On April 16, 2013, United States Senator Barbara Boxer, a Democrat from California, introduced the National Nursing Shortage Reform and Patient Advocacy Act. When enacted, this law would protect the rights of nurses to advocate on behalf of their patients, establish minimum nurse-to-patient ratios in hospitals, and fund efforts to retain nurses and reduce turnover. This legislation builds on a California law that set minimum nurse-to-patient ratios, and extends those minimum standards to Medicare and Medicaid participating hospitals.
The law would prohibit “averaging” within a hospital and instead require that hospitals cannot average the total number of patients and total number of direct care RNs during any one shift or over any period of time for the purposes of meeting the requirements set forth in the legislations. Further, a hospital cannot impose mandatory overtime in order to meet the staffing requirement, and must ensure that only a direct care RN may relieve another direct care RN for breaks, meals, and other routine expected absences from a hospital unit.
For most hospitals, the bill calls for a direct care RN to be assigned to no more than 1 emergency trauma patient, 1 patient in the operating room, 2 critical care patients, 3 patients in emergency departments and labor and delivery units, 4 patients on medical-surgical and psychiatric units, 5 patients in rehabilitation and skilled nursing units, and 6 patients in well-baby nursery and postpartum units (3 sets of mothers and babies).
The bill also provides whistleblower protection to support the right of nurses to advocate for patient safety and report violations of minimum standards of care, and funds nursing mentorship demonstration programs. The bill has been assigned to the Health, Education, Labor and Pensions Committee, which will consider it and may send it on to the Senate. The text of the bill and updates on how it is progressing are available at www.govtrack.us/congress/bills/113/s739.