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Keeping Patients Safe: Transforming the Work Environment of Nurses
contending with an unexpected increase in patient census, coupled with understaffing. Investigations showed that the nurses, who were fatigued and stressed, compromised the usual standards of care by skipping steps or rushing through aseptic procedures.
Legislation has been introduced at both the federal and state levels to ban mandatory overtime. Two bills were introduced during the 107th U.S. Congress that would prohibit mandatory overtime for nurses and other licensed health care providers (Golden and Jorgensen, 2002). The first bill2 would amend Title XVIII of the Social Security Act (Medicare Act), while the second bill3 would amend the Fair Labor Standards Act. The Safe Nursing and Patient Care Act of 2001 also contained provisions that would have required the Agency for Healthcare Research and Quality to conduct a study to determine the numbers of hours a nurse can work without compromising the safety of patients. Similar legislation has been introduced in the 108th Congress.
State legislatures in approximately 19 states have considered bans on mandatory overtime for nurses and other health care professionals. Most proposed measures prohibit hospitals from requiring nurses to work more than their regularly scheduled 8- or 12-hour shifts. Some bills specify that nurses cannot be required to work more than 40 hours a week, while others prohibit hospitals from requiring employees to work more than 80 hours of overtime in any consecutive 2-week period (Golden and Jorgensen, 2002). Maine’s law (Ch. 401) also mandates that if nurses work longer than 12 hours, they must be given at least 10 hours off before their next shift (Golden and Jorgensen, 2002). To date, bills prohibiting mandatory overtime for nurses have passed in only four states—California, Maine, New Jersey, and Oregon. No measure, either proposed or enacted, addresses how long nurses may work on a voluntary basis.
The hours physicians work, particularly during their residency training, are often quite demanding. Although the Association of American Medical Colleges (AAMC) and the Accreditation Council for Graduate Medical Education (ACGME) have recommended that house staff work no more than 80–84 hours per week, it is still common for medical residents to work over 100 hours per week for prolonged periods (Patton et al., 2001). Work days are typically 12–14 hours (Czeisler et al., 2002), and workloads vary by specialty (Patton et al., 2001), with surgical residents typically working
Safe Nursing and Patient Care Act of 2001. S. 1686, H.R. 3238 (2001).
Registered Nurses and Patient Protection Act. H.R. 1289 (2001).