Vermont Legislature SmartTranscripts:

[Sen. Alison Clarkson (Chair)]: And we are like We just took on a huge challenge. Okay. Welcome back to Senate Economic Development, Housing, and General Affairs. Right now, we are going to pivot to another area of workforce. We're going to address our nurses and to address S-two 77, we welcome to our committee, Senator Martin, it is a total pleasure to have you here. And would you be kind enough

[Sen. Martine Gulick (Chittenden Central District)]: to introduce your bill and introduce yourself? Thank you very much, Madam Chair and Committee. I am Senator Marcini Dorothea from the Chittenden Central District. This bill, some might call a mandatory a ban on mandatory overtime for nurses. I'd like to call it safe hours for safe care because that's what it's all about. It needed

[Sen. Alison Clarkson (Chair)]: to be the like your statement of what the name of

[Sophie (Office of Legislative Counsel)]: the bill.

[Sen. Martine Gulick (Chittenden Central District)]: Yeah, Safe Hours for Safe Care. The idea of this bill came to me from a few constituents who are either work as a nurse or are, you know, related to someone who works as a nurse. And this particular gentleman, he was concerned about his girlfriend and her experience as a Vermont nurse who would work these twelve hour shifts, get a relatively short break, and then have to work again. And she was concerned that these long hours were having an effect on the quality of care that she was providing. As you all know, nurses are incredible professionals who take their patient care as their primary responsibility, but they are human and we all know that sleep is incredibly vital to mental acuity, not to mention physical stamina. So, yeah, so if this is an issue, having, you know, lived with someone who works in the airline industry, there are very clear guidelines to how many hours you can fly and then you need a certain amount of a rest period before you can fly again. This is, you know, sort of same idea because you've got the safety of human beings in your hands. 18 states have laws that ban or strictly limit mandatory overtime for many nurses and a small group of states go further by requiring a defined rest period after long shifts. So an eight to ten hours off after a twelve hour work shift,

[Sen. Randy Brock (Vice Chair)]: for

[Sen. Martine Gulick (Chittenden Central District)]: example. And then there are states with explicit minimum rest between shifts for nurses. I can provide you with all this information if you'd like. Among these states, a few write a specific off duty period into law after long shifts, directly addressing twelve hours, then call back same day scenarios. Illinois, for example, after working twelve hours, a nurse must receive eight hours of rest before the next shift. Maine, after working eight hours, eight consecutive hours, a nurse must receive ten hours off. New Hampshire, after working twelve hours, a nurse must receive eight. West Virginia, per shifts of twelve hours or longer, nurses must receive eight hours of rest after the shift. And then one other I'll mention is Oregon, the general rule for all employees of at least eight hours between shifts, a twelve hour nurse shift cap. And it guarantees a minimal rest period in most cases. So the bill itself, as you can see, it would prohibit hospitals and long term care facilities in Vermont requiring nurses to work mandatory overtime except in limited emergency situations. Its stated goals are to protect patient safety, safeguard nurses' health, and improve working conditions. I'd be happy to continue work and let Ledge Council

[Sen. Alison Clarkson (Chair)]: think Sophie is happy to let you go back to health and welfare. We're doing all sorts of

[Sen. Martine Gulick (Chittenden Central District)]: important work. We are. Yes.

[Sen. Alison Clarkson (Chair)]: So if we have questions from our team before we move to Sophie, let's ask.

[Sen. Martine Gulick (Chittenden Central District)]: Well, Wait. I wasn't I wasn't trying to ignore the the introduction. It's just that this was one of the first pills we did sixteen years ago. So I'm hoping to see I'm hoping to hear from Sophie, like, what we And had or didn't we had discussed even a a cap on what you could volunteer for because, you know, people are kind of told, like Yeah.

[Sophie (Office of Legislative Counsel)]: We need you to volunteer for this.

[Sen. Martine Gulick (Chittenden Central District)]: Right. How how to make it all work. So I feel like we've had this discussion, like, every

[Sen. Alison Clarkson (Chair)]: four years forever. Yeah. We'll find out from someone

[Sen. Martine Gulick (Chittenden Central District)]: who's having what what we're is if there's no oversight and that's why you're getting a complaint or you haven't quite gotten it right. So

[Sen. Alison Clarkson (Chair)]: Well, also, would just tag on nurses. What about doctors? I mean, I'm sorry. Residents who've been up for sixteen hours, I think to do nurses without doing doctors as well, it does seem a little pointless.

