PlainBillCongress, translated.Legislation. Context. Public interest.Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Congressional Research Service
Version 00 · Introduced in House · Aug 6, 2026
Nurse Overtime and Patient Safety Act of 2026
This bill requires certain providers, as a condition of Medicare participation, to limit mandatory overtime for nurses.
Specifically, the bill prohibits hospitals, ambulatory surgical centers, home health agencies, rural health clinics, federally qualified health centers, and other specified providers from requiring nurses to work (1) more than a previously scheduled shift, 48 hours in a workweek, or 12 consecutive hours in a 24-hour period; or (2) during the 10 hours immediately following the 12th hour worked in a shift during a 24-hour period.
Qualifying work hours include time spent in training, on call, and on standby. The bill's provisions do not apply during declared emergencies or disasters, subject to specified conditions, and do not preclude voluntary overtime.
The bill also establishes (1) certain protections for nurses who file complaints against providers, (2) documentation and notice requirements for providers, and (3) potential civil penalties for violations.
People & committees
Rep. Matsui, Doris O. [D-CA-7] · D–CA
Legislative record
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Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced in House
Introduced in House
Primary sources
Text links open the official source. We also preserved the text version used in the PlainBill explanation below.
Source last updated: Aug 26, 2026. Consult Congress.gov for the current record.
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PlainBill explanation
Based on the full Introduced in House · 2026-08-06 text. This explanation has not received human editorial review. This overview describes the proposal’s major provisions; it does not establish what its real-world effects would be.
The proposed Nurse Overtime and Patient Safety Act of 2026 would limit when covered health care providers can require nurses to work extra hours. It would protect nurses who refuse mandatory overtime or report violations, while allowing voluntary overtime and a limited emergency exception. It would also require federal studies of safe working hours and overtime practices in federally operated medical facilities.
This Act may be cited as the Nurse Overtime and Patient Safety Act of 2026.
Except as provided in this subsection, a provider of services shall not directly or indirectly, require a nurse to work—
Nothing in this subsection shall be construed to preclude a nurse from volunteering to work overtime.
the requirements of paragraph (1) shall not apply to a provider of services during a declared emergency or disaster (as defined in paragraph (9)(E)) if the provider is requested, or otherwise is expected, to provide an exceptional level of emergency or other medical services to the community.
A provider of services shall not terminate or propose to terminate, penalize, discriminate, or retaliate in any manner with respect to any aspect of employment, including discharge, promotion, compensation, or terms, conditions, or privileges of employment, against a nurse who refuses to work mandatory overtime or who in good faith, individually or in conjunction with another person or persons— (i) reports a violation or suspected violation of this subsection
shall conduct a study to establish appropriate standards for the maximum number of hours that a nurse who furnishes health care to patients may work without compromising the safety of such patients.
The Director of the Office of Management and Budget shall conduct a study to determine the extent to which federally operated medical facilities have in effect practices and policies with respect to overtime requirements for nurses that are inconsistent with the provisions of section 1866(l) of the Social Security Act, as added by section 3.
The bill's findings describe fatigue and patient safety as reasons for restricting mandatory overtime. These are Congress's stated findings in the proposal, not proof of the bill's future effects.
Congress finds as follows:
Nurses working long hours often experience fatigue, poor sleep quality, impaired vigilance, and lack of alertness, which contributes to medical errors and results in other consequences that compromise patient safety, even after controlling for staffing levels and hospital characteristics.
Section 3 would add compliance with the overtime requirements to provider agreements under section 1866 of the Social Security Act. The protections would cover registered nurses, licensed practical nurses, and licensed vocational nurses.
Provider agreements Section 1866 of the Social Security Act (42 U.S.C. 1395cc) is amended—
(Z) to comply with the requirements of subsection (l) (relating to limitations on mandatory overtime for nurses).
The term nurse means a registered nurse, a licensed practical nurse, or a licensed vocational nurse.
The provider definition would include hospitals, psychiatric hospitals, hospital outpatient departments, critical access hospitals, outpatient surgical centers, home health agencies, rehabilitation agencies, clinics, and federally qualified health centers. The Secretary could include other facilities.
