A Senate bill calls for unit-by-unit staffing plans and publicly reporting those staffing plans, but stops short of dictating mandated nurse-patient ratios.
Federal requirements for unit-by-unit staffing plans and publicly reporting those staffing plans are at the heart of the newly introduced Registered Nurse Safe Staffing Act of 2014 (S. 2353), which stops short of dictating across-the-board, mandated, nurse-patient ratios.
Crafted with input from the ANA, the legislation is sponsored by Sen. Jeff Merkley (D-OR) and is companion legislation to a House bill introduced a year ago, the Registered Nurse Safe Staffing Act of 2013 (H.R. 1821).
Jerome Mayer, associate director, Department of Government Affairs at the ANA, tells me that the ANA isn't "directly opposed" to the kind of mandated nurse-patient ratios that California has in place and that some nurses in Massachusetts are fighting for (and against).
"But we think we have a more pragmatic approach," which is outlined in the new legislation, Mayer says.
That approach does include staffing ratios, but they would be set by the nurses themselves and would vary by unit and even by shift.
The bill would require hospitals to establish committees that would create unit-by-unit nurse staffing plans based factors such as the number of patients on the unit, severity of the patients' conditions, experience and skill level of the RNs, availability of support staff, and technological resources.
One crucial part of the bill is that those committees would be required to that it consist of at least 55% direct care nurses. The rest of the committee can be made up of anyone else the hospital wants to appoint, from nursing administrators to physicians, and other stakeholders.
"If you don't give a simple majority to direct care nurses nothing's really going to change," Mayer says. "If you don't have some power behind the staff nurses…chances are it's not going to really work very well."
The committee would go unit by unit, and shift by shift, to determine the minimum number of nurses for each, and that ratio would be upwardly adjustable. The ANA would develop guidelines to help the committees set their staffing plans.
"There is a ratio but the committee sets it," Mayer says. "If you need to bump a couple more nurses on the unit you can do that."
Mayer says this legislation is driven by ANA-members who want better staffing, but avoids the "hard-line approach" of one-size-fits-all ratios because when it comes to nursing, one size does not fit all.
"What works in a rural hospital in my hometown [in North Dakota] may not be the same thing in an urban trauma center," Mayer says. "It allows flexibility and it also allows buy-in."
Although it might be possible for a committee to create an inadequate, slapdash staffing plan simply to comply with the rules, another critical aspect of the legislation is the requirement to publicly report the staffing plans.
"We as consumers of healthcare are getting smarter about the delivery of care," Mayer says. "If you're able to compare the staffing levels… you're probably going to go to the one that has a better ratio of nurses to patients."
If passed, the federal law wouldn't supersede any existing state legislation that's stronger, but would require other states and hospitals to come up to snuff.
Mayer admits that passing this or any legislation is a marathon, not a sprint. The bill was read twice on May 15th and referred to the Committee on Finance. No vote has yet been scheduled.
"It's a long process. Sometimes it takes a decade or more to get real movement," he says. "After the Affordable Care Act, I think healthcare has taken a backseat federally… there's not a lot of appetite for it."
But even though the legislation might not pass soon, doesn't mean that it's unimportant. Mayer says ANA's members always say that their top concern is adequate staffing.
"Just because it's a long uphill fight doesn't mean it's not one worth fighting," he says.
Moreover, there's no reason for hospitals to wait for a federal or state mandate to create the kind of committee and staffing plan that the legislation calls for. They can do it now.
"We encourage them to do something similar," Mayer says. "It's just not getting done."
Alexandra Wilson Pecci is an editor for HealthLeaders.