[Sen. Martine Gulick (Chittenden Central District)]: Yeah. So I think the residents have brought this up, like the new SEIU Yes. The residents, but they have wait. They haven't acted. Yeah. We've talked about that a couple

[Sen. Alison Clarkson (Chair)]: of weeks. Exactly. Yeah. I think any other questions from our team before we move to Sophie?

[Sen. Randy Brock (Vice Chair)]: Any. Any? Wow. Okay. Great.

[Sen. Martine Gulick (Chittenden Central District)]: Great. Well, I hope you support this. Will watch the testimony online at a later date.

[Sen. Alison Clarkson (Chair)]: When she's not sleeping, you should be doing as a legislator because we need good sleep to go Exactly. With life here in

[Sen. Martine Gulick (Chittenden Central District)]: the State House every day. Yeah. Alright. Well, let me know how I can support you all with this bill, and thank you very And come back. Thank you so much. Martine, thanks for introducing us. Yeah. You're welcome. Thank you. And it's just a reminder when

[Sen. Alison Clarkson (Chair)]: comes I know. And, Sophie, if you'd be kind enough to join us, that'd be great.

[Sen. Martine Gulick (Chittenden Central District)]: Wonderful. Thank you. State.

[Sophie (Office of Legislative Counsel)]: Wonderful. State Hospital, Sophie, is that me? Well, that's So, yeah, so, so visit Antony for the Office of Legislative Council, and I will say upfront, I'm not aware of what you did sixteen years ago. Okay. You can certainly look into it. There's nothing right now, as far as I'm aware of, in statute. Well then, I'm glad we're doing this. I was maybe at the Diamond Senate.

[Sen. Alison Clarkson (Chair)]: Signal teacher, how we vote blame the Senate for inaction.

[Sen. Randy Brock (Vice Chair)]: With that said, is there any comparable bill for any type of profession?

[Sophie (Office of Legislative Counsel)]: So right now there is a short form bill in the House.

[Sen. Randy Brock (Vice Chair)]: No, no, actual law. No.

[Sen. Martine Gulick (Chittenden Central District)]: But pilots have a federal requirement, is that what

[Sophie (Office of Legislative Counsel)]: I'm saying? There is the medical students, medical residents, there is the accreditation council on graduate Medical Education that so there was what was called the design board that came out in the 1980s involving a Dunnington student in New York who died, and there was an investigation, and it was concluded, it was due in part that the physicians that were treating her were just exhausted, and so her father was, I believe, a plaintiff's lawyer, filed a lawsuit, and so there was laws passed, and again, where that landed up is on graduate medical education and making sure that, sort of restricting the number of hours that medical students and residents can work. So we have that in place currently? So that's federal. That's federal. In order to be accredited as a medical school, you need to meet the requirements, and one

[Sen. Alison Clarkson (Chair)]: of the accreditation requirements is around hours that can be, that they can work. When we take this up next, if we could have that, because it does strike that that nurses and doctors should be aligned on this, it seems crazy if they're not aligned, given they're doing similar things. Okay. All right.

[Sophie (Office of Legislative Counsel)]: I think you have a pain point. But I

[Sen. Alison Clarkson (Chair)]: think the other, that's a good key question, is that the other professions that where we may or may not limit over time for public safety or or human safety. I mean, I think that's a that's a question because you could probably argue the same thing about our professionals, firefighters, our professional police, financial leaders. We Those without saying lunches. So,

[Sophie (Office of Legislative Counsel)]: was one of the questions of this bill. This was one of the first bill requests that I received, and there was a question as to where it should go. Should it go into one of the titles involving healthcare, should it go in for labor employment? And I did a deep dive, I'm happy to share that with you. I mean, Senator Kulik mentioned 18 states. I went through all the 18 states, their statutes, what they provide, and they're kind of split fifty-fifty as to where they put these laws. Do they put them in their healthcare provisions? Do they put them in their labour provisions? Because there isn't really anything comparable in Vermont under their healthcare provisions.

[Sen. Alison Clarkson (Chair)]: Might as well do it here.

[Sophie (Office of Legislative Counsel)]: We decided to put it under labor. There are a number of other bills, you have one on the wall, involving overtime for professional firefighters. So one thought is that right now the section this would go under in Title 21 is called minimum wage, and it covers minimum wages and overtime, but it's not included in the language in this bill, but one thought would be just to change the title to minimum wage and overtime, and then just keep any profession specific And then

[Sen. Alison Clarkson (Chair)]: we can do both at the same time. In fact, we can do both bills in the same breath. Yeah. So is it do I have

[Sophie (Office of Legislative Counsel)]: your permission to share my screen? Of course. Okay.

[Sen. Alison Clarkson (Chair)]: You're already up there.

