riod be prevented except in case of an emergency, such as a natural disaster. In the event that nurses are required to work excessive hours because of an emergency, this information should be immediately disclosed to the public so that elective admissions can be postponed and other admissions diverted to different units or facilities. Similarly, in any instance where a nursing shortage prevents an HCO from securing sufficient nurses to prevent work hours in excess of 12 hours in any 24-hour period and more than 60 hours in any 7-day period, this information also should be disclosed to the public, so that elective admissions can be referred to other facilities or delayed until staffing is remedied. If an admission cannot be delayed or referred to another HCO, the patient and their family should be informed about the shortage of staffing and that nursing staff is working under conditions adverse to patient safety. Family members may want to attend to a patient for longer periods of his or her inpatient stay, when nursing staff is working longer work hours and there is a shortage of nursing staff.

Finally, by recommending a regulatory role in encouraging safe work hours, the committee does not intend to encourage the creation of burdensome oversight mechanisms that, for example, would require the submission or inspection of individual nurse time sheets. Rather, the committee encourages HCOs, state boards of nursing, and schools of nursing to educate nurses and themselves about the dangers of fatigue. We also recommend that HCOs, working with their labor partners, develop staffing and work-hour policies designed to prevent fatigue caused by excessive work hours. Such policies and procedures might include, for example:

  • Acknowledging the responsibility of nurses who work in more than one facility to ensure that their total patient care hours worked do not exceed the patient safety thresholds identified in the above recommendation.

  • Ensuring that any use of mandatory overtime by the facility will not require nurses to provide more than 12 hours of patient care in any 24-hour period or more than 60 hours of patient care in any 7-day period.

  • In health care organizations that allow nursing staff to self-schedule, preventing nursing staff from scheduling more than 12 hours of patient care in any 24-hour period or more than 60 hours of patient care in any 7-day period.

The committee anticipates these policies being facilitated by the authority of regulations promulgated by state boards of nursing, which license nurses and regulate the practice of nursing, and by other state agencies that have authority over the work of nurses and unlicensed NAs.

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