[Congressional Record Volume 151, Number 14 (Thursday, February 10, 2005)]
[Extensions of Remarks]
[Pages E212-E213]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                 THE SAFE NURSING AND PATIENT CARE ACT

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                      Thursday, February 10, 2005

  Mr. STARK. Mr. Speaker, I rise to introduce the Safe Nursing and 
Patient Act with Rep. Steven LaTourette (R-OH). Assuring quality 
medical care and addressing our nursing shortage should not divide us 
on partisan lines. That's why I'm especially pleased to be working 
across the aisle with my friend from Ohio, Mr. LaTourette, in this 
important endeavor. Senator Kennedy is introducing the companion 
legislation in the Senate.
  There are some 500,000 trained nurses in this country who are not 
working in their profession. Of course, their reasons for leaving 
nursing are many. But nurses consistently cite their concerns about the 
quality of care they feel that are able to provide in many health care 
settings today. Nurses are also greatly concerned about being forced to 
work mandatory overtime.
  Listen to these words of a nurse in the state of Washington:

       I have been a nurse for six years and most of the time I 
     have worked in the hospital environment. It is difficult to 
     tell you how terrible it is to ``work scared'' all the time. 
     A mistake that I might make could easily cost someone their 
     life and ruin mine. Every night at work we routinely ``face 
     the clock.'' All of us do without lunch and breaks and work 
     overtime, often without pay, to ensure continuity of care for 
     our patients. Yet, we are constantly asked to do more. It has 
     become the norm for us to have patient assignments two and a 
     half times greater than the staffing guidelines established 
     by the hospital itself. I cannot continue to participate in 
     this unsafe and irresponsible practice. So I am leaving, not 
     because I don't love being a nurse, but because hospitals are 
     not safe places: not for patients and not for nurses.

  While stories like this are telling, we also have a growing body of 
research to back up the anecdotes. Premier among these studies is a 
comprehensive report issued by the Institute of Medicine in November 
2003 entitled, ``Keeping Patients Safe, Transforming the Work 
Environment of Nurses.'' Highlighting their concern with regard to this 
issue, the IOM headline for their release of the report was, 
``Substantial Changes Required in Nurses' Work Environment to Protect 
Patients from Health Care Errors.'' Within the report, they concluded 
that ``limiting the number of hours worked per day and consecutive days 
of work by nursing staff, as is done in other safety-sensitive 
industries, is a fundamental safety precaution.'' The report went on to 
specifically recommend that ``working more than 12 hours in any 24-hour 
period and more than 60 hours in any 7-day period be prevented except 
in case of an emergency, such as a natural disaster.''
  Another study published in the July/August 2004 Health Affairs 
Journal, ``The Working Hours of Hospital Staff Nurses and Patient 
Safety,'' found that nurses who worked shifts of twelve and a half 
hours or more were three times more likely to commit an error than 
nurses who worked eight and a half hours (a standard shift) or less. 
The study also found that working overtime increased the odds of making 
at least one error, regardless of how long the shift was originally 
scheduled. Finally, this article illustrates how nurses are being 
forced to work more and more overtime. The majority of nurses surveyed 
reported working overtime ten or more times in a twenty-eight day 
period and one-sixth reported working sixteen or more consecutive hours 
at least once during the period. Nurses reported being mandated to work 
overtime on 360 shifts and on another 143 shifts they described being 
``coerced'' into working voluntary overtime.

  As these studies show, the widespread practice of requiring nurses to 
work extended

[[Page E213]]

shifts and forgo days off causes nurses to frequently provide care in a 
state of fatigue, contributing to medical errors and other consequences 
that compromise patient safety. In addition to endangering patients, 
studies also point to overtime issues as a prime contributing factor to 
our nation's nursing shortage. For example, a 2001 report by the 
General Accounting Office, Nursing Workforce: Emerging Nurse Shortages 
Due to Multiple Factors, concluded:

       [T]he current high levels of job dissatisfaction among 
     nurses may also play a crucial role in determining the extent 
     of current and future nurse shortages. Efforts undertaken to 
     improve the workplace environment may both reduce the 
     likelihood of nurses leaving the field and encourage more 
     young people to enter the nursing profession . . .

