Bill Would Establish Minimum Staffing Levels in Nursing Facilities

Reps. Lois Capps, D-CA, and Robert Simmons, R-CT, recently introduced the Quality Nursing Care Act of 2005, legislation that would force hospitals to meet nurse-to-patient ratios specific to each department and post staffing levels daily. 

The Quality Nursing Care Act of 2005 will ensure that patients receive adequate 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. 71, which was introduced by Sen. Daniel Inouye (D-HI) on Jan. 24, 2005.

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 in partnership with direct-care RNs or their designated representative;
• be based on the number of patients and level and
• intensity of care to be provided, including admissions, discharges and transfers;
• 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 "float" to a particular unit without prior training or orientation.

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

Advocates of nursing immigration see the recruitment of nurses from abroad as one of the ways to bridge the gap an meet staffing ratio requirements while longer term efforts to boost nursing numbers are pursued.

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