,f7 ,when nurses with more than one position of employment are taken into account1 total nurse work hours may be greater than the estimate above4 7,g7 ,furthermore1 because nurses frequently work under a #ab-;hour shift schedule1 they not only work extended hours but also return to work often without sufficient time for rest4 7,h7 ,newly licensed nurses work an average of #ci4d hours a week1 predominantly in #ab-;hour shifts4 7,i7 ,more than #ac percent of newly licensed nurses report having a second paid job4 7,j7 ,new nurses prefer working the day shift1 and the preferred shift length is #ab hours4 7,k7 ,twelve percent of nurses report working mandatory overtime1 and nearly half work voluntary overtime at an average of three hours in a workweek4 7#c7 ,nurses working long hours often experience fatigue1 poor sleep quality1 impaired vigilance1 and lack of alertness1 which contributes to medical errors and results in other consequences that compromise patient safety1 even after controlling for staffing levels and hospital characteristics4 7#d7 ,eighteen ,states have passed legislation or promulgated regulations restricting mandatory overtime for nurses4 #c4 ,limitations on mandatory overtime for nurses 7a7 ,provider agreements ,section #ahff of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7 is amended-- 7#a7 in subsection 7a77#a7-- 7,a7 in subparagraph 7,x71 by striking and at the end2 7,b7 in subparagraph 7,y71 by striking the period and inserting 1 and2 and 7,c7 by inserting after subparagraph 7,y7 the following new subparagraph3 7,z7 to comply with the requirements of subsection 7l7 7relating to limitations on mandatory overtime for nurses74 2 and 7#b7 by adding at the end the following new subsection3 7l7 ,limitations on mandatory overtime for nurses ,for purposes of subsection 7a77#a77,z71 the requirements of this subsection are the following3 7#a7 ,prohibition on mandatory overtime 7,a7 ,in general ,except as provided in this subsection1 a provider of services shall not1 directly or indirectly1 require a nurse to work-- 7i7 in excess of-- 7,i7 a previously scheduled work shift or duty period of the nurse1 regardless of the length of the shift2 7,,ii7 #dh hours in any workweek 7as defined in section #ggh4aje of title #bi1 ,code of ,federal ,regulations1 or any successor regulation72 or 7,,iii7 #ab consecutive hours in a #bd-;hour period2 or 7ii7 during the #aj-;hour period immediately following the #abth hour worked in a shift or duty period during a #bd-;hour period4 7,b7 ,hours worked ,for purposes of subparagraph 7,a71 time spent by a nurse in the following shall be included as hours worked3 7i7 ,required meetings or while receiving education or training4 7ii7 ,on call or on standby when the nurse is required to be at the provider of services4 7iii7 ,on call or on standby when the nurse is not required to be at the provider of services4 7,c7 ,clarification regarding voluntary overtime ,nothing in this subsection shall be construed to preclude a nurse from volunteering to work overtime4 7#b7 ,exceptions 7,a7 ,in general ,subject to subparagraph 7,b71 the requirements of paragraph 7#a7 shall not apply to a provider of services during a declared emergency or disaster 7as defined in paragraph 7#i77;,e77 if the provider is requested1 or otherwise is expected1 to provide an exceptional level of emergency or other medical services to the community4 7,b7 ,limitations ,with respect to a provider of services to which subparagraph 7,a7 applies1 a nurse may only be required to work for periods in excess of the periods described in paragraph 7#a7 if-- 7i7 the provider has made reasonable efforts to fill the immediate staffing needs of the provider through alternative means2 7ii7 the duration of the work requirement does not extend past the earlier of-- 7,i7 the date on which the declared emergency or disaster ends2 or 7,,ii7 the date on which the provider's direct role in responding to the medical needs resulting from the declared emergency or disaster ends2 7iii7 a staff vacancy for the next shift becomes known at the end of the current shift2 and 7iv7 there is potential harm to an assigned patient if the nursing staff member leaves the assignment or transfers care to another nursing staff member4 7#c7 ,whistleblower protections for nurses 7,a7 ,right to report 7i7 ,in general ,a nurse may file a complaint with the ,secretary against a provider of services who violates the provisions of this subsection4 7ii7 ,procedure ,the ,secretary shall establish a procedure under which a nurse may file a complaint under clause 7i74 7,b7 ,investigation of complaint ,the ,secretary shall investigate complaints of violations filed by a nurse under subparagraph 7,a74 7,c7 ,actions ,if the ,secretary determines that a provider of services has violated the provisions of this subsection1 the ,secretary shall require the provider to establish a plan of action to eliminate the occurrence of such violation1 and may seek civil money penalties under paragraph 7#g74 7#d7 ,nurse nondiscrimination protections 7,a7 ,in general ,a provider of services shall not terminate or propose to terminate1 penalize1 discriminate1 or retaliate in any manner with respect to any aspect of employment1 including discharge1 promotion1 compensation1 or terms1 conditions1 or privileges of employment1 against a nurse who refuses to work mandatory overtime or who in good faith1 individually or in conjunction with another person or persons-- 7i7 reports a violation or suspected violation of this subsection to a public regulatory agency1 a private accreditation body1 or the management personnel of the provider of services2 7ii7 initiates1 cooperates1 or otherwise participates in an investigation or proceeding brought by a regulatory agency or private accreditation body concerning matters covered by this subsection2 or 7iii7 informs or discusses with other employees1 with representatives of those employees1 or with representatives of associations of health care professionals1 violations or suspected violations of this subsection4 7,b7 ,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 overtime4 7,c7 ,good faith ,for purposes of this paragraph1 a nurse is deemed to be acting in good faith if the nurse reasonably believes-- 7i7 that the information reported or disclosed is true2 and 7ii7 that a violation