Skip to main content

Congressional Bill Seeks to Set Federal Nurse-to-Patient Staffing Requirements

Analysis  |  By Carol Davis  
   May 13, 2021

'Safe staffing levels save lives,' says one of the bill's sponsors.

Congressional Democrats introduced a bill this week that sets minimum nurse-to-patient staffing requirements and provides whistleblower protections for nurses who report violations to those rules.

U.S. Rep. Jan Schakowsky (D-IL) joined U.S. Sen. Sherrod Brown (D-OH) in introducing the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act, which gives hospitals two years—and rural hospitals four years—to develop and implement nurse staffing plans that meet minimum RN-to-patient ratios; adjust staffing levels based on acuity, nursing care plans, and other factors; and ensure quality care and patient safety.

According to the bill, a hospital would be required during each shift, except during a declared emergency, to assign a direct care RN to no more than the following number of patients in designated units:

  • 1 patient in an operating room and trauma emergency unit
  • 2 patients in all critical care units, intensive care, labor and delivery, post-anesthesia, and burn units
  • 3 patients in ante-partum, emergency, pediatrics, step-down, and telemetry units
  • 4 patients in intermediate care nursery, medical/surgical, and acute care psychiatric units
  • 5 patients in rehabilitation units
  • 6 patients in postpartum (3 couplets) and well-baby nursery units

California is the only state now requiring minimum RN-to-patient ratios. Its ground-breaking safe-staffing standards took effect in 2004.

Studies, including a 2010 research project on the California RN staffing ratio law, support an association between nurse staffing and better patient outcomes. 

"Lower ratios are associated with significantly lower mortality," said the study, which compared California's data to two other states without minimum RN-to-patient ratios. "When nurses' workloads were in line with California-mandated ratios in all three states, nurses' burnout and job dissatisfaction were lower, and nurses reported consistently better quality of care."

"Safe staffing levels save lives," Schakowsky said in a press release. "Numerous studies have shown that safe nurse-to-patient staffing ratios result in higher quality care for patients, lower healthcare costs, and a better workplace for nurses."

The bill also calls for:

Staffing plans developed together with direct care nurses: Hospitals will be required to develop staffing plans within one year after enactment date. Hospitals must involve direct care nurses (chosen by direct care nurses from their unit) and other direct care healthcare workers or their representatives (chosen by those direct care healthcare workers) in the development and the annual evaluation of their staffing plans. After two years, plans must comply with minimum ratio standards.

Enforcement: Hospitals that fail to comply with the nurse staffing plan requirements could face financial penalties.

Whistleblower protection: The bill protects a nurse's right to refuse an assignment that violates the minimum ratios. It also protects any hospital employee who reports a violation of this act.

Reimbursement: The bill allows for hospitals to receive additional Medicare reimbursement related to costs incurred related to compliance with this bill.

Promoting nurse workforce: The bill creates a preceptorship program to provide practical clinical experiences and training for students and early career nurses and a mentorship program to help new and transitioning nurses adapt to the hospital setting.

"It is past time that we act on the evidence and give nurses the support they deserve, and put patients over profits," Schakowsky said. "I will continue to partner with nurses across the country in promoting this bill and fighting to end dangerous staffing."

“Numerous studies have shown that safe nurse-to-patient staffing ratios result in higher quality care for patients, lower healthcare costs, and a better workplace for nurses.”

Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.


KEY TAKEAWAYS

A new Congressional bill sets minimum nurse-to-patient staffing requirements.

Hospitals have two years—rural hospitals, four years—to meet minimum RN-to-patient ratios.

Hospitals that fail to comply could face financial penalties.


Get the latest on healthcare leadership in your inbox.