# What This Bill Does: Nurse Staffing Requirements in Hospitals

This bill would require hospitals across the country to maintain minimum numbers of registered nurses on their floors based on the type of unit and patient needs. Right now, there's no federal requirement for how many nurses must care for patients, so staffing levels vary widely from hospital to hospital. This bill would change that by setting specific nurse-to-patient ratios that hospitals must follow.

Here's what the actual numbers would look like: In the most critical units like trauma centers and operating rooms, one nurse would care for just one patient. In intensive care units, one nurse would handle two patients. Emergency rooms and pediatric units would have one nurse per three patients. Regular medical-surgical floors would have one nurse per four patients. The ratios get a bit higher for less acute care areas—rehabilitation units would have one nurse per five patients. The bill gives hospitals up to two years to meet these requirements, or four years if they're in rural areas.

The bill also includes important protections to make sure these ratios actually work in practice. Hospitals can't average staffing numbers across shifts to make it look like they're meeting requirements when they're not. They can't force nurses to work mandatory overtime just to fill staffing gaps. Nurses must be properly trained and oriented to each unit before being assigned there, and temporary staffing agency nurses must meet the same standards. The bill also prohibits hospitals from using video monitors or other technology as a substitute for actual nurse presence and assessment.

The reasoning behind this is straightforward: research shows that when hospitals have adequate nursing staff, patients have better outcomes, fewer medical errors occur, and nurses are more likely to stay in their jobs rather than burning out. The bill acknowledges that hospitals have been cutting nursing staff to save money, which puts patients at risk and makes the nursing shortage worse by driving experienced nurses out of the profession. By setting minimum standards, the bill aims to improve patient safety while also making nursing jobs more sustainable.

Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2021

Schakowsky, Janice D.

Nurse Staffing Standards for Patient Safety and Quality Care Act of 2021 This bill requires hospitals to implement and submit to the Department of Health and Human Services (HHS) a staffing plan that complies with specified minimum nurse-to-patient ratios by unit. Hospitals must post a notice regarding nurse-to-patient ratios in each unit and maintain records of actual ratios for each shift in each unit. The bill also requires hospitals to follow certain procedures regarding how ratios are determined and other staff are prohibited from performing nurse functions unless specifically authorized within a state's scope of practice rules, among other requirements. HHS must adjust Medicare payments to hospitals to cover additional costs attributable to compliance with these ratios. Nurses may object to, or refuse to participate in, an assignment if it would violate minimum ratios or if they are not prepared by education or experience to fulfill the assignment without compromising the safety of a patient or jeopardizing their nurse's license. Hospitals may not (1) take adverse actions against a nurse based on the nurse's reasonable refusal to accept an assignment; or (2) discriminate against individuals for good faith complaints relating to the care, services, or conditions of the hospital or related facilities. HHS may impose civil monetary penalties on hospitals violating the ratio requirements and must publish the names of such hospitals. The bill provides stipends to the nurse workforce loan repayment and scholarship program and expands the nurse retention grant program to include nurse preceptorship and mentorship projects.