The Nurse Staffing Standards Act
H.R. 2123, Introduced by Rep. Jan Schakowsky (D-IL)
Visit Rep. Schakowsky's website to learn moreNurse Staffing Standards for Patient Safety and Quality Care Act of
2007 - Amends the Public Health Service Act to require hospitals to
implement staffing plans that meet specified ratios for direct care
registered nurse-to-patient staffing levels for each unit and other
requirements, including for receiving input from nurses. It also allows the
Secretary of Health and Human Services to further limit such ratios as
needed to ensure public safety and to establish ratios for units not
specified. It also requires hospitals to provide the
federal government with their staffing plan and annual updates.
Bill Summary
Two years after passage-and four years for rural hospitals-hospitals will be expected to develop and implement nurse staffing plans that meet newly-established minimum direct care registered nurse-to-patient ratios, adjust staffing levels based on acuity of patients and other factors, and ensure quality care and patient safety.
Minimum direct care registered nurse-to-patient ratios: A hospital would be required during each shift, except during a declared emergency, to assign a direct care registered nurse to no more than the following number of patients in designated units:
- 1 patient in an operating room and trauma emergency operating room and trauma emergency unit
- 2 patients in all critical care units, intensive care, labor and delivery and postanesthesia units
- 3 patients in antepartum, emergency, pediatrics, step-down and telemetry units
- 4 patients in intermediate care nursery, medical/surgical and acute care psychiatric care units
- 5 patients in rehabilitation units
- 6 patients in postpartum (3 couplets) and well baby nursery units
Based on the outcome of a required study, staffing requirements will be established for licensed practical nurses and will be required to be implemented in all hospitals within 18 months of the act's passage.
Staffing Plans Developed Together with Direct Care Nurses: Hospitals will be required to develop staffing plans no later than one year after the passage of the act, and must involve direct care nurses and other health care workers or their representatives in the development and the annual re-evaluation of those plans.The plans must identify and employ an approved acuity system that will establish guidelines by which the hospital must increase staffing above the required minimums based on patient need. The plans must also factor in an appropriate skill mix of other health care workers to ensure that staffing levels account for patient care needs that do not require a direct care registered nurse.
Enforcement: Uniform notices stating the requirements of this bill including the actual direct care nurse-to-patient ratios for each unit must be posted in a visible, conspicuous and accessible location for both patients and direct care staff.
Hospitals that fail to comply with the nurse staffing plan requirements could face a range of corrective actions, including civil monetary penalties and loss of funds.
Whistleblower Protection: This bill would provide whistleblower protection for nurses by securing a nurse's right and obligation to refuse assignment if doing so threatens the safety and health of a patient by violating the minimum ratios as set forth in this bill or if a nurse is not professionally prepared to fulfill an assignment. The bill also provides protections to 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. Such reimbursement will be based on recommendations by Medicare Payment Advisory Commission (MedPAC).