The Seventeenth Hour: Why a Staff Nurse Belongs at the Hearing on a State Mandatory Overtime Bill
Student Name
American College of Education
NUR4013: Transition to Professional Nursing: Issues and Concepts
Module 6 Assignment
Instructor Name
February 16, 2026
Introduction and Position
Twice in the past year, the author of this paper has been told at 1845, fifteen minutes before the end of a twelve-hour day shift on a 30-bed medical-surgical unit, that she could not leave because the night nurse had called out and no replacement was available. Both times she stayed until 0300, for a total of more than twenty hours awake by the time she drove home. The unit and the events described here are composites written for this assignment, but the practice is common enough that several states now limit it by law. A bill before the state legislature this session would prohibit hospitals from requiring registered nurses to work beyond their scheduled shift except during a declared emergency, while leaving voluntary overtime untouched.
This paper takes the position that the bill deserves nursing support, and that the staff nurses who work these shifts belong in the debate as witnesses with evidence, not only as members of an organization that has endorsed the bill. The paper reviews the research on long work hours and patient safety, examines whether state work hour laws change practice, responds to the main objection raised by hospitals and closes with the testimony a staff nurse could deliver at the committee hearing.
What Long Hours Do to Patient Care
The patient safety case against extended hours rests on a small number of well-designed studies. Rogers et al. (2004) analyzed logbooks completed by hospital staff nurses over four weeks and found that the risk of making an error rose significantly when nurses worked shifts longer than twelve hours, when they worked overtime and when they worked more than forty hours in a week. The study relied on nurses reporting their own errors and near misses, which likely undercounts both, so its estimates are more plausibly conservative than inflated.
Stimpfel et al. (2012) approached the problem from the side of outcomes that hospitals track. Using survey data from nurses in four states linked to patient experience data, they found that as the proportion of nurses working shifts longer than thirteen hours increased, patient dissatisfaction with care increased. Nurses whose shifts ran ten hours or more reported burnout, job dissatisfaction and plans to leave at odds as high as 2.5 times those of colleagues on shorter shifts. Long hours, in other words, are not only a risk to the patient in the seventeenth hour; they are a cause of the turnover that produces the next short-staffed shift.
Evidence of this kind informed a national recommendation more than two decades ago, when an expert committee urged state regulatory bodies to prohibit nurses from providing patient care for more than twelve hours in any twenty-four-hour period and more than sixty hours in any seven-day period (Institute of Medicine [IOM], 2004), noting that fatigue from extended hours degrades the vigilance and judgment nursing requires. The recommendation did not distinguish between voluntary and mandatory overtime, but it established that the length of a nurse's working day is a patient safety question, not only a labor question.
Do State Work Hour Laws Change Practice?
A reasonable objection to any law is that it may not change behavior. On this question there is direct evidence. Bae and Yoon (2014) used national survey data on registered nurses from 2004 and 2008 and compared nurses in states that adopted work hour regulations with nurses in states that did not. They found that mandatory overtime regulations were associated with a 3.9 percentage point decrease in the likelihood that a nurse worked mandatory overtime, and that regulations limiting consecutive work hours were associated with an 11.5 percentage point decrease in the likelihood of working more than forty hours a week. They concluded that both kinds of policy reduced nurse work hours, and that limits on consecutive hours appeared to be the stronger tool.
Two points from that study matter for this bill. First, a ban on mandatory overtime does reduce mandatory overtime, which answers the claim that such laws are symbolic. Second, the effect of a mandatory overtime ban alone is modest, because nurses who are not required to stay may still choose to, or may feel they have no real choice when a colleague is left alone with thirty patients. A nurse who supports this bill should do so knowing that it addresses the coercion without solving the staffing shortage behind it. That honesty makes the testimony more credible, not less.
The Strongest Objection
Hospital associations have generally argued that mandatory overtime bans reduce the flexibility hospitals need to cover unexpected absences, particularly in rural facilities that cannot draw on a large float pool or agency market. That concern is real. A small hospital with four nurses on a night shift cannot absorb a sudden absence the way a large academic center can, and a legal prohibition could leave a unit short in a way that also harms patients.
