Proposed federal law would set nurse-to-patient staffing levels

The Senate legislation (S.1113) tracks current California laws and calls for a direct care registered nurse to have limits on their number of patients, depending on the situation.

Examples of maximums would include one patient in a trauma emergency unit, two patients in critical care units, three patients in emergency room and pediatrics units, and five patients in rehabilitation and skilled nursing units.

The legislation also includes whistleblower protections to protect nurses who advocate for the safety of their patients. Studies have shown lower nurse-to-patient ratios are associated with lower mortality rates. In one study, each patient added to a nurse’s workload is associated with a 7% increase in risk-adjusted mortality following general surgery, according to researchers from the University of Pennsylvania.

“We know that safe staffing levels mean better outcomes for patients. But too often, nurses are stretched too thin, caring for too many patients with not enough support,” said Brown, D-Ohio. “Workers are the first line of defense keeping Ohioans safe — we just need to make sure there are enough of those workers on the job.”

The Greater Dayton Area Hospital Association said they appreciate Brown’s “continued support for the high-quality, clinical care provided by our region’s hospitals,” but added that a national standard on nurse staffing would take away “local decision-making” efforts.

“Imposing staffing mandates on hospitals would eliminate the necessary, local decision-making that allows hospitals to remain nimble and meet a community’s clinical care needs while upholding established patient safety and quality standards,” GDAHA said in an organizational statement responding to the legislation. “As hospitals continue to recover from COVID-19, mandating staffing levels would only further exacerbate current staffing challenges, thereby jeopardizing our hospitals’ ability to meet the diverse needs of our 11 counties.”

There is currently no national, enforceable standards of practice when it comes to how many patients is too many for a nurse to serve in various settings, Brown said. Ohio law requires hospitals to provide a nursing service staffing plan to the Ohio Department of Health.

National Nurses United, the Alliance for Retired Americans and a number of labor unions endorsed the legislation.

These nurse-to-patient ratios are coming at time hospitals across the U.S. are facing a staffing shortage, which nursing advocates say was brought about by the hospitals’ “intentional policies of short staffing” and other cost-cutting methods.

“Hospital employers have intentionally refused to hire enough nurses to staff our hospitals,” said Jean Ross, president of National Nurses United, who has been a nurse for over 40 years. “They are more concerned with reducing labor costs and increasing hospital profits. This puts our patients at risk.”

Nurses across the country have reached their breaking point, Ross said about “chronic and severe understaffing” of nurses at hospitals.

“I’ve seen the danger the nursing profession is in,” said Rhonda Risner, a nurse at the Dayton VA and member of National Nurses United. Risner has been a nurse for 34 years and an ER nurse for 29 of those years. She has worked at the Dayton VA for 16 years.

“Hospitals are hemorrhaging nurses. Why? Because nurses are being put between a rock and a hard place,” Risner said. “Every day they are forced to work in conditions that are unsafe for their patients and themselves.”

This was a problem before the pandemic, but the pandemic made it a “major national crisis,” Risner said.

Hospitals have previously told the Dayton Daily News about how they have had to increasingly contract with outside agencies to fill gaps in staffing. The American Hospital Association says prices with those agencies have risen dramatically from what they were prior to the pandemic.

“They need them because of what they’ve engineered,” Ross said. She said the solution to traveling nurses is to hire enough nurses to bring nurses back to the hospitals.

“Mandated nurse staffing ratios are a static and ineffective tool that does not guarantee a safe health care environment or quality level to achieve optimum patient outcomes,” said Robyn Begley, senior vice president of workforce for the American Hospital Association and chief executive officer of the American Organization for Nursing Leadership.

Staffing ratios are based off of “older care models,” Begley said, and do not take technology or “interprofessional team-care models” into account.

“These newer models incorporate not only nurses at various levels of licensure, but also respiratory therapists, occupational therapists, speech-language pathologists, physical therapists and case managers,” Begley said.