,,ii  #aaf? ,,congress  #b;d ,session   
,s4 #deda  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,septemb] #h1 #bjbj,mr4
 ,m]kley introduc$ ! foll[+ bill2 :i* 0 
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
provide = pati5t protection by limit+ ! 
numb] ( m&atory ov]time h\rs a nurse may
 be requir$ to "w 9 c]ta9 provid]s (    
s]vices to :i* paym5ts are made "u !    
,m$ic>e ,program4  #a4 ,%ort title ,?is 
,act may be cit$ z ! ,nurse ,ov]time &  
,pati5t ,safety ,act ( #bjbj4  #b4      
,f9d+s ,congress f9ds z foll[s3 7#a7 ,! 
,f$]al ,gov]nm5t has a sub/antial int]e/
 9 assur+ t ! deliv]y ( heal? c>e       
s]vices to pati5ts 9 heal? c>e          
facilities is adequate & safe4  7#b7    
,rese>*1 includ+ a /udy publi%$ 9 !     
,heal? ,s]vices ,rese>* 9 ,octob] #bjad 
& a #bjai /udy f ,new ,york ,univ]sity1 
docum5t ! foll[+3 7,a7 ,limits on "w    
h\rs h long be5 f\nd 9 high-risk        
occupational sett+s :]e long "w h\rs c  

adv]sely affect safety & p]=mance z well
 z job satisfaction & quality ( life4   
7,b7 ,regulations limit+ "w h\rs 7 fir/ 
in/itut$ 9 ! #aicjs4  7,c7 ,adoption (  
"w h\r regulations has be5 sl[] 9 !     
heal? c>e sector4  7,d7 ,a review ( !   
curr5t lit]ature indicates t despite    
pot5tial pitfalls ( discont9uity 9 c>e1 
regulat$ "w h\rs = nurses improve       
occupational & pati5t safety4  7,e7 ,!  
"w ye> = regi/]$ nurses is sub/antially 
long] ?an ! national av]age by #bjj "w  
h\rs4  7,f7 ,:5 nurses ) m ?an "o       
position ( employm5t are tak5 into      
acc\nt1 total nurse "w h\rs may be      
great] ?an ! e/imate above4  7,g7       
,fur!rmore1 because nurses frequ5tly "w 
"u a #ab-;h\r %ift s*$ule1 !y n only "w 
ext5d$ h\rs b also return to "w (t5 )\t 
suffici5t "t = re/4  7,h7 ,newly lic5s$ 
nurses "w an av]age ( #ci4d h\rs a week1
 pr$om9antly 9 #ab-;h\r %ifts4  7,i7 ,m 
?an #ac p]c5t ( newly lic5s$ nurses     
report hav+ a second paid job4  7,j7    
,new nurses pref] work+ ! day %ift1 & ! 

pref]r$ %ift l5g? is #ab h\rs4  7,k7    
,twelve p]c5t ( nurses report work+     
m&atory ov]time1 & ne>ly half "w        
volunt>y ov]time at an av]age ( ?ree    
h\rs 9 a workweek4  7#c7 ,nurses work+  
long h\rs (t5 exp]i5ce fatigue1 poor    
sleep quality1 impair$ vigilance1 & lack
 ( al]tness1 :i* contributes to m$ical  
errors & results 9 o!r consequ5ces t    
compromise pati5t safety1 ev5 aft]      
controll+ = /aff+ levels & hospital     
*>act]i/ics4  7#d7 ,eighte5 ,/ates h    
pass$ legislation or promulgat$         
regulations re/rict+ m&atory ov]time =  
nurses4  #c4 ,limitations on m&atory    
ov]time = nurses  7a7 ,provid] agreem5ts
 ,section #ahff ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #acie;cc7 is am5d$--
 7#a7 9 subsection 7a77#a7-- 7,a7 9     
subp>agraph 7,x71 by /rik+ & at ! end2  
7,b7 9 subp>agraph 7,y71 by /rik+ !     
p]iod & ins]t+ 1 &2 &  7,c7 by ins]t+   
aft] subp>agraph 7,y7 ! foll[+ new      
subp>agraph3  7,z7 to comply ) !        
requirem5ts ( subsection 7l7 7relat+ to 