The term provider of services means— (i) a hospital (as defined in section 1861(e)); (ii) a psychiatric hospital (as defined in section 1861(f)); (iii) a hospital outpatient department; (iv) a critical access hospital (as defined in section 1861(mm)(1)); (v) an ambulatory surgical center; (vi) a home health agency (as defined in section 1861(o)); (vii) a rehabilitation agency; (viii) a clinic, including a rural health clinic (as defined in section 1861(aa)(2)); (ix) a Federally qualified health center (as defined in section 1861(aa)(4)); or (x) any other facility determined appropriate by the Secretary.
Mandatory overtime would mean work beyond the bill's limits requested under a threat of adverse employment consequences, subject to the emergency exception. Those consequences could include dismissal, discipline, loss of promotion, or retaliatory reporting to a state professional disciplinary agency.
The term mandatory overtime means hours worked in excess of the periods of time described in paragraph (1), except as provided in paragraph (2), pursuant to any request made by a provider of services to a nurse which, if refused or declined by the nurse involved, may result in an adverse employment consequence to the nurse, including discharge, discipline, loss of promotion, or retaliatory reporting of the nurse to the State professional disciplinary agency involved.
Except as permitted by the bill, providers could not directly or indirectly require work beyond a previously scheduled shift, beyond 48 hours in a workweek, or beyond 12 consecutive hours in a 24-hour period. They also could not require work during the 10 hours immediately following the 12th hour worked in a shift or duty period during a 24-hour period.
Except as provided in this subsection, a provider of services shall not directly or indirectly, require a nurse to work— (i) in excess of— (I) a previously scheduled work shift or duty period of the nurse, regardless of the length of the shift; (II) 48 hours in any workweek (as defined in section 778.105 of title 29, Code of Federal Regulations, or any successor regulation); or (III) 12 consecutive hours in a 24-hour period; or (ii) during the 10-hour period immediately following the 12th hour worked in a shift or duty period during a 24-hour period.
For these limits, hours worked would include required meetings, education or training, and time on call or on standby—including when the nurse is not required to be at the provider's premises.
For purposes of subparagraph (A), time spent by a nurse in the following shall be included as hours worked: (i) Required meetings or while receiving education or training. (ii) On call or on standby when the nurse is required to be at the provider of services. (iii) On call or on standby when the nurse is not required to be at the provider of services.
Nurses could still volunteer to work overtime; the proposal would not impose an absolute cap on voluntary hours.
Nothing in this subsection shall be construed to preclude a nurse from volunteering to work overtime.
The emergency exception would apply only during a qualifying declared emergency or disaster when a provider is requested or expected to deliver exceptional medical services to the community. The definition includes specified federal disasters and emergencies and declarations by a governor or Indian Tribal government. It excludes emergencies resulting from health care labor disputes or consistent understaffing.
Subject to subparagraph (B), the requirements of paragraph (1) shall not apply to a provider of services during a declared emergency or disaster (as defined in paragraph (9)(E)) if the provider is requested, or otherwise is expected, to provide an exceptional level of emergency or other medical services to the community.
The term declared emergency or disaster means a major disaster or an emergency (as those terms are defined in section 102 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. 5122)), or an emergency or disaster as declared by a Governor of any State or Indian Tribal government, but does not include an emergency that results from a labor dispute in the health care industry or consistent understaffing.
Even during a qualifying emergency, mandatory extra work would require reasonable efforts to find alternative staffing, a next-shift vacancy discovered at the end of the current shift, and potential harm to an assigned patient from departure or transfer of care. The requirement would have to end when either the declared emergency or the provider's direct response role ends, whichever happens first.
a nurse may only be required to work for periods in excess of the periods described in paragraph (1) if— (i) the provider has made reasonable efforts to fill the immediate staffing needs of the provider through alternative means; (ii) the duration of the work requirement does not extend past the earlier of— (I) the date on which the declared emergency or disaster ends; or (II) the date on which the provider’s direct role in responding to the medical needs resulting from the declared emergency or disaster ends; (iii) a staff vacancy for the next shift becomes known at the end of the current shift; and (iv) there is potential harm to an assigned patient if the nursing staff member leaves the assignment or transfers care to another nursing staff member.
Nurses could complain to the Secretary about violations. The Secretary would have to establish a complaint process, investigate complaints, and require a corrective plan when a violation is found. Seeking a financial penalty would be discretionary.
A nurse may file a complaint with the Secretary against a provider of services who violates the provisions of this subsection.
The Secretary shall establish a procedure under which a nurse may file a complaint under clause (i).
The Secretary shall investigate complaints of violations filed by a nurse under subparagraph (A).
