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A bipartisan federal bill would set nationwide limits on mandatory overtime for nurses, protect nurses who refuse excessive hours from retaliation, and penalize healthcare facilities that violate the proposed requirements.
The Nurse Overtime and Patient Safety Act was reintroduced in Congress on Aug. 12 by Sen. Jeff Merkley (D-Oregon) and Reps. Doris Matsui (D-California) and Jen Kiggans (R-Virginia), an adult-geriatric nurse practitioner. The bicameral legislation targets excessive work hours, nurse fatigue, and patient safety.
The American Nurses Association (ANA) announced its support for the legislation. According to Merkley’s office, more than 50 organizations are backing the proposal.
“Senator Merkley and Representatives Matsui and Kiggans understand what’s at stake: patient safety starts with nurse safety,” said Jennifer Mensik Kennedy, PhD, MBA, RN, NEA-BC, FAAN, president of the American Nurses Association. “Mandatory overtime is not a staffing strategy. It is a symptom of systemic workforce challenges that put nurses in impossible positions and increase risk at the bedside through physical fatigue and burnout. ANA supports federal action that sets clear limits, strengthens protections for nurses who speak up, and helps create the safe work environments nurses and patients deserve.”
What the Mandatory Overtime Limits Would Mean for Nurses
Under the legislation, covered healthcare providers generally could not directly or indirectly require a nurse to work beyond a previously scheduled shift or duty period, regardless of the shift’s length.
The legislation would also prohibit requiring nurses to work more than 48 hours in a workweek or more than 12 consecutive hours in 24 hours. Nurses generally could not be required to work during the 10 hours immediately following the 12th hour worked in 24 hours.
Time spent in required meetings, education, or training would count toward hours worked. The legislation also addresses time nurses spend on call or standby.
The restrictions would apply to registered nurses and licensed practical nurses. Covered healthcare providers would include hospitals, psychiatric hospitals, hospital outpatient departments, critical access hospitals, ambulatory surgical centers, home health agencies, rehabilitation agencies, clinics, rural health clinics and federally qualified health centers.
The bill would not prevent nurses from voluntarily working overtime.
Eighteen states have already enacted laws or regulations restricting mandatory overtime for nurses. The federal legislation would not override state laws that provide greater protections.
Nurses Would Receive Anti-Retaliation Protections
The Nurse Overtime and Patient Safety Act goes beyond establishing limits on required work hours.
Healthcare providers would be prohibited from terminating, penalizing, discriminating against, or retaliating against nurses who refuse mandatory overtime covered by the legislation.
Protections would also apply to nurses who, in good faith, report suspected violations, participate in investigations or proceedings, or discuss potential violations with other employees or representatives of healthcare professional associations.
Providers would also be prohibited from filing a complaint or report against a nurse with a state professional disciplinary agency because the nurse refused a request to work mandatory overtime.
Nurses could file complaints about violations with the Secretary of Health and Human Services. If a violation were found, the provider could be required to establish a corrective action plan and could face civil monetary penalties.
The legislation provides for penalties of up to $10,000 for each knowing violation and calls for more severe penalties for providers that establish patterns of repeated violations.
Why Supporters Are Connecting Overtime With Patient Safety
Supporters of the legislation are framing mandatory overtime as both a workforce and patient safety issue.
The legislation cites research showing that nurses working long hours can experience fatigue, poor sleep quality, impaired vigilance, and reduced alertness, factors that can contribute to medical errors and compromise patient safety.
“We know that when truck drivers or pilots are pushed past the point of exhaustion, lives are put at risk. The same is true for nurses, and they should not be forced to work to the point that patient safety is jeopardized,” Merkley said. “As the husband of a nurse, I know these heroes take care of us when we are in need, and we need to take care of them. Our bipartisan Nurse Overtime and Patient Safety Act would protect lives by limiting mandatory overtime and ensuring nurses have the support, respect, and working conditions they need and deserve.”
Matsui said persistent staffing shortages have forced too many nurses to work excessive hours, contributing to exhaustion and burnout while potentially affecting patient safety.
Kiggans connected the issue to nurse retention, saying workplace challenges and excessive overtime can contribute to nurses leaving the profession.
Healthcare Facilities Would Face New Requirements
The legislation would require covered healthcare providers to establish written mandatory overtime policies and procedures and make them available to nursing staff.
Facilities would also have to post notices informing nurses of their rights under the law and explaining how they can file a complaint.
Providers would be required to regularly post nurse schedules by department or unit and make daily schedules available upon request to nurses assigned to those areas.
Chronic Understaffing Would Not Qualify as an Emergency
The legislation includes exceptions for declared emergencies or disasters when a healthcare provider is expected to deliver an exceptional level of emergency or other medical services to the community.
Even under those circumstances, providers would have to make reasonable efforts to fill immediate staffing needs through alternative means before requiring nurses to exceed the proposed limits.
The legislation specifically excludes emergencies resulting from a healthcare labor dispute or consistent understaffing.
That means chronic understaffing alone could not qualify for the emergency exception to the proposed mandatory overtime restrictions.
What Happens Next
If enacted, the mandatory overtime provisions would take effect one year after enactment.
The legislation also calls for the Agency for Healthcare Research and Quality to study appropriate standards for the maximum number of hours nurses can work without compromising patient safety. Those standards could vary by healthcare provider type, department, nursing duties, shift, and other factors.
The Secretary of Health and Human Services would be required to submit a report to Congress on the study, including recommendations for appropriate maximum work-hour standards, within two years of enactment.