limitations on m&atory ov]time =        
nurses74  2 &  7#b7 by add+ at ! end !  
foll[+ new subsection3  7l7 ,limitations
 on m&atory ov]time = nurses ,= purposes
 ( subsection 7a77#a77,z71 ! requirem5ts
 ( ?is subsection are ! foll[+3 7#a7    
,prohibition on m&atory ov]time  7,a7 ,9
 g5]al ,except z provid$ 9 ?is          
subsection1 a provid] ( s]vices %all n1 
directly or indirectly1 require a nurse 
to "w-- 7i7 9 excess (-- 7,i7 a         
previ\sly s*$ul$ "w %ift or duty p]iod (
 ! nurse1 reg>dless ( ! l5g? ( ! %ift2  
7,,ii7 #dh h\rs 9 any workweek 7z def9$ 
9 section #ggh4aje ( title #bi1 ,code ( 
,f$]al ,regulations1 or any successor   
regulation72 or  7,,iii7 #ab consecutive
 h\rs 9 a #bd-;h\r p]iod2 or  7ii7 dur+ 
! #aj-;h\r p]iod imm$iately foll[+ !    
#ab? h\r work$ 9 a %ift or duty p]iod   
dur+ a #bd-;h\r p]iod4  7,b7 ,h\rs work$
 ,= purposes ( subp>agraph 7,a71 "t sp5t
 by a nurse 9 ! foll[+ %all be includ$ z
 h\rs work$3 7i7 ,requir$ meet+s or :ile
 receiv+ education or tra9+4  7ii7 ,on  

call or on /&by :5 ! nurse is requir$ to
 be at ! provid] ( s]vices4  7iii7 ,on  
call or on /&by :5 ! nurse is n requir$ 
to be at ! provid] ( s]vices4  7,c7     
,cl>ification reg>d+ volunt>y ov]time   
,no?+ 9 ?is subsection %all be con/ru$  
to preclude a nurse f volunte]+ to "w   
ov]time4  7#b7 ,exceptions  7,a7 ,9     
g5]al ,subject to subp>agraph 7,b71 !   
requirem5ts ( p>agraph 7#a7 %all n apply
 to a provid] ( s]vices dur+ a decl>$   
em]g5cy or disa/] 7z def9$ 9 p>agraph   
7#i77;,e77 if ! provid] is reque/$1 or  
o!rwise is expect$1 to provide an       
exceptional level ( em]g5cy or o!r      
m$ical s]vices to ! community4  7,b7    
,limitations ,) respect to a provid] (  
s]vices to :i* subp>agraph 7,a7 applies1
 a nurse may only be requir$ to "w =    
p]iods 9 excess ( ! p]iods describ$ 9   
p>agraph 7#a7 if-- 7i7 ! provid] has    
made reasonable ef=ts to fill ! imm$iate
 /aff+ ne$s ( ! provid] ?r\gh alt]native
 means2  7ii7 ! duration ( ! "w         
requirem5t does n ext5d pa/ ! e>li] (-- 

7,i7 ! date on :i* ! decl>$ em]g5cy or  
disa/] ends2 or  7,,ii7 ! date on :i* ! 
provid]'s direct role 9 respond+ to !   
m$ical ne$s result+ f ! decl>$ em]g5cy  
or disa/] ends2  7iii7 a /aff vacancy = 
! next %ift becomes kn[n at ! end ( !   
curr5t %ift2 &  7iv7 !re is pot5tial h>m
 to an assign$ pati5t if ! nurs+ /aff   
memb] leaves ! assignm5t or transf]s c>e
 to ano!r nurs+ /aff memb]4  7#c7       
,:i/lebl[] protections = nurses  7,a7   
,"r to report  7i7 ,9 g5]al ,a nurse may
 file a compla9t ) ! ,secret>y aga9/ a  
provid] ( s]vices :o violates !         
provisions ( ?is subsection4  7ii7      
,proc$ure ,! ,secret>y %all e/abli% a   
proc$ure "u :i* a nurse may file a      
compla9t "u clause 7i74  7,b7           
,inve/igation ( compla9t ,! ,secret>y   
%all inve/igate compla9ts ( violations  
fil$ by a nurse "u subp>agraph 7,a74    
7,c7 ,actions ,if ! ,secret>y det]m9es t
 a provid] ( s]vices has violat$ !      
provisions ( ?is subsection1 ! ,secret>y
 %all require ! provid] to e/abli% a    

