AORN Endorses Federal Safe Staffing Act

Published: May 13, 2015


Representatives Lois Capps (D-CA) and David Joyce (R-OH) and Senator Jeff Merkley (D-OR) introduced bi-partisan legislation in the House and Senate on April 29, 2015, that would require Medicare-participating hospitals to establish a committee comprised of at least 55% direct care nurses to create nurse staffing plans specific to each unit.  The legislation is backed by the American Nurses Association (ANA) and endorsed by AORN.  Adequate nurse staffing is needed to improve nurse retention rates and reduce hospital readmissions.  Increasing the number of RNs per patient improves both clinical and economic outcomes, and it ultimately saves lives.

Staffing Ratios v. Committee-led Approaches

There are two common approaches to nurse staffing bills: (i) mandatory nurse-to-patient staffing ratios determined by state law; and (ii) requirements in law that each facility establish its own nurse staffing plan in accordance with its needs. The mandatory nurse staffing ratio bills seek to establish minimum staffing levels and nurse-to-patient ratios for each department or unit of a hospital, and sometimes include ASCs. California implemented such a mandatory staffing bill in 2004, which required phased-in compliance by 2008.

A handful of states entertain staffing ratio bills each year, although none are expecting to see significant movement. 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 a comprehensive RN staffing ratio law. In 2014, Massachusetts passed a bill requiring a 1:1 or 1:2 nurse-to-patient ratio depending on the stability of the patient but for the ICU only.

Under the committee-led approach promoted by ANA, hospitals would be required to establish unit-by-unit staffing plans by committees which are comprised of at least 55% direct-care nurses. This approach recognizes that direct care nurses working closely with managers are best-equipped to determine staffing level needs for their patients. Seven states have already enacted committee-led safe staffing legislation: Oregon (2002); Illinois (2007); Connecticut (2008); Ohio (2008); Washington (2008); Texas (2009); and Nevada (2009). Several others states have pending legislation.

A third approach involves simply requiring facilities to disclose staffing levels to an agency or the public, which Minnesota adopted in 2013. Although none of the approaches directly address perioperative nursing, the politics surrounding the strict staffing ratio bills can be harmful to AORN’s RN Circulator initiatives if an RN Circulator bill is mischaracterized as a ratio bill. Together with the ANA, AORN supports the committee-led approach to RN staffing solutions in hospitals because of its balanced approach to improving both nursing care and patient outcomes.

Nurse Voices Needed

ANA is calling for registered nurses to reach out to their Congressional leaders with the message that safe RN staffing is non-negotiable and more bill co-sponsors are needed. “Optimal nurse staffing could mean the difference between a patient dying or surviving,” said ANA President Pamela F. Cipriano, PhD RN NEA-BC FAAN. “Research tells us it’s that crucial. If you or your loved one were in the hospital, you’d want to be certain that the hospital was continually setting, evaluating, and adjusting its nursing coverage to meet your changing needs and the conditions of all patients. That is what this legislation seeks to ensure.”

Representatives and Senators need to hear that higher staffing levels by experienced RNs lead to lower rates of patient falls, infections, medication errors, and even death. Understaffing of RNs can hit a hospital’s bottom line because it leads to lower nurse retention rates and higher readmission rates. The RN Safe Staffing Act considers RN educational preparation, professional certification, level of clinical experience, as well as the number and capacity of other available health care personnel, geography, and available technology, in addition to accounting for the intensity, complexity and stability of patients, making it an optimal approach for nurse-led staffing policies.

Safe RN staffing affects both you and your patients. Make your voice heard by contacting your representatives.