“Inappropriate nurse staffing is the number-one concern of nurses today,” said ANA President Barbara Blakeney, MS, APRN,BC, ANP. “More than a decade of research has shown that RNs make the difference in quality of patient care, and that when RN care is insufficient, patient safety is compromised and the risk of death is increased.”

The bill incorporates the ANA’s Principles of Nurse Staffing, developed in 1999. Rather than recommending specific ratios, Principles is a tool to help nurses better gauge appropriate staffing by taking into account not only the number of patients but other important considerations, such as the experience levels of nurses on the unit, the severity of patients’ conditions, and the availability of support services and resources.

The act would require the establishment of a system that ensures “a number of registered nurses on each shift and in each unit of the hospital.” Specifically, the staffing system must;

• be created with input from direct care RNs or their exclusive representatives.

• be organized according to the number of patients and level and intensity of care to be provided, with consideration given to the admissions, discharges, and transfers that nurses must handle on each shift.

• account for the architecture and geography of the environment and available technology.

• reflect the level of preparation and experience of those providing care.

• reflect staffing levels recommended by specialty nursing organizations.

• ensure that an RN not be assigned to work in a particular unit without first having established the ability to provide professional care in such a unit.

The ANA has long been supportive of establishing appropriate nurse-to-patient ratios,” said Blakeney. “However, the ANA has not supported the approach of legislating specific ratios, because that approach fails to take into consideration the many variables that affect nurse staffing at the unit level. Staffing systems can only be effective if the direct care nurses who work on a specific unit have input. This legislation provides a comprehensive solution to the complex and urgent problem of insufficient nurse staffing.”

In addition, the ANA sponsored a briefing on Capitol Hill on May 5 to teach congressional staff about staffing. Participants joined Blakeney in explaining the complex factors that affect staffing and why direct care nurses’ input is essential. Captain Kathleen Pierce, MS, RN, CPHQ, of the U.S. Navy and a congressional “detailee” in Senator Inouye’s office, spoke about the senator’s staffing bill as well as nurses’ need to maintain professional judgment in patient care. Holly DeGroot, PhD, RN, FAAN, an expert in nursing workload and staff utilization research, described how California is dealing with the implementation of its ratio law—AB 394, signed into law in 1999—and the need for systems that can accurately reflect patient acuity level. Ann Tan Piazza, assistant director of government affairs and media relations of the Washington State Nurses Association, described the Washington state staffingbill—introduced as SB 5598 and HB 1602—and why the association developed legislation that does not mandate specific nurse–patient ratios. Finally, Tara Tehan, RN, BSN, a recent graduate and a critical care nurse at the Johns Hopkins University Hospital in Baltimore, Maryland, spoke about nurses’ dynamic work environments, underscoring the importance of adequate support services if good nursing care is to be provided.

The ANA encourages nurses to contact their senators and urge them to cosponsor S 991. A companion bill is expected to be introduced in the House of Representatives shortly.

Chris Donnellan is associate director in the ANA’s Department of Government Affairs.

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