S. 5319: Nurse Overtime and Patient Safety Act (119th Congress) Bill Summary

This bill would add new federal rules to limit mandatory overtime for nurses at many health care providers that participate in Medicare.

What the main rule would do

Hospitals, clinics, home health agencies, and other covered providers would generally be prohibited from requiring a nurse to work beyond certain limits. In practical terms, a nurse could not be forced to work:

past a previously scheduled shift or duty period;
more than 48 hours in a workweek;
more than 12 consecutive hours in a 24-hour period; or
during the 10-hour period after the nurse has already worked 12 hours in that 24-hour period.

The bill also says that certain time counts as work time for these limits, including:

required meetings, training, or education;
on-call or standby time when the nurse must remain at the facility; and
on-call or standby time even when the nurse is not required to stay at the facility.

Nurses would still be allowed to volunteer for overtime.

Emergency exceptions

The overtime limits would not apply during a declared emergency or disaster if the provider is expected to deliver extra emergency medical services to the community. Even then, mandatory overtime would be allowed only if:

the provider made reasonable efforts to find other staffing;
the overtime does not continue past the end of the emergency or the provider’s emergency response role;
the staffing shortage is discovered at the end of the current shift; and
there is a risk of harm to a patient if the nurse leaves or transfers care.

The bill says these exceptions do not cover emergencies caused by labor disputes in health care or by consistent understaffing.

Worker protections and enforcement

Nurses would be protected from retaliation if they refuse mandatory overtime or report violations. Covered providers could not fire, punish, discriminate against, or otherwise retaliate against a nurse for:

refusing mandatory overtime;
reporting or helping investigate a possible violation; or
discussing violations with coworkers or employee representatives.

Providers also could not report a nurse to a state licensing agency just because the nurse refused mandatory overtime.

Nurses would be allowed to file complaints with the Secretary of Health and Human Services, who would investigate them. If a violation is found, the provider could be ordered to create a corrective action plan and could face civil monetary penalties of up to $10,000 per knowing violation, with higher penalties for repeated violations. HHS would also publish the names of providers that are penalized.

Notice and scheduling requirements

Covered providers would have to:

create written policies and procedures on mandatory overtime;
document any mandatory overtime that is allowed under the emergency exception;
give those policies to new nursing staff and make them available to all nursing staff;
post a notice explaining nurses’ rights and how to file a complaint; and
regularly post nurse schedules and provide daily schedules to nurses upon request.

Studies and reports

The bill would require two studies and reports to Congress:

HHS would study what the maximum safe working hours for nurses should be and report recommendations within 2 years.
OMB would study whether federally operated medical facilities, such as those run by the VA or Department of Defense, have overtime practices that conflict with the new rules and report within 6 months.