[Congressional Record Volume 153, Number 73 (Friday, May 4, 2007)]
[Extensions of Remarks]
[Pages E961-E962]
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, May 3, 2007

  Mr. STARK. Madam Speaker, I rise to introduce the Safe Nursing and 
Patient Act with Representative Steven LaTourette (R-OH). Our 
legislation would achieve two vitally important goals. First, it would 
improve quality of care for patients across our country by assuring 
that nurses are not forced to work beyond the time they feel safe. 
Second, it would address our national nursing shortage by improving the 
working conditions that are causing nurses to leave their profession.
  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. This is legislation we've 
introduced together for several sessions of Congress. Given our changed 
environment in Congress, we are hopeful that we'll be able to enact it 
this time.
  There are some 500,000 trained nurses in our country who are not 
working in their profession. While they leave nursing for many 
different reasons, nurses consistently cite 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.


[[Page E962]]


  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.'' The report finds 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 28-day period and one-
sixth reported working 16 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 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.

  As usual, many States are ahead of the Federal Government when it 
comes to pinpointing problems that need to be addressed. Numerous 
States are currently considering bills 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.
  The Safe Nursing and Patient Care Act 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 Nation's hospital trade associations will claim that 
our 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, UAN, and UAW--
organizations that speak for millions of America's nurses.
  Again, our bill is not the sole solution. For example, 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.
  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.

                          ____________________