In conjunction with National Nurses Week, Sen. Barbara Boxer (D-CA) reintroduced legislation on May 12 that would establish minimum nurse-to-patient ratios, require hospitals to implement nurse-to-patient staffing plans, and provide whistleblower protection for patients and hospital employees. The National Nursing Shortage Reform and Patient Advocacy Act (S. 992) is the latest in a number of bills introduced in recent years that are designed to provide nurses – and their unions – with greater influence on nurse staffing levels.

According to a press release, the bill “builds on the success of California’s historic law that set minimum nurse-to-patient ratios and extends those standards to all general and long-term care hospitals that participate in Medicare.”

The proposed bill would:

• Establish minimum direct care registered nurse-to-patient ratios, subject to exemptions in emergency situations;
• Prohibit hospitals from averaging the number of patients and nurses during any one shift or imposing mandatory overtime in order to meet the minimum ratios;
• Require hospitals to develop, maintain, and make available to the public a nurse staffing plan developed in conjunction with direct care registered nurses working at the hospital and, where applicable, with the collective bargaining representative of the nurses;
• Require hospitals to maintain records of the actual direct care registered nurse-to-patient ratio in each unit for each shift, and to make these available to the public for no less than 2 years;
• Provide whistleblower protection for nurses who refuse to accept an assignment if they believe it would violate the requirements of this Act or if they do not have the qualifications or experience necessary to perform the assignment.
• Make hospitals that take adverse action against a nurse for refusing an assignment under these conditions, or for filing a complaint about such assignments, liable for reinstatement, lost wages, other damages and attorneys’ fees;
• Subject hospitals found in violation of the law to civil monetary penalties of up to $25,000 for each knowing violation, or to greater, unspecified monetary penalties if the Secretary of Health and Human Services determines the hospital has a pattern or practice of such violation; and
• Subject individual employees of the hospital found in willful violation of the law to civil monetary penalties of up to $20,000 for each such violation.

Many provisions of the bill are similar to legislation introduced previously, such as the Registered Nurse Safe Staffing Act of 2011 (H.R. 876, S. 58), introduced earlier this year, which would require Medicare-participating hospitals to establish staffing plans for nursing services, provide certain whistleblower protections for employees and patients, and subject employers in violation of the bill to monetary penalties.

Nurses’ unions have seized upon this issue during recent years, protesting staffing ratios during a number of strikes and walkouts. Staffing levels also remain a major bargaining issue during negotiations.

UPDATE: On June 15, 2011, similar legislation – the Nurse Staffing Standards for Patient Safety and Quality Care Act of 2011 (HR. 2187) – was introduced in the House of Representatives.

Photo credit: AlexRaths