The American Nurses Association has developed nursing sensitive indicators that capture outcomes most affected by nursing care. ANA is promoting, through it's Nationwide State Legislative Agenda, state legislation that would require health care facilities to collect nursing sensitive indicator data and make it publically available. The appropriate numbers and mix of nursing personnel (RN's LPNs and Unlicensed Staff) are imperative for the delivery of safe, cost-effective quality care. Nurses are pushing for research projects that will collect data to establish the relationship between the right mix of staff and positive patient outcomes. Preliminary studies comparing staffing information and information on patient outcomes show that when there are more registered nurses, patients experience fewer complications, shorter lengths of stay, decreased mortality rates and even lower overall costs. However, a critical need remains for more definitive data to show the clear linkages between nursing interventions, staffing levels, and positive patient outcomes.

In 2002, legislation was passed in CT establishing a quality of care program within the Department of Public Health. The department is now required to develop standardized data sets to measure the clinical performance of health care facilities. TX regulations require hospitals to develop nurse staffing systems and to measure patient outcomes through the collection of nursing quality indicators.

The following legislation was proposed but failed in 2002: IA legislation called for the establishment of a nursing workforce data base that would include the collection of patient outcomes and outcomes indicators; NJ legislation would have required the public disclosure of staffing levels as well as patient care incidents including medication errors, patient injuries, decubitus ulcers and nosocomial infections; NY legislation would have required every licensed facility to make available to the public, information regarding nurse staffing and patient outcomes. This information would include the number of registered nurses providing direct care and the ratio of patients per registered nurse as well as the incidence of adverse patient care incidents; PA tried to amend the Health Care Cost Containment Council (collects and disseminates data for public accountability of health care costs) to include four nurse representatives and to collect data including medication errors, injury rates, nosocomial infections, pressure ulcers, patient satisfaction and the number of nurses providing care. WV legislation would have required any provider under the Medicaid program to make publicly available information regarding nurse staffing and patient outcomes such as mortality rates, adverse patient care incidents including medication errors, patient injury, decubitus ulcers, and nosocomial infections.

A study bill was enacted in FL in 1996. In 2000, legislation enacted in RI required an advisory council to consider nursing sensitive performance measures. Regulations are being written in NJ regarding the mandatory collection and public disclosure of nursing quality indicators by health care facilities.