[Sen. Randy Brock (Vice Chair)]: So So

[Sen. Alison Clarkson (Chair)]: is it large enough for you? I'll keep trying to get bigger. Thank you. So, Senator Okay, great.

[Sophie (Office of Legislative Counsel)]: Yeah, Senator Gulick mentioned a couple of things that I was going to mention around there's no federal prohibition on overtime for nurses. There is a federal law that was, proposed law that was introduced in Congress in March 2024 called the Nurse Overtime Patient Safety Act, and as far as I can tell, there was also a similar bill on the House side. It hasn't moved, which I suppose is not surprising right now at the congressional level. There are 18 states that do have limits on overtime. The state laws vary, but they set limits on maximum shift, the amount of reported rest periods, and then their definition of emergency exceptions. And so some of the common exceptions are around, you know, if you're in the middle of a surgery, there's catastrophic mass casualty event, kinds of things. And then the definitions as to which employers and employees are covered also varies by state. So we'll get into the definitions in this one, but just so you're aware there, you know, that may be something for the committee to think about is which employer should

[Sen. Thomas Chittenden (Member)]: be

[Sophie (Office of Legislative Counsel)]: covered and which employee should be covered. So

[Sen. Alison Clarkson (Chair)]: And this bill doesn't specify that?

[Sophie (Office of Legislative Counsel)]: Yes, it does. Okay. All right. The first section talks about policy, and again, the goal here is to promote patient safety, protect the health of nurses, improve working conditions in hospitals and long term care facilities. So this would cover hospitals and long term care facilities and cover nurses, providing direct patient care or clinical services to patients by prohibiting mandatory overtime. So the employer is going hospital or a long term care facility, and then the definitions of hospital and long term care facility are the ones that are currently in statute. So, B2 at the bottom of page one has the definition of a hospital.

[Sen. Alison Clarkson (Chair)]: So it could be exploding. It could be

[Sophie (Office of Legislative Counsel)]: Yes, so the definition is a place devoted primarily to the maintenance and operation of diagnostic and therapeutic facilities for inpatient medical or surgical care of individuals who have an illness, disease, injury or physical disability or for obstetric that's licensed or required to be licensed and then under Title of 18. And then long term care facility covers residential care homes, nursing homes, assisted living residences, homes for persons who are terminally ill or therapeutic community residences, and again that references Title 33 in the definition in there. The definition of mandatory overtime means work required of a nurse by an employer in excess of an agreed upon predetermined regularly scheduled shift, but in no case shall it be more than twelve hours in any twenty four hour period, or forty eight hours in any work week. And again, just a flag here for nurse, the definition under subsection five is a registered nurse or a licensed practical nurse. The definition's in Title 26. Title 26 also has a definition for advanced practice registered nurses, so this does not include advanced practice registered nurses. What is that? We would hope that all nurses were advanced in their breast. This is a particular designation. It's a particular, I guess, qualification that you have. So again, in some states, they have broader definitions of the employees that are covered. Some are narrower, some exclude, for some reason, nurse anesthetists. So again, this is something for the committee to hear from in terms of what nurses should be covered. But right now, covers registered nurses and licensed practical nurses. And then on call time is the time spent by a nurse who's not working but is compensated for being available. So often, you know, being on call means, you know, we don't need you right now, but you need to be nearby, available to come in if we need you. And then the prohibition from subsection c, no nurse shall be required to work mandatory overtime. A nurse may not be disciplined for refusing to work in excess of an agreed upon predetermined regularly scheduled shift, but may be disciplined for refusing to work mandatory overtime if any of the exceptions to the prohibition, which we're going to get to next, apply. So, this language says may, just wanted to flag that, and that's may not be disciplined, and again, you know, I don't know if you want to change that to shall, shall be disciplined, or some language that's more forceful than may. Right now, it's just that parallel construction of may not be disciplined, but may be disciplined. Getting into subsection d, these are the lists of the of the exceptions. And again, these are pretty standard compared to the ones that are being used nationally. So the first one is if a federal, state or local state emergency has been declared. Two, if the nurse is actively engaged in an ongoing medical or surgical procedure and the continued presence of the nurse through the completion of the procedure is necessary to the health and safety of the patient. And then three, it's an unforeseen disaster or other catastrophic event occurs that substantially affects or increases the need for healthcare services. And then it goes on to provide a definition of that. So it's one that does not occur regularly, that increases the need for nurses to provide safe patient care, and could not be prudently anticipated by the employer. Then it specifically states, this does not include situations in which the employer fails to have sufficient nursing staff to meet the usual and predictable nursing needs of its patients. So that was something that came through the team nationally, was making sure that there isn't a, you know, I think that it reflects that there are shortages of nurses nationally, and so mandatory overtime is being used to fill the gaps, And these boards are intended to prevent hospitals from, you know, requiring people to work these excessively long shifts because of nursing shortages. So, substantial But that