plan ( action to elim9ate ! occurr5ce ( 
su* violation1 & may seek civil money   
p5alties "u p>agraph 7#g74  7#d7 ,nurse 
nondiscrim9ation protections  7,a7 ,9   
g5]al ,a provid] ( s]vices %all n       
t]m9ate or propose to t]m9ate1 p5alize1 
discrim9ate1 or retaliate 9 any mann] ) 
respect to any aspect ( employm5t1      
includ+ dis*>ge1 promotion1 comp5sation1
 or t]ms1 conditions1 or privileges (   
employm5t1 aga9/ a nurse :o refuses to  
"w m&atory ov]time or :o 9 good fai?1   
individually or 9 conjunction ) ano!r   
p]son or p]sons-- 7i7 reports a         
violation or suspect$ violation ( ?is   
subsection to a public regulatory ag5cy1
 a private accr$itation body1 or !      
managem5t p]sonnel ( ! provid] (        
s]vices2  7ii7 initiates1 coop]ates1 or 
o!rwise p>ticipates 9 an inve/igation or
 proce$+ br\ght by a regulatory ag5cy or
 private accr$itation body conc]n+      
matt]s cov]$ by ?is subsection2 or      
7iii7 in=ms or discusses ) o!r          
employees1 ) repres5tatives ( ^?        

employees1 or ) repres5tatives (        
associations ( heal? c>e pr(essionals1  
violations or suspect$ violations ( ?is 
subsection4  7,b7 ,retaliatory report+  
,a provid] ( s]vices may n file a       
compla9t or a report aga9/ a nurse ) !  
appropriate ,/ate pr(essional discipl9>y
 ag5cy because ! nurse refus$ to comply 
) a reque/ to "w m&atory ov]time4  7,c7 
,good fai? ,= purposes ( ?is p>agraph1 a
 nurse is deem$ to be act+ 9 good fai?  
if ! nurse reasonably believes-- 7i7 t !
 in=mation report$ or disclos$ is true2 
&  7ii7 t a violation has occurr$ or may
 occur4  7#e7 ,notice policy &          
requirem5ts  7,a7 ,requirem5t to develop
 a policy & proc$ure ,ea* provid] (     
s]vices %all develop a policy & h 9     
place proc$ures to ensure1 at a m9imum1 
t-- 7i7 m&atory ov]time1 :5 requir$ z   
describ$ 9 p>agraph 7#b77;,b71 is       
docum5t$ 9 writ+2 &  7ii7 m&atory       
ov]time policies & proc$ures are cle>ly 
writt51 provid$ to all new nurs+ /aff & 
readily available to all nurs+ /aff4    

7,b7 ,requirem5t to po/ notice ,ea*     
provid] ( s]vices %all po/ conspicu\sly 
9 an appropriate location a sign 79 a =m
 specifi$ by ! ,secret>y7 specify+      
rights ( nurses "u ?is subsection4  7,c7
 ,"r to file compla9t ,su* sign %all    
include a /atem5t t a nurse may file a  
compla9t ) ! ,secret>y aga9/ a provid] (
 s]vices :o violates ! provisions ( ?is 
subsection & in=mation ) respect to !   
mann] ( fil+ su* a compla9t4  7#f7 ,po/+
 ( nurse s*$ules ,a provid] ( s]vices   
%all regul>ly po/ 9 a conspicu\s mann] !
 nurse s*$ules 7= su* p]iods ( "t t !   
,secret>y det]m9es appropriate by type  
or class ( provid] ( s]vices7 = !       
dep>tm5t or unit involv$1 & %all make   
available ^u reque/ to nurses assign$ to
 ! dep>tm5t or unit ! daily nurse s*$ule
 = su* dep>tm5t or unit4  7#g7 ,civil   
money p5alty  7,a7 ,9 g5]al ,! ,secret>y
 may impose a civil money p5alty ( n m  
?an #aj1jjj = ea* kn[+ violation ( !    
provisions ( ?is subsection committ$ by 
a provid] ( s]vices4  7,b7 ,patt]ns (   

