ANA Applauds Nurse Staffing Bill Introduced In U.S. House of Representatives

Washington, DC --The American Nurses Association (ANA) today commended the introduction of federal legislation that will ensure adequate registered nurse (RN) staffing in health care facilities, a step that takes into account the recommendations of recent reports and the public outcry of health care consumers and nurses over unsafe staffing practices in the United States. The bill, the Quality Nursing Care Act of 2004 (H.R. 3656), was introduced Dec. 8 by U.S. Rep. Lois Capps (D-CA).

ANA, working closely with Representative Capps' office on the bill, lobbied for this legislation to protect patients and RNs. If enacted, the legislation will mandate the development of staffing systems in hospitals aimed at ending the widespread practice of health care facilities stretching their nursing staff with unsafe patient loads, mandatory overtime, “floating” to specialty units without training and orientation, and other practices that undermine the delivery of safe, quality care.

“ANA commends Representative Capps for her leadership on this issue and for her commitment to protecting patients and nurses from practices that are dangerous," said ANA President Barbara Blakeney, MS, APRN,BC, ANP. “This legislation is necessary to improve the work environment for nurses, and it will help in recruiting new nurses into the profession while also retaining those nurses who are already practicing.”

The Quality Nursing Care Act builds on more than a decade of research which shows that RNs make the quality difference in patient care and that when RN care is insufficient, patient safety is compromised and the risk of death is increased. The most recent example is an Institute of Medicine study, released on Nov. 4, 2003, which highlights the importance of improved nurse staffing. This report, Keeping Patients Safe: Transforming the Workplace Environment for Nurses, also recommends that nurses be involved in staffing and patient care decision making.

The Quality Nursing Care Act of 2004 will ensure that patients receive safe, quality nursing care in hospitals and other health care institutions. The proposed legislation mandates the development of staffing systems that require the input of direct-care RNs, and it provides whistle-blower protections for RNs who speak out about patient care issues, including inadequate levels of nurse staffing. The bill complements S. 991, which was introduced by Sen. Daniel Inouye (D-HI) in May 2003.

In addition, the bill amends the conditions of participation in the Medicare program and establishes a requirement for minimum staffing ratios. Rather than establishing a specific numeric ratio, the act requires the establishment of a staffing system that “ensures a number of registered nurses on each shift and in each unit of the hospital to ensure appropriate staffing levels for patient care.” Specifically, the staffing system must:

• be created with input from direct-care RNs or their designated representative;
• be based on the number of patients and level and intensity of care to be provided, with consideration given to patient admissions, discharges and transfers on each shift;
• account for 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; and
• provide that an RN not be forced to work in a particular unit without having first established that she or he is able to provide professional care in such a unit.

Another key provision of the bill is that it requires public reporting of staffing information. Under this mandate, hospitals would be required to daily post the number of licensed and unlicensed staff providing direct patient care on each unit and each shift, while specifically noting the number of RNs.

In addition, the bill incorporates ANA's Principles of Nurse Staffing. Rather than recommending specific numeric ratios, ANA developed the Principles of Nurse Staffing in 1999 as a tool for nurses to better gauge appropriate staffing. The principles not only take into account the number of patients but also look at other important staffing considerations, such as the experience level of nurses on the unit, the severity of patients’ conditions and the availability of support services and resources.

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ANA is the only full-service professional organization representing the nation's 2.7 million Registered Nurses through its 54 constituent associations. ANA advances the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public.

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