If the Secretary determines that a provider of services has violated the provisions of this subsection, the Secretary shall require the provider to establish a plan of action to eliminate the occurrence of such violation, and may seek civil money penalties under paragraph (7).
Providers would be barred from employment retaliation against nurses for refusing mandatory overtime or acting in good faith to report suspected violations, participate in relevant investigations or proceedings, or discuss suspected violations with coworkers, employee representatives, or health professional associations.
A provider of services shall not terminate or propose to terminate, penalize, discriminate, or retaliate in any manner with respect to any aspect of employment, including discharge, promotion, compensation, or terms, conditions, or privileges of employment, against a nurse who refuses to work mandatory overtime or who in good faith, individually or in conjunction with another person or persons— (i) reports a violation or suspected violation of this subsection to a public regulatory agency, a private accreditation body, or the management personnel of the provider of services; (ii) initiates, cooperates, or otherwise participates in an investigation or proceeding brought by a regulatory agency or private accreditation body concerning matters covered by this subsection; or (iii) informs or discusses with other employees, with representatives of those employees, or with representatives of associations of health care professionals, violations or suspected violations of this subsection.
Providers could not report a nurse to a state professional disciplinary agency because the nurse refused mandatory overtime. Good faith would mean reasonably believing both that the disclosed information is true and that a violation has occurred or may occur.
A provider of services may not file a complaint or a report against a nurse with the appropriate State professional disciplinary agency because the nurse refused to comply with a request to work mandatory overtime.
a nurse is deemed to be acting in good faith if the nurse reasonably believes— (i) that the information reported or disclosed is true; and (ii) that a violation has occurred or may occur.
Providers would have to document permitted mandatory overtime in writing, give clearly written overtime policies and procedures to new nursing staff, and make them readily available to all nursing staff. They would also have to display a notice explaining nurses' rights and how to file a complaint.
Each provider of services shall develop a policy and have in place procedures to ensure, at a minimum, that— (i) mandatory overtime, when required as described in paragraph (2)(B), is documented in writing; and (ii) mandatory overtime policies and procedures are clearly written, provided to all new nursing staff and readily available to all nursing staff.
Each provider of services shall post conspicuously in an appropriate location a sign (in a form specified by the Secretary) specifying rights of nurses under this subsection.
Such sign shall include a statement that a nurse may file a complaint with the Secretary against a provider of services who violates the provisions of this subsection and information with respect to the manner of filing such a complaint.
Providers would have to regularly display department or unit nursing schedules and provide daily schedules on request to nurses assigned there. The Secretary would determine the scheduling periods by provider type or class.
A provider of services shall regularly post in a conspicuous manner the nurse schedules (for such periods of time that the Secretary determines appropriate by type or class of provider of services) for the department or unit involved, and shall make available upon request to nurses assigned to the department or unit the daily nurse schedule for such department or unit.
The Secretary could impose a civil financial penalty of up to $10,000 for each knowing violation. The bill would require more severe penalties for patterns of repeated violations, without specifying their amount. It would incorporate existing penalty procedures from section 1128A, except subsections (a) and (b).
The Secretary may impose a civil money penalty of not more than $10,000 for each knowing violation of the provisions of this subsection committed by a provider of services.
Notwithstanding subparagraph (A), the Secretary shall provide for the imposition of more severe civil money penalties under this paragraph for providers of services that establish patterns of repeated violations of such provisions.
The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under this paragraph in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a).
The Department of Health and Human Services would publish penalized providers' names and violations online. If ownership changes, as determined by the Secretary, publication of penalties imposed under the previous ownership would end after one year from the ownership change.
The Secretary shall publish on the internet site of the Department of Health and Human Services the names of providers of services against which civil money penalties have been imposed under this paragraph, the violation for which the penalty was imposed, and such additional information as the Secretary determines appropriate.
With respect to a provider of services that has had a change in ownership, as determined by the Secretary, penalties imposed on the provider of services while under previous ownership shall no longer be published by the Secretary on such internet site after the 1-year period beginning on the date of change in ownership.
The proposal would preserve nurses' existing legal and contractual rights, remedies, and procedures. It would also leave stronger state protections against mandatory overtime in place.
Nothing in this subsection shall be construed to alter or otherwise affect the rights, remedies, and procedures afforded to nurses under Federal, State, or local laws or under the terms of collective bargaining agreements, memorandums of understanding, or other agreements between such employees and their employers.