violations ,not)/&+ subp>agraph 7,a71 ! 
,secret>y %all provide = ! imposition ( 
m sev]e civil money p5alties "u ?is     
p>agraph = provid]s ( s]vices t e/abli% 
patt]ns ( repeat$ violations ( su*      
provisions4  7,c7 ,adm9i/ration (       
p5alties ,! provisions ( section        
#aabh;,a 7o!r ?an subsections 7a7 & 7b77
 %all apply to a civil money p5alty "u  
?is p>agraph 9 ! same mann] z su*       
provisions apply to a p5alty or proce$+ 
"u section #aabh;,a7a74  ,! ,secret>y   
%all publi% on ! int]net site ( !       
,dep>tm5t ( ,heal? & ,human ,s]vices !  
names ( provid]s ( s]vices aga9/ :i*    
civil money p5alties h be5 impos$ "u ?is
 p>agraph1 ! violation = :i* ! p5alty 0 
impos$1 & su* additional in=mation z !  
,secret>y det]m9es appropriate4 ,)      
respect to a provid] ( s]vices t has _h 
a *ange 9 own]%ip1 z det]m9$ by !       
,secret>y1 p5alties impos$ on ! provid] 
( s]vices :ile "u previ\s own]%ip %all  
no long] be publi%$ by ! ,secret>y on   
su* int]net site aft] ! #a-ye> p]iod    

beg9n+ on ! date ( *ange 9 own]%ip4     
7#h7 ,rule ( con/ruction reg>d+ o!r     
rights1 rem$ies1 & proc$ures ,no?+ 9 ?is
 subsection %all be con/ru$ to alt] or  
o!rwise affect ! rights1 rem$ies1 &     
proc$ures af=ds to nurses "u ,f$]al1    
,/ate1 or local laws or "u ! t]ms (     
collective b>ga9+ agreem5ts1 memor&ums (
 und]/&+1 or o!r agreem5ts betwe5 su*   
employees & _! employ]s4  7#i7          
,def9itions ,9 ?is subsection3 7,a7     
,m&atory ov]time ,! t]m m&atory ov]time 
means h\rs work$ 9 excess ( ! p]iods (  
"t describ$ 9 p>agraph 7#a71 except z   
provid$ 9 p>agraph 7#b71 pursuant to any
 reque/ made by a provid] ( s]vices to a
 nurse :i*1 if refus$ or decl9$ by !    
nurse involv$1 may result 9 an adv]se   
employm5t consequ5ce to ! nurse1 includ+
 dis*>ge1 discipl9e1 loss ( promotion1  
or retaliatory report+ ( ! nurse to !   
,/ate pr(essional discipl9>y ag5cy      
involv$4  7,b7 ,ov]time ,! t]m ov]time  
means "t work$ 9 excess ( ! p]iods ( "t 
describ$ 9 p>agraph 7#a74  7,c7 ,nurse  

,! t]m nurse means a regi/]$ nurse or a 
lic5s$ practical nurse4  7,d7 ,provid] (
 s]vices ,! t]m provid] ( s]vices       
means-- 7i7 a hospital 7z def9$ 9       
section #ahfa7;e772  7ii7 a psy*iatric  
hospital 7z def9$ 9 section #ahfa7;f772 
7iii7 a hospital outpati5t dep>tm5t2    
7iv7 a critical access hospital 7z def9$
 9 section #ahfa7mm77#a772  7v7 an      
ambulatory surgical c5t]2  7vi7 a home  
heal? ag5cy 7z def9$ 9 section          
#ahfa7o772  7vii7 a rehabilitation      
ag5cy2  7viii7 a cl9ic1 includ+ a rural 
heal? cl9ic 7z def9$ 9 section          
#ahfa7;aa77#b772 or  7ix7 a ,f$]ally    
qualifi$ heal? c5t] 7z def9$ 9 section  
#ahfa7;aa77#d774  7,e7 ,decl>$ em]g5cy  
or disa/] ,! t]m decl>$ em]g5cy or      
disa/] means a major disa/] or an       
em]g5cy 7z ^? t]ms are def9$ 9 section  
#ajb ( ! ,rob]t ,t4 ,/af=d ,disa/]      
,relief & ,em]g5cy ,assi/ance ,act 7#db 
,u4,s4,c4 #eabb771 or an em]g5cy or     
disa/] z decl>$ by a ,gov]nor ( any     
,/ate or ,indian ,tribal gov]nm5t1 b    

