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Staffing Ratio Bills Harming RN as Circulator Efforts

Publish Date: 2/16/2011

AORN’s government affairs office is seeing an increase in nurse staffing bills being introduced in the states this year. There are two approaches to nurse staffing bills: (i) mandatory nurse-to-patient staffing ratios determined by state law, and (ii) requirements in state law that each facility establish its own nurse staffing plan in accordance with its needs.

The mandatory nurse staffing ratio bill establishes minimum staffing levels and nurse-to-patient ratios for each department or unit of the hospital and sometimes includes ASCs. California implemented such a mandatory staffing bill in 2004 which required phased-in compliance by 2008. Many people believe that California’s law has resulted in hardship on hospitals without a correlating benefit for patient safety in the state. Legislated nurse-to-patient staffing ratios are widely opposed by hospital and physician groups. Hospital administrators and associations have maintained that they cannot operate under mandatory staffing laws and, if forced to do so, could have to close hospital units where compliance is not feasible, increase ER bypass, and/or limit access to services and procedures. California remains the only state to have enacted and implemented such legislation to date.

The American Nurses Association has taken the second approach for nurse staffing ratios at the federal level, but has not developed an approach at the state level. ANA would not legislate minimum staffing levels, but would require hospitals to set their own staffing plans for each department or unit based on patient acuity, patient numbers, nurse skills and experience, support staff and technology. ANA’s legislative model supports nurses creating staffing plans specific to the facility, unit and patient population, and then holding facilities accountable for adherence to those staffing plans.

In addition to advocating for RN circulator legislation, AORN’s government affairs office is monitoring staffing ratio and safe staffing legislation modeled after the ANA approach in the states this year with the help of our dedicated state legislative coordinators and NLC members. Please take a moment to educate yourself on the safe staffing principles being advanced by ANA. If there is activity in your state, please be ready to articulate how AORN’s legislative priority for RN as Circulator is based on patient safety and should not be considered a mandatory staffing ratio bill like the California model. AORN needs your voice to promote the importance of the RN circulator.  Now is the time to get involved!

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