Nursing Legislation Summary - Nurse Staffing for Hospital Patient Safety and Quality

Nursing Legislation Summary: Nurse Staffing for Hospital Patient Safety and Quality Care Act

Brittany Spence, BSN, RN, CEN - CRMH Emergency Department Legislation can make a difference to address the nurse staffing crisis. As of 2019, only 15 states have legislation in place to address nurse staffing ratios (American Nurses Association, 2019). Though helpful, “in 13 of those states, the laws only require there to be a general plan in place to manage the ratio as opposed to regulate it” (King University Online, 2019). The American Nurses Association, Emergency Nurses Association, and The American Academy of Emergency Medicine agree that states should require hospitals to formulate staffing plans for all nursing areas (Eales, 2019). The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (H.R. 2392, Schakowsky, 2017), sponsored by Illinois Representative Jan Schakowsky and Ohio Senator Sherrod Brown, focused on nurse-to-patient ratios to improve the safety and quality of patient care. Prior to this bill, there were no federal guidelines describing the appropriate number of patients a nurse could safely care for in all areas (National Nurses United, 2021). This paper explores the need for specific nurse-to-patient ratios within hospitals from a legislative perspective.

The higher the number of patients a nurse is required to care for at one time, the higher the rate of burnout, risk of errors, and inappropriate care for these patients (National Nurses United, 2021). According to National Nurses United (2021), each patient beyond recommended ratio limits increases the risk of adverse patient outcomes by 7 percent. There are several factors to consider when determining an appropriate nurse to patient ratio which include, but are not limited to, acuity, staff numbers, department volume, type and location of the facility, individual staff ability and experience, area of care (American Nurses Association, 2019). H.R. 2392 identified recommended patient to nurse ratios for specific care areas, including trauma emergency (1:1), operating room (1:1), critical care (1:2), emergency room /pediatric /stepdown /telemetry /antepartum /combined labor and delivery and postpartum (1:3), medical-surgical units/intermediate care nursery /acute care psychiatric /other specialty care (1:4), rehabilitation and skilled nursing (1:5), and postpartum/ well-baby nursery (1:6). This bill required hospitals to create and maintain plans for staffing each year to ensure that the minimum ratio requirements were met. It also required that hospitals maintain detailed records of how these ratios were maintained. The bill included protection for staff who reported unsafe ratios.

I have worked in 5 different emergency departments and have clearly seen how staffing ratios affect patient care and nurse wellbeing. When nurses get behind because they have more patients than is safe, the care of all patients suffer, and stress and burnout increases for the staff (Vuong, 2020). When the expectation is to take as many patients as necessary to fill the needs, care feels unsafe and nurses are discouraged to not be able to attend to their patients’ needs. The American Academy of Emergency Medicine advocate for a maximum ratio of 1 nurse per 3 patients in emergency departments (Eales, 2019), and in my experience I agree that this would allow for sustainable, safe and effective patient care with less stress for staff. Safe ratios also lead to decreased nursing errors, departmental efficiency, and lower nursing turnover (Eales, 2019; National Nurses United, 2021).

A bill that addresses safe staffing ratios is necessary to ensure that patient and staff safety are maintained in all hospitals. However, H.R. 2392 was never made into a law. However, bill

co-sponsor Senator Sherrod Brown has proposed a similar bill entitled Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2021. Currently, California is the only state that has a law passed specifically addressing nurse-to-patient ratios on specific hospital units (Eales, 2019; National Nurses United, 2021). Clearly, other states have a lot of work to do to pass similar laws to improve patient safety and nurse burnout.

In conclusion, nurses in the remaining states should advocate for best practices in safe patient care by working with their hospital safety committees and state nursing associations. Additionally, nurses can increase their political activism and awareness. One way is for nurses to contact legislators to provide testimony and helpful information to be used to develop legislation.

References

American Nurses Association. (2019, July). Nurse Staffing Advocacy. Nursingworld.Org. https://www.nursingworld.org/practice-policy/nurse-staffing/nurse-staffing-advocacy/

Eales, T. (2019, April 8). Unsafe Nursing Ratios Incapacitate EDs, Endanger Patients. Emergency Medicine Residents’ Association. https://www.emra.org/emresident/article/nursingratios/#:~:text=The%20American%Academy%20of%20Emergency,roles%20for%20higher%ac ity%320departments.

King University Online. (2019, March 12). Nurse-to-Patient Ratio: How Many is Too Many? Nursing Center. https://www.nursingcenter.com/ncblog/december-2019/nurse-patient-ratio

National Nurses United. (2021, April 29). Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act Sponsored by Senator Sherrod Brown Representative Jan Schakowsky. nationalnursesunited.org/sites/default/files/nnu/documents/0421_Ratios_Federal_FactSheet.pdf

Schakowsky, J. (2017, May 4). H.R. 2392 - Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2017. In govtrack. Retrieved June 29, 2021, from https://www.govinfo.gov/content/pkg/BILLS-115hr2392ih/pdf/BILLS-115hr2392ih.pdf

Vuong, L. (2020). Staffing Ratios and Burnout. American Journal of Nursing, 120(5), 13. https://doi.org/10.1097/01.NAJ.0000662724.83879.81