has occurred or may occur4 7#e7 ,notice policy and requirements 7,a7 ,requirement to develop a policy and procedure ,each provider of services shall develop a policy and have in place procedures to ensure1 at a minimum1 that-- 7i7 mandatory overtime1 when required as described in paragraph 7#b77;,b71 is documented in writing2 and 7ii7 mandatory overtime policies and procedures are clearly written1 provided to all new nursing staff and readily available to all nursing staff4 7,b7 ,requirement to post notice ,each provider of services shall post conspicuously in an appropriate location a sign 7in a form specified by the ,secretary7 specifying rights of nurses under this subsection4 7,c7 ,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 complaint4 7#f7 ,posting of nurse schedules ,a provider of services shall regularly post in a conspicuous manner the nurse schedules 7for such periods of time that the ,secretary determines appropriate by type or class of provider of services7 for the department or unit involved1 and shall make available upon request to nurses assigned to the department or unit the daily nurse schedule for such department or unit4 7#g7 ,civil money penalty 7,a7 ,in general ,the ,secretary may impose a civil money penalty of not more than #aj1jjj for each knowing violation of the provisions of this subsection committed by a provider of services4 7,b7 ,patterns of violations ,notwithstanding subparagraph 7,a71 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 provisions4 7,c7 ,administration of penalties ,the provisions of section #aabh;,a 7other than subsections 7a7 and 7b77 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 #aabh;,a7a74 ,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 paragraph1 the violation for which the penalty was imposed1 and such additional information as the ,secretary determines appropriate4 ,with respect to a provider of services that has had a change in ownership1 as determined by the ,secretary1 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 #a-year period beginning on the date of change in ownership4 7#h7 ,rule of construction regarding other rights1 remedies1 and procedures ,nothing in this subsection shall be construed to alter or otherwise affect the rights1 remedies1 and procedures affords to nurses under ,federal1 ,state1 or local laws or under the terms of collective bargaining agreements1 memorandums of understanding1 or other agreements between such employees and their employers4 7#i7 ,definitions ,in this subsection3 7,a7 ,mandatory overtime ,the term mandatory overtime means hours worked in excess of the periods of time described in paragraph 7#a71 except as provided in paragraph 7#b71 pursuant to any request made by a provider of services to a nurse which1 if refused or declined by the nurse involved1 may result in an adverse employment consequence to the nurse1 including discharge1 discipline1 loss of promotion1 or retaliatory reporting of the nurse to the ,state professional disciplinary agency involved4 7,b7 ,overtime ,the term overtime means time worked in excess of the periods of time described in paragraph 7#a74 7,c7 ,nurse ,the term nurse means a registered nurse or a licensed practical nurse4 7,d7 ,provider of services ,the term provider of services means-- 7i7 a hospital 7as defined in section #ahfa7;e772 7ii7 a psychiatric hospital 7as defined in section #ahfa7;f772 7iii7 a hospital outpatient department2 7iv7 a critical access hospital 7as defined in section #ahfa7mm77#a772 7v7 an ambulatory surgical center2 7vi7 a home health agency 7as defined in section #ahfa7o772 7vii7 a rehabilitation agency2 7viii7 a clinic1 including a rural health clinic 7as defined in section #ahfa7;aa77#b772 or 7ix7 a ,federally qualified health center 7as defined in section #ahfa7;aa77#d774 7,e7 ,declared emergency or disaster ,the term declared emergency or disaster means a major disaster or an emergency 7as those terms are defined in section #ajb of the ,robert ,t4 ,stafford ,disaster ,relief and ,emergency ,assistance ,act 7#db ,u4,s4,c4 #eabb771 or an emergency or disaster as declared by a ,governor of any ,state or ,indian ,tribal government1 but does not include an emergency that results from a labor dispute in the health care industry or consistent understaffing4 7,f7 ,standards of safe patient care ,the term standards of safe patient care means the recognized professional standards governing the profession of the nurse involved4 7#aj7 ,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 nurses4 4 7b7 ,effective date ,the amendments made by this section shall take effect #a year after the date of enactment of this ,act4 #d4 ,reports 7a7 ,standards on safe working hours for nurses 7#a7 ,study ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,agency for ,healthcare ,research and ,quality1 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 patients4 ,such standards may vary by provider of service and by department within a provider of services1 by duties or functions carried out by nurses1 by shift1 and by other factors that the ,director determines appropriate4 ,the ,director may contract with an eligible entity or organization to carry out the study under this paragraph4 7#b7 ,report ,not later than #b years after the date of the enactment of this ,act1 the ,secretary shall submit to ,congress a report on the study conducted under paragraph 7#a7 and shall include recommendations for such appropriate standards of maximum work hours4 7b7 ,report on mandatory overtime in ,federally operated medical facilities 7#a7 ,study 7,a7 ,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 #ahff7l7 of the ,social ,security ,act1 as added by section #c4 7,b7 ,federally operated medical facilities defined ,in this subsection1 the term federally operated medical facilities means acute care hospitals1 freestanding clinics1 and home health care clinics that are operated by the ,department of ,veterans ,affairs1 the ,department of ,defense1 or any other department or agency of the ,united ,states4 7#b7 ,report ,not later than #f months after the date of the enactment of this ,act1 the ,director of the ,office of ,management and ,budget shall submit to ,congress a report on the study conducted under paragraph 7#a7 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 #ahff7l71 as so added4