WASHINGTON, D.C. — Today, on International Nurses Day, U.S. Senators Alex Padilla (D-Calif.) and Jeff Merkley (D-Ore.) introduced the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act to improve hospital patient care and nurse retention by setting mandatory minimum registered nurse-to-patient staffing ratios. Representative Jan Schakowsky (D-Ill.-09) is leading companion legislation in the House of Representatives.
There are no federal mandates regulating the number of patients a registered nurse (RN) can care for at one time in U.S. hospitals. As a result, RNs are consistently required to care for more patients than is safe, negatively impacting patient outcomes. Studies show that when RNs are forced to care for too many patients at one time, patients are at higher risk of preventable medical errors, avoidable complications, falls and injuries, pressure sores, increased length of hospital stay, higher numbers of hospital readmissions, and death. For each additional surgical patient in a registered nurse’s workload above the baseline nurse-to-patient ratio of 1:4, the likelihood of patient death within 30 days increases by seven percent.
California is currently the only state with an enforceable nurse-to-patient safe staffing law, which the California Nurses Association successfully pushed to pass in 1999. The law has significantly expanded nurse staffing at California’s acute-care hospitals and saved thousands of lives since it was fully implemented in 2004. For instance, a widely cited 2010 University of Pennsylvania study showed that if New Jersey and Pennsylvania matched California’s 1:5 RN-to-patient ratio, their surgical units would have 14 percent fewer deaths and 11 percent fewer deaths, respectively.
“Every patient deserves access to quality care, but the registered nursing staffing crisis across the country is putting patients at risk and leading to preventable health complications, especially in communities of color,” said Senator Padilla. “The numbers are clear: California’s mandatory minimum nurse-to-patient ratio is saving lives. Extending safe staffing at hospitals across the country is long overdue and is essential to retaining our nursing workforce and improving health outcomes.”
“As the husband of a nurse, I’ve seen how our health care heroes give so much to keep communities in Oregon healthy every day,” said Senator Merkley, Co-Chair of the Senate Nursing Caucus. “As we celebrate National Nurses Week, I am committed to fighting for safe staffing levels for both nurses and patients, to enhance the quality of patient care, reduce medical errors, and increase nurse retention. Nurses make the world so much better, one bedside at a time, and Congress must do all it can to tackle the challenges these life-saving professionals face.”
“I am proud to reintroduce the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act with Senators Padilla and Merkley that will establish registered nurse-to-patient ratios in hospitals, provide whistleblower protection for nurses who advocate on behalf of their patients, and invest in training and career development to retain hardworking nurses in the workforce,” said Congresswoman Schakowsky. “For years, I’ve talked to exhausted nurses who have said they go home at night, wondering if they forgot to turn a patient because they were stretched far too thin. Study after study shows that safe nurse-to-patient staffing ratios result in higher quality care for patients, lower health care costs, and a better workplace for nurses. It is past time that we act on the evidence, give nurses the support they deserve, and put patients over profits. Let’s get it done!”
“Nurses are constantly forced by our employers to care for too many patients than is safe. Yet, during National Nurses Week, those same employers hang banners or give out a free cookie to show their appreciation of us. It’s a slap in the face,” said Nancy Hagans, RN and NNU president. “Our patients deserve high-quality care, and nurses have always stood up to protect our patients. It’s time hospital managers are mandated to staff our units safely for our patients’ sake and to actually give nurses the resources and respect we deserve.”
“Nurses know from caring for patients at the bedside, that safe nurse-to-patient staffing ratios save lives. CNA fought for and won legislation in California ensuring safe staffing ratios, and unfortunately two decades later, we are still the only state in the country with a law of its kind,” said Sandy Reding, RN and CNA/NNOC President. “Nurses come to California from all over because of our ratios, and we are proud to continue the fight on the national level until every nurse is guaranteed safe staffing ratios, and our patients and our profession are protected.”