  We have the voices of nurses and the research evidence to prove that 
the practice of requiring nurses to work beyond the point they believe 
is safe is jeopardizing the quality of care patients receive. It is 
also contributing to the growing nurse shortage. Current projections 
are that the nurse workforce in 2020 will have fallen 20 percent below 
the level necessary to meet demand.
  We have existing federal government standards that limit the hours 
that pilots, flight attendants, truck drivers, railroad engineers and 
other professions can safely work before consumer safety is endangered. 
However, no similar limitation currently exists for our nation's nurses 
who are caring for us at often the most vulnerable times in our lives.
  The Safe Nursing and Patient Care Act would change that. It would set 
strict, new federal limits on the ability of health facilities to 
require mandatory overtime from nurses. Nurses would be allowed to 
continue to volunteer for overtime if and when they feel they can 
continue to provide safe, quality care. But, forced mandatory overtime 
would only be allowed when an official state of emergency was declared 
by federal, state or local government. These limits would be part of 
Medicare's provider agreements. They would not apply to nursing homes 
since alternative staffing and quality measures are already moving 
forward for those facilities.
  To assure compliance, the bill provides HHS with the authority to 
investigate complaints from nurses about violations. It also grants HHS 
the power to issue civil monetary penalties of up to $10,000 for 
violations of the act and to increase those fines for patterns of 
violations.
  Providers would be required to post notices explaining these new 
rights and to post nurse schedules in prominent workplace locations. 
Nurses would also obtain anti-discrimination protections against 
employers who continued to force work hours for nurses beyond what a 
nurse believes is safe for quality care. Providers found to have 
violated the law would be posted on Medicare's website.
  Often the states are ahead of the federal government when it comes to 
pinpointing problems that need to be addressed. It is worth noting that 
many states are considering such laws to strictly limit the use of 
mandatory nurse overtime. Several states--including California, 
Connecticut, Maine, Maryland, Minnesota, New Jersey, Oregon, Washington 
and West Virginia--have already passed laws or regulations limiting the 
practice.

  This bill is an important first step, but it isn't the complete 
solution. I believe that standards must be developed to define 
timeframes for safe nursing care within the wide variety of health 
settings (whether such overtime is mandatory or voluntary). That is why 
the legislation also requires the Agency on Healthcare Research and 
Quality to report back to Congress with recommendations for developing 
overall standards to protect patient safety in nursing care. Once we 
have better data in that regard, I will support broader limitations on 
all types of overtime. But, we must not wait to act until that data can 
be developed. The data collection will take years and the crisis of 
mandatory overtime is upon us now.
  I know that our nations hospital trade associations will claim that 
my solution misses the mark because it is precisely the lack of nurses 
in the profession today that is necessitating their need to require 
mandatory overtime. Let me respond directly. Mandatory overtime is 
dangerous for patients plain and simple. It is also a driving force for 
nurses leaving the profession. These twin realities make mandatory 
overtime a dangerous short-term gamble at best. We should join together 
to end the practice.
  Mandatory overtime is a very real problem facing the nursing 
profession and that is why our bill is endorsed by the American Nurses 
Association, the AFL-CIO, AFSCME, AFT, SEIU, AFGE, UAW, UAN, and UFCW--
organizations that speak for America's nearly 3 million nurses.
  Again, our bill is not the sole solution. I supported the Nurse 
Reinvestment Act, which was passed by Congress and signed into law in 
August 2002. That legislation authorizes new federal investment and 
initiatives to increase the number of people pursuing a nursing 
education. Such efforts will help in the future, but it will be years 
before that law's impact is felt in our medical system. And, it will 
take even longer if the President and Republicans in Congress continue 
to withhold the funding necessary for the act to be fully implemented.
  We need to help now. We must take steps to improve the nursing 
profession immediately so that today's nurses will remain in the field 
to care for those of us who need such care before new nurses can be 
trained. We also need today's nurses to be there as mentors for the 
nurses of tomorrow.
  Mandatory nurse overtime is a very real quality of care issue for our 
health system and I look forward to working with my colleagues enact 
the Safe Nursing and Patient Care Act. It will start us down the right 
path toward protecting patients and encouraging people to remain in--
and enter--the nursing profession.

                          ____________________