I 
109TH CONGRESS 
1ST SESSION 
H. R. 791
To amend title XVIII of the Social Security Act to provide for patient 
protection by limiting the number of mandatory overtime hours a nurse 
may be required to work in certain providers of services to which pay-
ments are made under the Medicare Program. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 14, 2005
Mr. STARK (for himself and Mr. LATOURETTE) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committee on Ways and Means, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
for patient protection by limiting the number of manda-
tory overtime hours a nurse may be required to work 
in certain providers of services to which payments are 
made under the Medicare Program.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Safe Nursing and Pa-
tient Care Act of 2005’’.
SEC. 2. FINDINGS. 
The Congress finds as follows: 
(1) The Federal Government has a substantial 
interest in assuring that the delivery of health care 
services to patients in health care facilities is ade-
quate and safe. 
(2) Research, including a study published in the 
Journal of the American Medical Association (in the 
October 23–30, 2002 issue), documents that higher 
nurse staffing levels result in better patient out-
comes. However, health care facilities report sub-
stantial difficulties in recruiting and retaining suffi-
cient nursing staff, as evidenced by the fact that ap-
proximately 500,000 licensed nurses are not prac-
ticing nursing. 
(3) Job dissatisfaction and overtime work are 
contributing to the departure of nurses from their 
profession, as documented by the Government Ac-
countability Office in a July 2001 report. Yet, health 
care providers continue to make use of mandatory 
overtime as a staffing model. 
(4) The widespread practice of requiring nurses 
to work extended shifts and forgo days off frequently 
causes nurses to provide care in a state of fatigue 
which contributes to medical errors and results in 
other consequences that compromise patient safety.
(5) The dangers with mandatory overtime are 
made clear by numerous studies. A November 2003 
Institute of Medicine report, Keeping Patients Safe: 
Transforming the Work Environment of Nurses, 
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. 
(6) 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 com-
mit an error than nurses who worked standard shifts 
of eight and a half hours 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. 
(7) That same study also 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 pe-
riod 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 de-
scribed being ‘‘coerced’’ into working voluntary over-
time. 
(8) While no Federal standards currently re-
strict mandatory nurse overtime, many States are 
considering such laws and several States, including 
California, Connecticut, Maine, Maryland, Min-
nesota, New Jersey, Oregon, Washington, and West 
Virginia, have enacted laws or prescribed regula-
tions. 
(9) Federal limitations on mandatory nurse 
overtime will ensure that health care facilities 
throughout the country operate in a manner that 
safeguards public safety by helping assure the deliv-
ery of quality nursing care and facilitating the reten-
tion and recruitment of nurses. 
SEC. 3. LIMITATIONS ON MANDATORY OVERTIME FOR 
NURSES. 
(a) PROVIDER AGREEMENTS.—Section 1866 of the 
Social Security Act (42 U.S.C. 1395cc) is amended—
(1) in subsection (a)(1)—
(A) in subparagraph (U), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (V), by striking the 
period and inserting ‘‘, and’’; and 
(C) by inserting after subparagraph (V), 
the following: 
‘‘(W) to comply with the requirements of 
subsection (k) (relating to limitations on man-
datory overtime for nurses).’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(k) LIMITATIONS ON MANDATORY OVERTIME FOR 
NURSES.—For purposes of subsection (a)(1)(W), the re-
quirements of this subsection are the following: 
‘‘(1) PROHIBITION
ON
MANDATORY
OVER-
TIME.—Except as provided in this subsection, a pro-
vider of services shall not, directly or indirectly, re-
quire a nurse to work in excess of any of the fol-
lowing: 
‘‘(A) The scheduled work shift or duty pe-
riod of the nurse. 
‘‘(B) 12 hours in a 24-hour period. 
‘‘(C) 80 hours in a consecutive 14-day pe-
riod. 
‘‘(2) EXCEPTIONS.—