[Sen. Alison Clarkson (Chair)]: is going to be our biggest challenge and pushback, is that we are in a workforce. And not I wouldn't necessarily use the crisis, but close to, hence our dependence on traveling nurses, hence our dependence on overtime. And it will be, you know, there's a balancing act that we're all going to have to do. All of us do do in our lives between life, really strong life needs, keeping a hospital open, keeping a ward open, and somebody's work time. So I think this is gonna be a crux of some of our challenge right here.

[Sophie (Office of Legislative Counsel)]: So subsection E requires that hospitals' long term care homes make a good faith effort. If an employer determines that an exception exists, then the employer shall make a good faith effort to meet the staffing need through voluntary overtime or calling in for DMs and agency nurses before requiring mandatory overtime. So it does, it is recognizing that you have these other avenues you can use before you require people to come in. Right. But, still. Subsection F at the top of page four, on call time. So, again, if somebody's on call, they're not actually working, but they're available, they're being compensated for being available, that doesn't count towards the twelve hour shift.

[Sen. Randy Brock (Vice Chair)]: Then voluntary Until they do. Right.

[Sophie (Office of Legislative Counsel)]: And then subsection G, voluntary overtime, so again, nurse could voluntarily agree to work overtime. H, off duty, and this is again what Senator Gulick was referring to. Any work any nurse who works more than twelve consecutive hours must be about it at least ten consecutive hours off duty immediately following the worked overtime. And I did just want to she mentioned within some other states, the ones that I saw that had the longest shifts were, there were a couple of states that allowed, like, up to fourteen hours, but again, twelve hours was pretty much the standard length of maximum amount of time somebody could work on a shift. Subsection I provides that nothing in this section shall be construed to limit, alter or modify the terms, conditions or provisions of a collective bargaining agreement entered into between an employer and a labour organisation representing nurses. So I am aware, for example, that UVM Medical Center, their collective bargaining agreement does prohibit mandatory overtime, so

[Sen. Alison Clarkson (Chair)]: that is already in that contract. And how many, do you have a rough guess of how many of our nurses are in that union around the state?

[Sophie (Office of Legislative Counsel)]: Is it only UPM? I'm just aware of UPM Medical Center. Don't know about the other

[Sen. Alison Clarkson (Chair)]: hospitals I'm sure. I thought the union, the nurses union was statewide. Just one facility. I'm just aware of that contract. So the union contract already in it's AFT became the nurses' union. Yeah, AFT. AFT, right. So the nurses' union already prohibits.

[Sophie (Office of Legislative Counsel)]: Right. And if they say except for an emergency, they don't define what emergency is in the collective bargaining agreement, which is different than here. At least it spells out what the kind of emergency would be that would justify having somebody come in. So section two, this provides for a report on mandatory overtime for nurses. So again, this requires, and again, there's a balancing act here between the Department of Labor is responsible for enforcing overtime and minimum wage laws, and then the Department of Health obviously has oversight of the hospitals and the long term care facilities. So this proposes that employers will report all instances of mandatory overtime and the circumstances requiring its use to the Department of Health, and then if this is appropriately included in the report, so an explanation for the use of the overtime and any applicable exception, and then the good faith efforts that the employer undertook to avoid needing to require people to come in. And then again, we're on page five, subsection three. Those reports would be subject to inspection copying, but any personally identifiable information would be redacted. And then subsection c would require employment to post in a conspicuous place a printed notice of the requirements of the chapter, the subcapture by the mandatory overtime provision. And then section three gets into the investigation of complaints. Again, would be by the Commissioner of Labour, which currently has authority to investigate complaints relating to minimum wage and overtime. And it provides in subsection b a sliding scale of violations. So from a thousand dollars for the first violation up to $2,000 per third and any subsequent violations. And then if an employer fails to report, which is what's in section three eighty nine, the fine would be $500 for that. And again, I can share with you if the committee's interested what other states do. There's just enormous variety in terms of violations. So some of them, Alaska is 25,000, but they have a sliding scale of reprimands with $25,000 California, 50 per employee, up to $100 per employee. New Hampshire, dollars 2,500 for a willful violation. New York, dollars 1,000 to 3,000 for violations within a twelve month period. So again, that's just a huge range of penalties.

