an average of three hours in a workweek. (3) 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. (4) 18 States have passed legislation or promulgated regulations restricting mandatory overtime for nurses. 3. Limitations on mandatory overtime for nurses (a) Provider agreements Section 1866 of the Social Security Act ( 42 U.S.C. 1395cc ) is amended— (1) in subsection (a)(1)— (A) in subparagraph (X), by striking and at the end