Nurse Overtime and Patient Safety Act of 2026

This bill limits mandatory nurse overtime at healthcare facilities that participate in Medicare. It establishes specific limits on working hours, creates retaliation protections for nurses, requires facilities to post schedules and policies, and sets up penalties for non-compliance. It also orders federal studies regarding safe nurse working hours and overtime practices in federal medical facilities.

* **Nurses:** Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Licensed Vocational Nurses (LVNs). * **Healthcare Providers:** Facilities that participate in Medicare, including hospitals, critical access hospitals, ambulatory surgical centers, home health agencies, clinics, and Federally Qualified Health Centers. * **Federal Agencies:** The Department of Health and Human Services (HHS), the Agency for Healthcare Research and Quality (AHRQ), and the Office of Management and Budget (OMB).

* **Limits on Mandatory Overtime:** Covered providers are prohibited from requiring nurses to work: * Beyond their scheduled shift or duty period. * More than 48 hours in a single workweek. * More than 12 consecutive hours in a 24-hour period. * During the 10 hours immediately following a 12-hour shift. * **Calculation of Work Hours:** Mandatory meetings, required training, and both on-site and off-site on-call or standby time must be counted as hours worked. * **Voluntary Overtime:** Nurses remain permitted to volunteer for overtime shifts. * **Nurse Protections:** * Providers are prohibited from firing, penalizing, discriminating, or retaliating against nurses who refuse mandatory overtime, file a complaint, discuss potential violations, or participate in an investigation. * Providers are forbidden from reporting nurses to state licensing boards for refusing mandatory overtime. * Nurses are authorized to file complaints about violations directly with HHS. * **Administrative Requirements for Facilities:** * Providers must create and share written policies explaining how mandatory overtime is used during emergency exceptions. * Providers must post signs detailing nurse rights under this law and directions for filing complaints with HHS. * Providers must publicly post department schedules and make daily schedules available to nurses upon request. * **Enforcement:** * HHS is authorized to require non-compliant providers to carry out corrective action plans. * HHS is required to publish a list of penalized providers on its website for one year (with exceptions for facilities undergoing ownership changes). * **Implementation Timelines and Studies:** * Provider requirements and protections take effect **1 year** after the bill is enacted. * OMB must study nurse overtime in federally run medical facilities (such as VA and Department of Defense hospitals) and report recommendations within **6 months** to align their practices with these rules. * HHS, through AHRQ, must study safe working hour limits for nurses and report recommendations to Congress within **2 years**.

* **Penalties:** HHS is authorized to assess civil money penalties of up to $10,000 for each knowing violation, with higher penalties allowed for repeat violations. * **Funding:** The provided summaries do not specify direct funding amounts or appropriations allocated to federal agencies to conduct the studies or carry out enforcement.

* **Emergency Exception:** Providers are permitted to require overtime during declared state, federal, or tribal disasters or emergencies if the facility is expected to deliver exceptional emergency services. This exception applies only if: * The facility made reasonable efforts to fill staffing needs through other means. * The overtime stops once the direct emergency response ends. * A staff vacancy for the next shift becomes unexpectedly known at the end of the current shift. * Leaving or transferring care would risk harm to an assigned patient. * **What Does Not Count as an Emergency:** Labor disputes and routine or consistent facility understaffing are explicitly barred from being treated as emergencies. * **Other Laws and Contracts:** The bill does not override state laws that offer stronger nurse overtime protections. It also does not restrict rights under existing collective bargaining agreements or other federal, state, or local laws.

This bill bans Medicare-funded healthcare facilities from forcing nurses to work mandatory overtime beyond set daily and weekly limits, except during qualified emergency situations. It gives nurses the right to refuse forced overtime without losing their jobs or facing licensing penalties, imposes fines up to $10,000 on violating facilities, and orders studies to guide future nurse work-hour policies.