[Congressional Record (Bound Edition), Volume 149 (2003), Part 3]
[Extensions of Remarks]
[Page 4086]
[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

                      Wednesday, February 12, 2003

  Mr. STARK. Mr. Speaker, I rise to introduce the Safe Nursing and 
Patient Act of 2003 with Rep. Steven LaTourette and more than 40 of our 
colleagues. Assuring quality medical care and addressing our nursing 
shortage should not divide us on partisan lines. That's why I'm 
especially pleased that the bill we're introducing today has support 
from Democrats and Republicans alike. 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 they 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 research to back up 
the concern. A recent study published in JAMA (October 23/30, 2002) 
proves what nurses have been telling us--that working too many hours 
while caring for too many patients leads to increased patient deaths 
and increased job dissatisfaction. The study found that the risk of 
death to a patient who has undergone surgery increases by 7 percent for 
each patient over four in a nurse's workload. It also found that 
patients in hospitals with the lowest nurse staffing levels (eight 
patients per nurse) have a 31% greater chance of dying than those 
patients in hospitals with four patients per nurse.
  Studies also point to overtime issues as reasons for the 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 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.
  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 safe 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.
  Again, my bill is not the sole solution. I supported the Nurse 
Reinvestment Act, which was passed by Congress and signed into law last 
year. 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 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 to 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.

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