[Congressional Record (Bound Edition), Volume 147 (2001), Part 15]
[Extensions of Remarks]
[Page 21808]
[From the U.S. Government Publishing Office, www.gpo.gov]



         INTRODUCTION OF THE SAFE NURSING AND PATIENT CARE ACT

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                       Tuesday, November 6, 2001

  Mr. STARK. Mr. Speaker, I rise to introduce the Safe Nursing and 
Patient Act of 2001 which I am introducing with a group of colleagues 
today.
  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 consistently cited are concerns about the quality 
of care that nurses' feel able to provide in many health care settings 
today and increasing requirements 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.

  If we want to ensure quality patient care and a strong nurse work 
force today and in the future, we must make stories like this nurse's 
much less frequent. One way to do that is to enact legislation 
prohibiting hospitals and other health care providers from forcing 
nurses to work hours beyond what that professional nurse believes to be 
safe for patient care. That is the purpose of the Safe Nursing and 
Patient Care Act.
  The current practice of mandatory overtime 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.
  A recent report by the General Accounting Office, Nursing Workforce: 
Emerging Nurse Shortage Due to Multiple Factors, concludes as follows:

       [T]he current high levels of job dissatisfaction among 
     nurses may also play a critical 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 existing government standards that limit the hours that 
pilots, flight attendants, truck drivers, railroad engineers, and other 
professions can safely work before consumer safety could be impinged. 
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 set strict limits on the 
ability of health facilities to require mandatory overtime from nurses. 
While nurses would be allowed to continue to volunteer for overtime if 
and when they feel they can continue to provide safe, quality care, 
mandatory overtime would only be allowed when an official state of 
emergency was declared by the Federal, State or local government. These 
limits would be part of Medicare's provider agreements. They would not 
apply to nursing homes as there are alternative staffing and quality 
measures 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 antidiscrimination 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.
  This legislation is not the final 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.
  I know that our Nation's 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.
  This bill takes the first step to address the problem by strictly 
limiting the ability of providers to force nurses to work beyond their 
professional opinion of what is safer for fear of losing their jobs. 
This is a very real problem facing the nursing profession and that is 
why my bill is endorsed by the American Nurses Association, AFSCME, 
AFT, SEIU, AFGE, UAW, and the AFL-CIO--organizations that speak for 
America's nearly 3 million nurses.
  I urge my colleagues to join with me in support of the Safe Nursing 
and Patient Care Act. Again, my bill is not the only solution. I also 
support efforts to increase the number of people entering the nursing 
profession and have cosponsored legislation to achieve that goal. But, 
we must also take steps to improve nursing now so that today's nurses 
will remain in the profession to care for those of us who need such 
care before new nurses can be trained and 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 to enact 
the Safe Nursing and Patient Care Act which will start us down the 
right path toward protecting patients and encouraging people to remain 
in--and enter--the nursing profession.

                          ____________________