Updates on Safe Staffing Legislation in the U.S.

Nurses are frontline workers who are often the first to connect with people who are seeking medical care. Along with creating a comforting atmosphere for patients, nurses may also act as mediators between patients and doctors.

Despite nursing being an important and essential profession, the last few taxing years have highlighted the challenges nurses face in today’s increasingly demanding and ever-changing healthcare system.

Recognizing these obstacles, on May 11, 2021, Senator Sherrod Brown of Ohio introduced the S.1567 Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2021. This legislation aims to amend the Public Health Service Act and create a federal standard for safe nurse staffing ratios and guidelines.

S.1567 has since been referred to the Committee on Health, Education, Labor, and Pensions for further guidance. Once the bill is released by the committee, the legislation will go back to the Senate to be voted on.

The Senate can either vote to pass the bill or it can be debated and amended until there is a majority vote. Once the bill passes the Senate, it will go to the House. If the legislation passes the House, it will continue on to be signed into law by the president of the United States.

According to the Bureau of Labor Statistics (BLS), in June 2022, healthcare employment has decreased 1.1% since February 2020. Although healthcare employment has seen an increase in job fulfillment, about 176,000 positions have remained open in the last two years.

During the COVID-19 pandemic, many nurses left traditional bedside roles for travel jobs with higher compensation, according to Becker’s Hospital Review. Poor staffing numbers and high turnover rates can have detrimental impacts on patient outcomes and nurses’ health, suggest 2018 studies from PubMed and Marshall University.

Improper staffing can lead to more mistakes and less patient satisfaction. Nurses have also pointed to poor staffing ratios as a cause of burnout, which has led nurses to consider leaving the profession.

S.1567 asks for federally mandated nurse-to-patient ratios to reduce the negative impact low staffing can have on the health of patients and their nurses. Currently, no federal guidelines exist for nurse staffing ratios.

The bill also recognizes the need for more students to enter the healthcare field, especially in nursing. Along with setting ratios, the bill also asks that the government provide more scholarship opportunities to encourage more people to study nursing and expand the nurse retention grant program.

Although no federal standard currently exists, many states have their own regulations around safe staffing. In March 2022, 16 states had laws or regulations in place to address nurse staffing in hospitals. For instance, both California and Massachusetts have nurse-to-patient ratios or standards.

The bill’s primary focus is on regulating the nurse-to-patient ratios in a hospital. The bill creates a straight-forward, numerical ratio for hospitals to follow. Instead of assigning a nurse to a general number of patients, the bill categorizes the amount of patients per department.

The ratio is broken down to account for various departments within a hospital and factors in the demands nurses will most likely encounter with patients in each unit. For example, the bill establishes that a nurse can only care for one patient in a trauma emergency unit, and five patients in skilled nursing units or rehabilitation units.

Having a minimum staffing requirement would allow nurses to refuse to participate in assignments if the staffing ratio could not be followed, or if nurses felt unable to care for a patient without jeopardizing their licenses. Nurses would have federal protection against any employer retaliation if staffing ratios are not followed.

Along with requiring safe staffing ratios, S.1567 also mandates employers to have a staffing plan and post their nurse staffing ratios. These plans must be updated annually. Once the bill passes, hospitals will have two years to comply (and rural areas will have up to four years).

S.1567 also amends areas of the scholarship and grant portions of the Public Health Service Act. The bill would add a stipend component to the scholarship program and rename the grant as a grant for nurse retention, making it more affordable to become a registered nurse.

The grant for nurse retention would provide more mentorship projects for new nurses, graduates, and nursing students. The bill seeks to retain nurses by providing additional support in the workplace, especially in the hospital setting.

Safe staffing is important in all areas of employment, but especially in healthcare. Numerous studies have linked patient safety and staffing ratios. By being mindful of safe staff-to-patient ratios, healthcare facilities can increase positive patient outcomes and decrease mistakes.

Not only is safe staffing beneficial to patient outcomes, but having appropriate ratios can also help decrease burnout experienced by nurses and other healthcare professionals. Burnout can cause staff to have more errors in patient care and nurses to leave the profession.

The current safe staff legislation is working to create a federal mandate for safe staffing regulations for nurses, however currently no measurable definition of unsafe staffing exists. Some states, like Washington, are working on creating their own state guidelines.

Other states, like Massachusetts, have a less defined explanation of unsafe staffing. For example, the Massachusetts Nursing Association defines unsafe staffing as any time the nurse on duty believes the staffing ratio is unsafe.

There are several ways healthcare administrators may calculate nursing staff ratios. One of the more popular methods is the hours of care per patient day (HPPD) method. This ratio calculates the paid hours of healthcare staff compared to the number of patients cared for over that time.

However, opponents of safe staffing legislation argue that too many variables exist to apply a blanket HPPD ratio to nursing staff. They argue patients require different levels of care. Many calculations may factor in the number of nurses, the number of patients, and the type of care the patient may need to receive.