As time has passed, nurses throughout the country have been pushing for legislation similar to what was passed in California, mandating minimum staffing requirements.

More recently, the Oregon arm of the National Nurses United was successful in obtaining an agreement with the State Hospital Association over a compromise bill (House Bill 2697) mandating minimum staffing levels at hospitals. At the federal level, the National Nurses United has been able to convince Senator Brown of Ohio in the Senate and Representative Schakowsky in the House to reintroduce a minimum staffing level bill for nurses, referencing the Nurse Staffing Standards for Hospital Patient Care and Quality Care Act. This bill will also provide for whistle-blower protection. It was previously introduced in 2021 but never made it out of Committee. The federal bill is mirrored after the California law which passed in 1999, and took effect in 2004.

This bill requires hospitals to implement and submit to the Department of Health and Human Services (HHS) a staffing plan that complies with specified minimum nurse-to-patient ratios by unit. Hospitals must post a notice regarding nurse-to-patient ratios in each unit and maintain records of actual ratios for each shift in each unit. The bill also requires hospitals to follow certain procedures regarding how ratios are determined and other staff are prohibited from performing nurse functions unless specifically authorized within a state’s scope of practice rules, among other requirements. HHS must adjust Medicare payments to hospitals to cover additional costs attributable to compliance with these ratios.

Nurses may object to, or refuse to participate in, an assignment if it would violate minimum ratios or if they are not prepared by education or experience to fulfill the assignment without compromising the safety of a patient or jeopardizing their nurse’s license. Hospitals may not (1) take adverse actions against a nurse based on the nurse’s reasonable refusal to accept an assignment; or (2) discriminate against individuals for good faith complaints relating to the care, services, or conditions of the hospital or related facilities. HHS may impose civil monetary penalties on hospitals violating the ratio requirements and must publish the names of such hospitals.

The bill provides stipends to the nurse workforce loan repayment and scholarship program and expands the nurse retention grant program to include nurse preceptorship and mentorship projects. 

I suggest that those of you in the healthcare sector pay close attention in particular to the federal legislation that is now in play.