does n include an em]g5cy t results f a 
labor dispute 9 ! heal? c>e indu/ry or  
consi/5t und]/aff+4  7,f7 ,/&>ds ( safe 
pati5t c>e ,! t]m /&>ds ( safe pati5t   
c>e means ! recogniz$ pr(essional /&>ds 
gov]n+ ! pr(ession ( ! nurse involv$4   
7#aj7 ,relation%ip to ,/ate law ,no?+ 9 
?is subsection %all be con/ru$ to       
preempt any ,/ate law t provides great] 
protections ) respect to m&atory ov]time
 = nurses4  4  7b7 ,effective date ,!   
am5dm5ts made by ?is section %all take  
effect #a ye> aft] ! date ( enactm5t (  
?is ,act4  #d4 ,reports  7a7 ,/&>ds on  
safe work+ h\rs = nurses  7#a7 ,/udy ,! 
,secret>y ( ,heal? & ,human ,s]vices1   
act+ ?r\gh ! ,director ( ! ,ag5cy =     
,heal?c>e ,rese>* & ,quality1 %all      
conduct a /udy to e/abli% appropriate   
/&>ds = ! maximum numb] ( h\rs t a nurse
 :o furni%es heal? c>e to pati5ts may "w
 )\t compromis+ ! safety ( su* pati5ts4 
,su* /&>ds may v>y by provid] ( s]vice &
 by dep>tm5t )9 a provid] ( s]vices1 by 
duties or functions c>ri$ out by nurses1

 by %ift1 & by o!r factors t ! ,director
 det]m9es appropriate4 ,! ,director may 
contract ) an eligible entity or        
organization to c>ry out ! /udy "u ?is  
p>agraph4  7#b7 ,report ,n lat] ?an #b  
ye>s aft] ! date ( ! enactm5t ( ?is     
,act1 ! ,secret>y %all submit to        
,congress a report on ! /udy conduct$ "u
 p>agraph 7#a7 & %all include           
recomm5dations = su* appropriate /&>ds (
 maximum "w h\rs4  7b7 ,report on       
m&atory ov]time 9 ,f$]ally op]at$ m$ical
 facilities  7#a7 ,/udy  7,a7 ,9 g5]al  
,! ,director ( ! ,(fice ( ,managem5t &  
,budget %all conduct a /udy to det]m9e !
 ext5t to :i* f$]ally op]at$ m$ical     
facilities h 9 effect practices &       
policies ) respect to ov]time           
requirem5ts = nurses t are inconsi/5t ) 
! provisions ( section #ahff7l7 ( !     
,social ,security ,act1 z add$ by       
section #c4  7,b7 ,f$]ally op]at$ m$ical
 facilities def9$ ,9 ?is subsection1 !  
t]m f$]ally op]at$ m$ical facilities    
means acute c>e hospitals1 free/&+      

cl9ics1 & home heal? c>e cl9ics t are   
op]at$ by ! ,dep>tm5t ( ,vet]ans        
,affairs1 ! ,dep>tm5t ( ,def5se1 or any 
o!r dep>tm5t or ag5cy ( ! ,unit$ ,/ates4
  7#b7 ,report ,n lat] ?an #f mon?s aft]
 ! date ( ! enactm5t ( ?is ,act1 !      
,director ( ! ,(fice ( ,managem5t &     
,budget %all submit to ,congress a      
report on ! /udy conduct$ "u p>agraph   
7#a7 & %all include recomm5dations = !  
implem5tation ( policies )9 f$]ally     
op]at$ m$ical facilities ) respect to   
ov]time requirem5ts = nurses t are      
consi/5t ) su* section #ahff7l71 z s    
add$4