Nothing in this subsection shall be construed to preempt any State law that provides greater protections with respect to mandatory overtime for nurses.
Section 3's amendments would take effect one year after enactment, rather than on a fixed calendar date.
The amendments made by this section shall take effect 1 year after the date of enactment of this Act.
The Health and Human Services Secretary, through the Agency for Healthcare Research and Quality director, would study maximum nursing hours consistent with patient safety. Recommended standards could vary by provider, department, nursing duties, shift, and other appropriate factors. The director could contract with an eligible organization to conduct the study.
The Secretary of Health and Human Services, acting through the Director of the Agency for Healthcare Research and Quality, shall conduct a study to establish appropriate standards for the maximum number of hours that a nurse who furnishes health care to patients may work without compromising the safety of such patients.
Such standards may vary by provider of service and by department within a provider of services, by duties or functions carried out by nurses, by shift, and by other factors that the Director determines appropriate. The Director may contract with an eligible entity or organization to carry out the study under this paragraph.
Within two years after enactment, the Secretary would have to report the safe-hours study to Congress with recommendations for maximum work-hour standards.
Not later than 2 years after the date of the enactment of this Act, the Secretary shall submit to Congress a report on the study con-ducted under paragraph (1) and shall include recommendations for such appropriate standards of maximum work hours.
The Office of Management and Budget director would study how federally operated facilities' nurse overtime policies differ from the proposed requirements. This study would cover acute care hospitals, freestanding clinics, and home health care clinics operated by Veterans Affairs, Defense, or other federal agencies.
The Director of the Office of Management and Budget shall conduct a study to determine the extent to which federally operated medical facilities have in effect practices and policies with respect to overtime requirements for nurses that are inconsistent with the provisions of section 1866(l) of the Social Security Act, as added by section 3.
the term federally operated medical facilities means acute care hospitals, freestanding clinics and home health care clinics that are operated by the Department of Veterans Affairs, the Department of Defense, or any other department or agency of the United States.
Within six months after enactment, the Office of Management and Budget director would have to report to Congress with recommendations for bringing federal facilities' nurse overtime policies into line with the proposed requirements.
Not later than 6 months after the date of the enactment of this Act, the Director of the Office of Management and Budget shall submit to Congress a report on the study conducted under paragraph (1) and shall include recommendations for the implementation of policies within federally operated medical facilities with respect to overtime requirements for nurses that are consistent with such section 1866(l), as so added.
The supplied actions snapshot, updated August 26, 2026, records introduction in the House and referral to the Energy and Commerce and Ways and Means committees on August 6, 2026.
Source snapshot updated 2026-08-26T15:45:59Z.
2026-08-06: Introduced in House
2026-08-06: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
A closer look
Reviewed version: Introduced in House · 2026-08-06. These findings describe provisions and who may benefit; they are not judgments of waste, corruption, or motive.
This review covers the supplied bill text. “None identified” does not rule out provisions in later versions or accompanying reports and disclosures.
Provisions outside the bill’s main subject, or policy changes attached to appropriations.
None identified in the reviewed text
No unrelated provision or policy change attached to appropriations was identified in the complete supplied introduced text. This conclusion does not cover other versions or accompanying materials.
Spending directed to particular recipients or places outside ordinary competitive or formula-based allocation.
None identified in the reviewed text
No congressionally directed spending for a particular recipient or place was identified in the complete supplied introduced text. This conclusion does not establish the absence of earmarks in other versions or accompanying materials.
Narrow exceptions, exemptions, or preferential treatment that warrant a closer look.
Findings to examine
The supplied introduced text contains a narrow exception to public disclosure within its enforcement provisions. This classification does not imply improper purpose.
Providers that change ownership would receive an exception to the general online disclosure requirement: penalties imposed under the prior ownership would stop appearing on the department's website after one year from the ownership change. This gives that subset of providers special treatment within the bill's enforcement system.
The Secretary shall publish on the internet site of the Department of Health and Human Services the names of providers of services against which civil money penalties have been imposed under this paragraph, the violation for which the penalty was imposed, and such additional information as the Secretary determines appropriate.
With respect to a provider of services that has had a change in ownership, as determined by the Secretary, penalties imposed on the provider of services while under previous ownership shall no longer be published by the Secretary on such internet site after the 1-year period beginning on the date of change in ownership.
Full text preserved for this analysis. Legislative record snapshot: Aug 26, 2026. How PlainBill uses AI