Bill Overview
Title: Nurse Overtime and Patient Safety Act
Description: This bill requires certain providers, as a condition of Medicare participation, to limit mandatory overtime for nurses. Specifically, the bill prohibits hospitals, ambulatory surgical centers, home health agencies, rural health clinics, federally qualified health centers, and other specified providers from requiring nurses to work (1) more than a previously scheduled shift, 48 hours in a workweek, or 12 consecutive hours in a 24-hour period; or (2) during the 10 hours immediately following the 12th hour worked in a shift during a 24-hour period. Qualifying work hours include time spent in training, on call, and on standby. The bill's provisions do not apply during declared emergencies or disasters, subject to specified conditions, and do not preclude voluntary overtime. The bill also establishes (1) certain protections for nurses who file complaints against providers, (2) documentation and notice requirements for providers, and (3) potential civil penalties for violations.
Sponsors: Sen. Merkley, Jeff [D-OR]
Target Audience
Population: Nurses working under providers participating in Medicare and their patients
Estimated Size: 4000000
- The bill impacts nurses working in various healthcare settings as it directly addresses their working hours and conditions.
- There are about 4 million registered nurses in the United States, many of whom work in settings covered by the bill, like hospitals and clinics.
- The bill affects healthcare settings that participate in Medicare, a major federal program in the U.S.
- The bill has implications for healthcare providers, as they need to comply with new regulations or face penalties.
- Globally, nursing workforce estimates suggest at least 20 million nurses and midwives worldwide could be indirectly affected if similar legislations are adopted elsewhere.
Reasoning
- The impact of this policy is primarily on registered nurses, a significant workforce within the healthcare system. Nurses in hospitals, rural health clinics, and other medical facilities will directly experience changes in working conditions.
- Nurse workload and overtime are already major issues in the healthcare industry, often affecting job satisfaction, burnout levels, and patient care quality.
- Patients may indirectly experience improved healthcare as nurses are less fatigued and possibly more attentive when overwork is reduced.
- Considerations include implementing policies and ensuring compliance, which involve administrative costs. These costs must fit the budget allocated and must be monitored for sustainability over ten years.
- Representation of diverse geographic and employment settings can reflect the varied impact across the healthcare sector.
- Relatively common occupation in large urban hospitals, moderate in rural centers, with distinct challenges faced in different settings.
Simulated Interviews
Registered Nurse (Chicago, IL)
Age: 32 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 15/20
Statement of Opinion:
- The policy sounds like it could provide some much-needed relief from the exhausting number of hours we work.
- It could improve my work-life balance, allowing me to spend more time with my family.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 8 | 5 |
| Year 5 | 8 | 4 |
| Year 10 | 9 | 3 |
| Year 20 | 9 | 3 |
Nurse Practitioner (Rural Mississippi)
Age: 45 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 10/20
Statement of Opinion:
- Anything that limits overtime is going to help, though in our clinic, we still have to get the job done.
- More resources would be necessary to make this policy really effective here.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 7 | 4 |
RN (Specializes in ICU) (New York City, NY)
Age: 28 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 15.0 years
Commonness: 12/20
Statement of Opinion:
- Limiting overtime could reduce burnout and improve patient care in critical areas like the ICU.
- It's promising, but I'll believe it when I see actual scheduling changes.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 3 |
| Year 5 | 8 | 3 |
| Year 10 | 8 | 2 |
| Year 20 | 8 | 2 |
Nurse Manager (Detroit, MI)
Age: 39 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 7.0 years
Commonness: 10/20
Statement of Opinion:
- While beneficial for staffing, compliance and administrative costs are a serious consideration for the hospital's budget.
- This might initially add stress as we adjust.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 5 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 4 |
| Year 10 | 7 | 4 |
| Year 20 | 7 | 3 |
Pediatric Nurse (San Francisco, CA)
Age: 50 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 8/20
Statement of Opinion:
- This policy might allow me to enjoy my remaining working years more, by lowering stress and physical demands.
- I hope the younger nurses really benefit from this.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 5 |
| Year 20 | 7 | 5 |
Travel Nurse (Seattle, WA)
Age: 29 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 2.0 years
Commonness: 7/20
Statement of Opinion:
- This policy won't impact my current job much as travel nurses work under different conditions.
- It may still alleviate some work-life pressure in future assignments.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 6 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 6 | 5 |
Home Health Nurse (Miami, FL)
Age: 55 | Gender: other
Wellbeing Before Policy: 6
Duration of Impact: 8.0 years
Commonness: 9/20
Statement of Opinion:
- Increased regulation could help ensure better care and manage self-expectations.
- It reassures some boundaries for a demanding job.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 4 |
| Year 20 | 7 | 4 |
Emergency Room Nurse (Phoenix, AZ)
Age: 38 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 15.0 years
Commonness: 14/20
Statement of Opinion:
- If implemented correctly, this could substantially reduce stress, although only if staffing levels are increased.
- There's always a concern that this will just limit hours without fixing systemic staffing issues.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 4 |
| Year 10 | 8 | 4 |
| Year 20 | 8 | 3 |
Veteran Nurse (Houston, TX)
Age: 60 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 3.0 years
Commonness: 6/20
Statement of Opinion:
- Reducing overtime hours is a fantastic move to maintain younger nurses' long-term health.
- Though retired soon, it highlights a shift towards sustainable job practices.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 8 | 7 |
| Year 20 | 8 | 7 |
LPN (Licensed Practical Nurse) (Atlanta, GA)
Age: 34 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 12.0 years
Commonness: 13/20
Statement of Opinion:
- The focus on overtime is welcome. It might lead to new hires to alleviate workload.
- Could allow me to focus more on my family without always thinking about work demands.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 8 | 4 |
| Year 20 | 8 | 4 |
Cost Estimates
Year 1: $2000000000 (Low: $1500000000, High: $2500000000)
Year 2: $2100000000 (Low: $1600000000, High: $2600000000)
Year 3: $2200000000 (Low: $1700000000, High: $2700000000)
Year 5: $2300000000 (Low: $1800000000, High: $2800000000)
Year 10: $2500000000 (Low: $2000000000, High: $3000000000)
Year 100: $3000000000 (Low: $2500000000, High: $3500000000)
Key Considerations
- The bill's cost will depend significantly on baseline staffing patterns and existing overtime practices in the targeted health facilities.
- The extent of administrative burdens and requirements for compliance could vary widely across different types of health institutions.
- Voluntary overtime policies will play a critical role in determining the actual fiscal impact and adaptation strategies of healthcare providers.
- The impact on emergency services staffing and operations will need careful consideration and accommodation under the policy.
- Unintended consequences on patient wait times and service availability, particularly in understaffed areas, should be considered.