Publications

Federal Nurse Staffing Bill Introduced

Rep. Jan Schakowsky (D-IL) introduced The Safe Nursing Staffing for Patient Safety and Quality Care Act of 2004 (H.R. 4316) on May 6. The bill would establish minimum nurse-to-patient staffing ratios to improve the quality of care and address the nursing shortage that has left our nation's hospitals critically understaffed.The bill's major provisions include:

Registered Nurse staffing:

Within two years after becoming law (four years for rural facilities), hospitals would be required to develop and implement nurse staffing plans that meet the following minimum registered nurse-to-patient ratios:

  • 1 RN for each patient in operating room and trauma emergency units;
  • 1 RN for 2 patients in critical care units, including emergency critical care and intensive care, labor and delivery units, and post-anesthesia units;
  • 1 RN for 3 patients in antepartum, emergency, pediatrics, step-down and telemetry units;
  • 1 RN for 4 patients in intermediate care nursery, medical/surgical and acute care psychiatric care units;
  • 1 RN for 5 patients in rehabilitation units; and
  • 1 RN for 6 patients in postpartum (3 couplets) and well-baby nursery units.

Licensed Practical/Vocational Nurse (LPN/LVN) staffing:

Unlike registered nurse staffing, there is not yet a body of research regarding safe staffing standards for LPN/LVNs.Therefore, the bill would require the U.S. Department of Health and Human Services to conduct a study to examine and establish LPN/LVN staffing standards. The bill would require hospitals to implement such staffing standards within two years (four years for rural hospitals) of enactment of the legislation.

Development of staffing plans:

Hospitals would be required to develop and annually re-evaluate staffing plans with the involvement of direct care nurses. The staffing plans would be required to adopt an acuity system and provide for increased nurse staffing where necessitated by patient need.The requirements for staffing levels would not apply during a state of emergency that has been declared by the federal government or a state or local official with authority to declare an emergency. The term "declared state of emergency" does NOT include situations caused by a labor dispute or consistent under-staffing.

Funding:

The bill would allow for increased federal Medicare and Medicaid reimbursements to hospitals in order to help pay for the cost of increased staffing.

Protection for nurses:

The bill would protect nurses who refuse assignments that threaten the health and safety of patients or that violate the minimum staffing established by the act.The bill also would provide whistleblower protections for health care workers who report violations of the act.

State Laws:

The bill would allow states to establish staffing levels that meet or exceed the federal standards.

The original co-sponsors of the bill were: Rep. John Conyers (D-MI), Rep. Rosa DeLauro (D-CT), Rep. Peter Deutsch (D-FL), Rep. Bob Filner (D-CA), Rep. Martin Frost (D-TX), Rep. Joseph Hoeffel III (D-PA), Rep.Tim Holden (D-PA), Rep. Eddie Bernice Johnson (D-TX), Rep. Carolyn McCarthy (D-NY), Rep. Kendrick Meek (D-FL), Rep. Jerrold Nadler (D-NY), Rep. Eleanor Holmes Norton (D-DC), Rep. Lucille Roybal-Allard (D-CA), Rep. Linda Sanchez (D-CA), and Rep. Peter Visciosky (D-IN).

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