The bill's emergency exception answers part of the objection, since a declared emergency such as a mass casualty event or a natural disaster would permit required overtime. The rest of the answer is that routine sick calls are predictable in aggregate even when they are unpredictable individually. A hospital that relies on mandatory overtime to cover them is treating a staffing plan as optional. Milstead and Short (2019) describe how effective policy advocacy anticipates the opposing side's interests and proposes workable alternatives; here, the alternative is an on-call system, regional float pools and incentives for voluntary extra shifts, all of which several states' hospitals already use under existing bans.
Why the Staff Nurse Belongs in the Room
The Code of Ethics for Nurses assigns the profession, acting collectively through its organizations, responsibility for articulating nursing values and integrating principles of social justice into health policy (American Nurses Association [ANA], 2015). Professional organizations usually carry that responsibility at a hearing, and their testimony matters. What an association cannot provide is a first-hand account of what the seventeenth hour of a shift feels like at a medication cart. Legislators hear statistics from every side of a debate, and the staff nurse's testimony gives the statistics a face that the opposing side cannot easily dismiss.
A three-minute testimony built from this paper would follow a simple structure. It would open with the speaker's name, unit and years of practice, and state her support for the bill. It would describe one shift in two or three sentences, including the time she was told she could not leave and the time she finally went home. It would cite two findings, the error risk after twelve hours and the reduction in mandatory overtime seen in states with similar laws, and it would acknowledge the rural hospital concern directly and point to the emergency exception. It would close with a single request: that the committee advance the bill. Written testimony submitted afterward would carry the full citations. The testimony works because it joins the two kinds of evidence a committee needs, the data that show a pattern and the witness who has lived inside it.
Conclusion
Mandatory overtime is often discussed as a workplace issue, but the evidence shows that it reaches patients through error risk, dissatisfaction and turnover. State laws that limit it have measurably reduced the practice, though they cannot by themselves solve the staffing shortages that drive it. A staff nurse who testifies for this bill brings the one form of evidence no report can supply, and she strengthens her case by being honest about what the bill will and will not do. Nurses belong in health policy for the same reason they belong at the bedside: they see what happens to patients when the system fails, and they are obliged to say so where the system is designed.
References
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Nursesbooks.org.
Bae, S.-H., & Yoon, J. (2014). Impact of states' nurse work hour regulations on overtime practices and work hours among registered nurses. Health Services Research, 49(5), 1638-1658. https://doi.org/10.1111/1475-6773.12179
Institute of Medicine. (2004). Keeping patients safe: Transforming the work environment of nurses. The National Academies Press. https://doi.org/10.17226/10851
Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse's guide (6th ed.). Jones & Bartlett Learning.
Rogers, A. E., Hwang, W.-T., Scott, L. D., Aiken, L. H., & Dinges, D. F. (2004). The working hours of hospital staff nurses and patient safety. Health Affairs, 23(4), 202-212. https://doi.org/10.1377/hlthaff.23.4.202
Stimpfel, A. W., Sloane, D. M., & Aiken, L. H. (2012). The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Health Affairs, 31(11), 2501-2509. https://doi.org/10.1377/hlthaff.2011.1377
How this NUR 4013 Module 6 example is structured
NUR 4013 Module 6 usually asks where a nurse belongs in health policy, and many sections want the answer argued with evidence rather than asserted as a value; your classroom's instructions decide the policy and the format. This example states a position on one concrete bill, sets out the patient safety evidence on long hours, tests whether state work hour laws change practice, answers the strongest objection from hospitals, and ends with the testimony itself. That final section turns the paper's argument into the action the module is asking about, which is why it closes the paper rather than sitting in an appendix.
NUR4013 Module 6 questions, answered
What does NUR4013 Module 6 usually ask?
NUR4013 Module 6 usually asks students to consider where a nurse belongs in health policy and to argue the answer with evidence. Many versions have students take a position on a specific law, regulation or proposal and explain how nurses can influence it. Your classroom's instructions decide whether the deliverable is a paper, a letter to a legislator or a presentation.
How do I choose a policy for a nursing position paper?
Choose a policy that is concrete, current and connected to nursing practice or patient outcomes, such as a state bill, a federal rule or a hospital policy with regulatory weight. A named bill or rule gives you something to support or oppose. Broad topics like healthcare reform are hard to argue in a short paper because there is no single position to defend.
Should a policy paper include the other side's argument?
Yes. A position paper is stronger when it states the most serious objection fairly and answers it with evidence or with the policy's own provisions. Graders and legislators both discount arguments that ignore the other side. Keep the counterargument to one focused section so it strengthens the position rather than taking over the paper.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official American College of Education document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.