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ANA State Goverment Affairs
Staffing Plans and Ratios Background Market forces have not resolved the issues of patient safety and quality of care related to nurse staffing. Massive reductions in nursing budgets have resulted in fewer nurses working longer hours, while caring for sicker patients. Nurses therefore, have requested the assistance of elected officials on the state and federal level to protect patients by holding hospitals accountable for the provision of adequate nurse staffing through legislative or regulatory means. Three general approaches to assure sufficient nurse staffing have been proposed. The first is to require and hold hospitals accountable for implementation of nurse staffing plans, with input from practicing nurses, to assure safe nurse to patient ratios are based on patient need and other criteria. The second approach is for legislators to mandate specific nurse to patient ratios in legislation or regulation. The third approach is a combination of nurse staffing plans and legislated nurse to patient ratios . Additionally, legislation was enacted that requires nurse staffing information be reported and made available to the public. Activities/Actions The American Nurses Association (ANA) and State Nurses Associations are promoting legislation to hold hospitals accountable for the development and implementation of valid and reliable nurse staffing plans. These plans are based upon ANA's Principles for Nurse Staffing which provide recommendations on appropriate staffing and require nurses to be an integral part of the nurse staffing plan development and decision-making process. This is not a "one size fits all" approach to staffing but instead provides hospitals with the flexibility of tailoring nurse staffing to the specific needs of patients based on factors including how sick the patient is, the experience of the nursing staff, technology, and support services available to the nurses. This flexibility does not negate the accountability of hospitals to ensure safe and effective nurse staffing. States are looking at enforcement measures ranging from termination or suspension of a facility's license to public disclosure of violations to fees, penalties and private right of action suits. In addition to state legislation, ANA has developed federal legislation, S 71, The Registered Nurse Safe Staffing Act. It was introduced by Senator Inouye (D-HI), and its companion bill, HR 1372 was introduced by Representative Lois Capps (D-CA) and Robert Simmons (R-CT. The bills require hospitals to develop and implement staffing plans as a condition of participation in Medicare. In 2006, VT enacted legislation which adds to the Hospital Patients' Bill of Rights a provision related to nursing staffing ratios, giving the public access to staffing ratios and also provides for public input as to the format for reporting staffing. Additionally HI adopted a resolution that urges health care facilities to implement ANA's Principles for Nurse Staffing. Legislation requiring health care facilities to develop staffing plans failed to pass in DC, FL, HI, MA, NY and WA. In 2005, OR legislation was enacted that strengthens landmark patient protection legislation that became law in 2002. The bill requires hospitals to develop and implement a written hospital-wide staffing plan for nursing services. The staffing plan shall include the number, qualifications and categories of nursing staff needed for all units and be developed by a committee composed of an equal number of hospital managers and direct care registered nurses. The bill also requires that staffing plans be consistent with nationally recognized evidence-based specialty standards and guidelines. Current law provides civil penalties for hospitals which violate the law and random audits of hospitals by the Oregon Health Division. In addition to pushing for the passage of this legislation, the Oregon Nurses Association has published a guide and developed a training program on approaches to addressing inadequate hospital nurse staffing. RI enacted legislation requires every licensed hospital to annually submit a core-staffing plan to the department of health in January of each year. The plan must specify for each patient care unit and each shift, the number of registered nurses, licensed practical nurses, and/or certified nursing assistants who shall ordinarily be assigned to provide direct patient care and the average number of patients upon which such staffing levels are based. In 2004, no legislation addressing nurse staffing plans was enacted. In 2003, NV enacted legislation that would require the Legislative Committee on Health Care to appoint a subcommittee to conduct an interim study on nurse staffing.
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ANA State Information for 
