About the Issue
Inadequate nurse staffing levels by experienced RNs are linked to higher rates of patient falls, infections, medication errors and even death. As a result of massive reductions in nursing budgets, combined with the challenges presented by a growing nursing shortage, fewer nurses work longer hours and care for sicker patients. This situation compromises care and contributes to the nursing shortage by creating an environment that drives nurses from the bedside.
ANA and its Constituent & State Nurses Associations (C/SNAs) in the states are promoting legislation to hold hospitals accountable for the development and implementation of valid, reliable, unit-by-unit nurse staffing plans. These staffing plans, based upon ANA's Principles for Nurse Staffing (member login required), are not mandated ratios. They are created in coordination with direct care registered nurses (RNs) themselves, and based on each unit’s unique circumstances and changing needs.
ANA Supports the Registered Nurse Safe Staffing Act (H.R. 2083 / S. 1132) which would require Medicare participating hospitals, through a committee comprised of at least 55% direct care nurses or their representatives, establish and publicly report unity-by-unit staffing plans.
These plans must:
- Establish adjustable minimum numbers of RNs;
- Include input from direct care RNs or their exclusive representatives;
- Be based upon patient numbers and the variable intensity of care needed.
- Take into account the level of education, training and experience of the RNs providing care;
- Take into account the staffing levels and services provided by other health care personnel associated with nursing care;
- Consider staffing levels recommended by specialty nursing organizations;
- Take into account unit and facility level staffing, quality and patient outcome data and national comparisons as available;
- Take into account other factors impacting the delivery of care, including unit geography and available technology; and
- Ensure that RNs are not forced to work in units where they are not trained or experienced.
The RN Safe Staffing Act Ensures Compliance by:
- Holding hospitals accountable and establishing procedures for receiving and investigating complaints;
- Allowing the Secretary of Health and Human Services to impose civil monetary penalties for each knowing violation;
- Including whistle-blower protections for RNs and others who may file a complaint regarding staffing; and
- Requiring public reporting of staffing information. Hospitals must post daily for each shift the number of licensed and unlicensed staff providing direct patient care, specifically noting the number of RNs. The bill also requires the collection, maintenance and submission of data by participating hospitals sufficient to establish a link between the staffing system and patient acuity. Such data includes nursing-sensitive patient outcomes, operational outcomes such as work-related injury or illness, as well as vacancy and turnover rates, and nursing care hours per patient day.
On April 29, 2015, U.S. Reps. Lois Capps, D-CA and David Joyce, R-OH, as well as Sen. Jeff Merkley, D-OR, introduced The Registered Nurse Safe Staffing Act (H.R. 2083/S. 1132). This bipartisan legislation requires Medicare-participating hospitals to establish a committee composed of at least 55 percent direct care nurses to create nurse staffing plans for each unit. By creating a committee to oversee staffing plans, direct care nurse (who work closely with managers) are recognized to be the best equipped to determine the staffing level for their patients. Without optimal RN staffing, patients risk longer hospital stays, increased infections, avoidable medication errors, falls, injuries and even death.
Adding RNs to unit staffing has eliminated nearly one-fifth of all hospital deaths, and reduced the relative risk of adverse patient events, such as infection and bleeding. (Kane, 2007)
Reducing medical errors is particularly important because the Centers for Medicare & Medicaid Services has started denying payment for preventable hospital-acquired injuries or illnesses, and other private insurers are expected to follow suit.
Increasing the number of RNs can yield a cost savings of nearly $3 billion – the result of more than 4 million avoided extra hospital stays for adverse patient events (Needleman, 2011) – and reduces costly hospital readmissions.
MIRRORS STATE MODELS
Collaborative efforts among state hospital associations, nurse executives and ANA-affiliated state nurses associations have resulted in balanced staffing legislation that benefits patients, nurses and hospitals.
Seven states have already enacted safe staffing legislation using the Registered Nurses Safe Staffing Act's committee approach:
- Oregon (2002),
- Texas (2009),
- Illinois (2007),
- Connecticut (2008),
- Ohio (2008),
- Washington (2008) and
- Nevada (2009).