[Sen. Alison Clarkson (Chair)]: That's also a challenge because our hospitals have no money, I mean, except for UBMs. I mean, yeah.

[Sen. Randy Brock (Vice Chair)]: Okay.

[Sophie (Office of Legislative Counsel)]: And then this provider would take about 07/01/2026.

[Sen. Alison Clarkson (Chair)]: Many, any questions for Sophie?

[Sen. Randy Brock (Vice Chair)]: Thank you. You know oh, David? No. Just if we continue, we tee this up for testimony, certainly hearing from nurses, the unions.

[Sen. Alison Clarkson (Chair)]: And we'll also, I think, tee it up with firefighters, and I think your suggestion of doing this in our labor statutes with minimum wage and overtime, doing that together makes sense because then it's clearer for future legislators. I would appreciate your finding out what happened to this. If we could just do a little legislative date on what happened to this bill. I guess both of us remember it, actually. I she served on house general. I did.

[Sophie (Office of Legislative Counsel)]: Okay. So

[Sen. Randy Brock (Vice Chair)]: Can someone also provide the 18 states and a matrix of what they do and do not? I'm

[Sophie (Office of Legislative Counsel)]: a complete note, so yes. She you already have one already, I will I will I will send it to

[Sen. Alison Clarkson (Chair)]: the It's be kind of to send that to so that those of us who are as as you are about these kind of this important I mean, it's important growth. You know? But thank you for digging so be so be it. Just your your prep is just incredible. So I really appreciate it. You must have been an academic or not an academic.

[Sophie (Office of Legislative Counsel)]: Married to an academic.

[Sen. Thomas Chittenden (Member)]: And testimony in each area, I'm assuming you'll be providing also competent testimony, in other words, management from hospitals.

[Sen. Alison Clarkson (Chair)]: Randy, that's our job, to provide balanced and ideas for that would be great because it's not just UVM filters.

[Sen. Randy Brock (Vice Chair)]: Can we have a check out if we were in the middle of a healthcare cost market and this may exacerbate that condition but you know it's just one potential side effect. Want to read and JFO give a short summary.

[Sen. Alison Clarkson (Chair)]: Absolutely, have you talked to Nolan at all about this?

[Sophie (Office of Legislative Counsel)]: No, I mean they're aware of it but I haven't studied.

[Sen. Alison Clarkson (Chair)]: So let's ask no one if he's able to weigh on this at the moment and the impact because clearly there are some hospitals functioning with unions and some hospitals may already be complying with this just because it serves them by having help. So, we will hear from the hospitals, we will hear from the union, we will hear from nurses. The hospitals,

[Sen. Thomas Chittenden (Member)]: just simply asking the question, how much a great time does the Chiropay nurses to pump their airways out

[Sen. Alison Clarkson (Chair)]: of the Well, and how much do you use that or do you have an agreement about time off? I mean, they may Yeah. For Yeah. So, an intro I think this is an interest I have interest in doing this with the Senate of Firefighters. I'm glad to know that I would love to hear, Sophie, what the agreement is federally for the doctors because I think it ought to be, I thought whatever we do for nurses and firefighters should be aligned with doctors.

[Sophie (Office of Legislative Counsel)]: Yeah, that may be, I don't know about doctors per se, I just know about graduate medical education accreditation requirements. Well, that's where

[Sen. Alison Clarkson (Chair)]: they're most abused, is in their residence Right. Internships. And, again, it

[Sophie (Office of Legislative Counsel)]: may be you know, I know there's federal accreditation of hospitals, so I don't know if there's anything in there about that, but I can check with her.

[Sen. Martine Gulick (Chittenden Central District)]: But I think would be

[Sen. Alison Clarkson (Chair)]: good to know what it is so that we don't do something that's I I think they should be a little aligned if we can.

[Sophie (Office of Legislative Counsel)]: Well, I mean, again, my con the concern would be if you if you, as a state, required something different for, say, medical residents that would then mean you know, if you only have one medical school in the hospital in the state, you wouldn't want to be in a position where it

[Sen. Alison Clarkson (Chair)]: loses its credit the East Side are served by residents on the East Side. Right. But who may not be impacted. But it would just be good to know at work if this bill is requiring more time off, less time off. And I just like to see it aligned. Give it another thought. Okay. Great. This is terrific. We are going to go offline because we are going

[Sen. Martine Gulick (Chittenden Central District)]: to take a break for fifteen

[Sen. Alison Clarkson (Chair)]: minutes and then we're going to address the new federal challenges and opportunities we have with the federal government and our laws. So we are going to be hearing from Tucker Anderson and Pepper.