Bill Proposal: Nursing Safe Staffing Act
Section 1: Title
This Act shall be known as the Nursing Safe Staffing Act.
Section 2: Purpose
The purpose of this Act is to:
- Establish safe nurse staffing standards across healthcare settings to ensure quality patient care and prevent nurse burnout.
- Protect the safety and well-being of patients and nurses by mandating minimum nurse-patient ratios in various healthcare settings.
- Ensure that safe staffing levels are maintained during times of state of emergency (including pandemics, natural disasters, or other declared crises).
- Provide guidelines for adjusting staffing levels during emergencies, while still upholding standards of care and worker protections.
- Enhance accountability and transparency for healthcare facilities in maintaining proper staffing levels.
Section 3: Definitions
For the purposes of this Act:
- Nurse-Patient Ratio: The number of patients assigned to a nurse or healthcare worker at any given time, ensuring safe care delivery, preventing nurse fatigue, and allowing time for each patient’s needs to be met.
- State of Emergency: A formally declared emergency by a state or federal authority, including but not limited to public health emergencies (e.g., pandemics), natural disasters (e.g., hurricanes or wildfires), and other crises requiring emergency healthcare responses.
- Safe Staffing: Staffing levels and work conditions that ensure all nurses can provide the necessary level of care to each patient based on their individual needs, without compromising patient safety or nurse well-being.
- Healthcare Facility: Includes hospitals, nursing homes, long-term care facilities, clinics, emergency departments, and other facilities that provide direct patient care.
- State Health Authority: The state agency responsible for healthcare regulation and oversight, such as the Department of Public Health (DPH) or equivalent agency.
Section 4: Safe Staffing Standards
- Establishment of Safe Staffing Ratios
- Healthcare facilities must maintain safe nurse-patient ratios for all clinical settings, including hospitals, nursing homes, and long-term care facilities. These ratios will be established by the National Nursing Standards Board (NNSB), which will work in consultation with the American Nurses Association (ANA)and other healthcare organizations.
- The following minimum nurse-patient ratios will be set for common healthcare settings:
- Hospitals: 1 nurse per 4-5 patients in general care units.
- Intensive Care Units (ICUs): 1 nurse per 1-2 patients.
- Emergency Rooms: 1 nurse per 3-4 patients, depending on patient acuity.
- Nursing Homes: 1 nurse per 8-10 residents in long-term care.
- Pediatric Units: 1 nurse per 3-4 pediatric patients (depending on severity of condition).
- Facility Accountability
- Healthcare facilities will be required to maintain accurate records and provide quarterly reports to the State Health Authority on staffing levels.
- Facilities will be held accountable for staffing violations and will face penalties, including fines or potential suspension of operating licenses, if staffing falls below required levels.
- Staffing Flexibility
- Healthcare facilities must implement staffing flexibility measures (e.g., overtime, shift adjustments, or temporary staffing) to meet staffing needs during periods of increased patient load without exceeding legal nurse-patient ratios.
Section 5: Safe Staffing During States of Emergency
- Minimum Staffing Requirements During Emergencies
- During a declared state of emergency (including pandemics, natural disasters, or other emergencies), minimum safe staffing ratios must be maintained to ensure the safety of both patients and nurses. However, the state or federal government may allow for temporary adjustments based on the circumstances of the emergency.
- During such emergencies:
- Hospitals and emergency departments must still meet core staffing ratios, though additional temporary staffing options may be used.
- Long-term care facilities must adjust staffing to maintain adequate care and avoid unsafe conditions, ensuring at least one nurse per 12 residents at any given time.
- Emergency Staffing Plans
- All healthcare facilities must develop an Emergency Staffing Plan that includes protocols for maintaining safe staffing levels during times of crisis. The plan should address:
- Utilization of temporary and emergency nurses, including travel nurses or retired nurses.
- Cross-training of staff to ensure that nurses can provide care across various departments during a surge of patients.
- Collaboration with local, state, and federal emergency response agencies to ensure rapid deployment of additional resources, including healthcare workers.
- Short-Term Adjustments in Staffing Ratios
- During declared states of emergency, temporary flexibility will be provided to staffing ratios, but not to the point where patient safety is jeopardized. For instance:
- In emergency situations where patient volumes exceed available staffing, healthcare facilities may request a waiver or temporary modification of nurse-patient ratios from the State Health Authority.
- These adjustments must be time-limited and reviewed regularly, with the goal of returning to normal staffing levels as soon as the emergency situation allows.
Section 6: Nurse Well-Being and Protections
- Nurse Protections from Exploitation and Burnout
- Nurses working during states of emergency or in high-demand settings must be provided with reasonable work hours and rest periods to prevent exhaustion and burnout. This includes:
- Ensuring that nurses are not forced into excessive overtime or work shifts that exceed 12 hours in a 24-hour period unless absolutely necessary, and with appropriate compensation.
- Providing mental health support, debriefing services, and resources to help nurses cope with stress and trauma during and after emergencies.
- Workplace Safety
- Employers must ensure that personal protective equipment (PPE) is available and accessible for nurses during emergency conditions, particularly in situations like pandemics where exposure risks are higher.
- In addition to physical health protections, healthcare employers must provide mental health resources to nurses, including access to counseling and support services, to mitigate the mental health toll of emergency care.
Section 7: Monitoring and Compliance
- State Health Authority Oversight
- The State Health Authority will monitor compliance with the safe staffing regulations and emergency staffing modifications through regular inspections, audits, and reporting requirements.
- A Nurse Staffing Task Force will be established within the State Health Authority to review any complaints about unsafe staffing levels, particularly in times of crisis, and provide recommendations for addressing those issues.
- Whistleblower Protections
- Nurses and other healthcare staff who report unsafe staffing conditions shall be protected from retaliation under state and federal whistleblower protection laws.
- Any nurse who reports staffing violations or unsafe working conditions will be entitled to remain anonymous, and healthcare employers will be prohibited from retaliating against whistleblowers.
- Annual Reporting to Congress
- The Department of Health and Human Services (HHS) will submit an annual report to Congress on the status of nurse staffing in the U.S., highlighting trends in staffing shortages, emergency staffing adjustments, and the impact of these on patient safety and nurse well-being.
Section 8: Penalties and Enforcement
- Penalties for Non-Compliance
- Healthcare facilities that fail to meet safe staffing standards or violate staffing levels during states of emergency will face:
- Fines of up to $100,000 per violation.
- Suspension or revocation of licenses for repeat offenders.
- Public disclosure of violations and non-compliance.
- Increased Funding for Staffing Resources
- The federal government will allocate additional funding to state and local healthcare systems to help ensure that healthcare facilities have the resources and workforce they need to meet safe staffing standards, especially during declared states of emergency.
Section 9: Effective Date
This Act shall take effect on January 1, 2025.
Section 10: Severability
If any provision of this Act is found to be invalid or unenforceable, the remaining provisions shall remain in full force and effect.
This bill ensures that safe staffing levels are maintained in healthcare settings under all circumstances, including in times of emergency, and provides both protections for patients and nurses as well as mechanisms to address staffing challenges without compromising the quality of care.