“The understaffing crisis at hospitals and health care facilities puts 60 million older Americans at risk every year,” said Richard Fiesta, Executive Director of the Alliance for Retired Americans. “This legislation will improve patient safety and health outcomes by requiring all healthcare facilities to maintain adequate nurse staffing ratios. Nurses, patients, and family members deserve nothing less.”
“As some in Congress try to cut healthcare to hand tax breaks to billionaires, others are trying to invest in the safe staffing levels needed for high-quality patient care. All too often, patients face interminable delays, overcrowded waiting rooms, and understaffing that puts them in danger. It does not have to be this way. In many cases, we have enough qualified nurses, but they’ve been driven from the bedside by a healthcare system that puts profits over patients. With this bill, Rep. Schakowsky and Sens. Padilla and Merkley give us a path forward that holds hospitals accountable for staffing levels. These standards will improve outcomes for patients, make healthcare careers more sustainable and, in a medical emergency, reassure families that their local hospital is a safe place to get the care they need,” said Randi Weingarten, President, AFT: Education, Healthcare, Public Services.
“Hospitals across the U.S. are faced with an intensifying staffing crisis, leaving dedicated nurses with no choice but to turn to jobs with better working conditions, regrettably leaving the patients they love and care for,” said Martha Baker, RN, Chairperson of the Nurse Alliance of SEIU Healthcare. “Congress needs to pass safe staffing ratios to allow all nurses—regardless of where we live or where we work—to provide the high-quality care that our patients need and deserve.
“One nurse can be responsible for the care of an entire hospital floor — keeping multiple patients alive and on the path to recovery,” said AFSCME President Lee Saunders. “They are truly the front-line heroes of our health care system, but they’re also human. Too often, they’re stretched thin, working exhausting hours that put patient care and their own health at risk. The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act gives nurses the backup they need to keep themselves and their patients safe and healthy. On behalf of the over 60,000 nurses in our AFSCME family, we thank Senator Padilla and Representative Schakowsky for championing real solutions for care and safety.”
Studies have also found that registered nurse staffing levels in hospitals that serve communities of color are often lower, exacerbating health care disparities. Setting a single standard of nursing care across hospitals would improve outcomes for patients, including patients of color, through reduced readmission rates, increased satisfaction, and better obstetrical outcomes.
Specifically, the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act would:
- Require hospitals to annually develop safe staffing plans that meet the bill’s mandated minimum RN staffing ratios and provide for additional staffing based on individual patient care needs;
- Mandate that hospitals post notices on minimum ratios and maintain records on RN and other staffing;
- Provide whistleblower protections, including administrative complaint process and cause of action, for nurses who speak out against assignments that are unsafe for the patient or nurse;
- Authorize the Secretary of the Department of Health and Human Services to enforce the minimum RN staffing ratios through administrative complaints and civil penalties.
The bill is endorsed by organizations including National Nurses United, California Nurses Association/National Nurses Organizing Committee, Alliance for Retired Americans, American Federation of Teachers (AFT), SEIU Healthcare, and American Federation of State, County and Municipal Employees (AFSCME).
Senator Padilla has long been a leader in the fight to make health care more equitable and affordable in the United States. Last year, Padilla, Senator Mazie Hirono (D-Hawaii), and Senator Cory Booker (D-N.J.) introduced the Health Equity and Accountability Act (HEAA) of 2024 to address health disparities among racial and ethnic minorities as well as women, the LGBTQ+ community, rural populations, and socioeconomically disadvantaged communities across the United States. Additionally, Padilla and Booker introduced the Equal Health Care for All Act, bicameral legislation that would make equal access to medical care a protected civil right to help address the racial inequities and structural failures in America’s health care system. He also recently joined Senator Bernie Sanders (I-Vt.) and over 100 lawmakers in reintroducing the Medicare for All Act, historic legislation that would guarantee health care as a fundamental human right to all people in the United States regardless of income or background.
A one-pager on the bill is available here.
Full text of the bill is available here.