On February 12, 2003, ANA hailed the Safe Nursing and Patient Care Act of 2003, a bill introduced by Rep. Pete Stark (D-CA) and Rep. Steven LaTourette (R-OH) that would strictly limit the use of mandatory overtime for nurses. Sens. Edward Kennedy (D-MA) and John Kerry (D-MA) introduced companion legislation in the Senate.

The proposed legislation, which has more than 36 U.S. House of Representatives and 10 U.S. Senate co-sponsors, would address the current nurse staffing crisis in the U.S. by strictly limiting the use of forced overtime among nurses, a dangerous practice that has contributed to a recent exodus of nurses from the nation’s hospitals and a decline in safe, quality patient care. ANA has been at the forefront of the push for this legislation and worked collabor-atively on its development with members of Congress and organizations representing nurses.

“We know that excessive use of mandatory overtime by health care facilities has been on the rise,” said ANA President Barbara Blakeney, MS, APRN,BC, ANP. “In fact, 67 percent of respondents to an ANA health and safety survey reported working some form of mandatory or unplanned overtime every month. This proposed legislation would prohibit health care facilities from forcing exhausted nurses to work extra shifts, an unsafe practice that puts both patients and nurses at risk.”

The Safe Nursing and Patient Care Act would:

• Prohibit health care facilities that receive Medicare funding from requiring a registered nurse (RN) or licensed practical nurse (LPN) to work beyond an agreed to, predetermined, regularly scheduled shift. In no instance could a nurse be required to work more than 12 hours in a 24-hour period or for more than 80 hours in a two-week period - a provision that would prevent an institution from altering shift schedules in a way that would undermine the law.

• Include nondiscrimination protections for nurses who refuse overtime and for nurses who provide information and/or cooperate with investigations about the use of overtime.

• Include an exception in the case of a declared national, state or local emergency. Such an emergency would be in response to an unpredictable disaster, not in response to a staffing deficiency resulting from management practices.

• Provide for a study by the Department of Health and Human Services on the maximum number of hours that may be worked by a nurse without compromising patient safety.

The ANA has long warned that mandatory overtime is dangerous for patients and nurses, and that the practice has been driving nurses away from the profession, thus exacerbating an emerging nursing shortage that is expected to worsen dramatically over the next 10 years.

To counter staffing insufficiencies that are already occurring, many health care facilities across the nation have increasingly imposed mandatory overtime as a common practice. Typically, an employer may insist that a nurse work an extra shift (or more) or face dismissal for insubordination, as well as being reported to the state board of nursing for patient abandonment, a charge that could lead to a loss of license for the nurse. At the same time, ethical nursing practice prohibits nurses from engaging in behavior that they know could harm patients, thus leading to a dilemma for many nurses.

By using health care law to address the problem, Congress is recognizing that mandatory overtime is a health care crisis that must be addressed if patients are to receive safe and effective care.