Introducing the Safe Staffing for Nurse and Patient Safety Act


Advocating for and passing legislation that helps nurses and patients is a fundamental part of our Year of Advocacy. Nurses advocate every day for their patients, their communities and the profession, but it is also important that nurses lend their expertise to elected officials as they draft and pass legislation relevant to the nursing profession.

Earlier this month our bipartisan champions in the House of Representatives and Senate introduced a bill that will improve care and help keep nurses and patients safe. Champions including Reps. David Joyce (R-OH-14), Suzan DelBene (D-WA-10), Suzanne Bonamici (D-OR-1), and Tulsi Gabbard (D-HI-2) as well as Senator Jeff Merkley (D-OR), came together to introduce the Safe Staffing for Nurse and Patient Safety Act of 2018 (S. 2446, H.R. 5052).

The bill requires hospitals to establish a committee, composed of at least 55 percent direct care nurses, to create nurse staffing plans that are specific to each unit. As nurses across the country know, patients risk longer hospital stays, increased infections, and avoidable injuries when units are understaffed. Understaffing also leads to lower nurse retention, higher rates of injury and burnout.

“RN staffing makes a critical difference for patients and the quality of their care,” said Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, president of the American Nurses Association. “Appropriate nurse staffing keeps patients safe and protects them from preventable complications, even lowering the risk of death. Nursing care is like medication—we would never withhold a medication when we know its lifesaving effects. The Safe Staffing for Nurse and Patient Safety Act empowers direct care nurses to determine the unique and variable needs of their patients to ensure the safety and quality outcomes of care.”

Our Congressional champions also understand why this legislation is so important.

“As a husband of a nurse, I have experienced first-hand the many challenges and responsibilities nurses face on a day to day basis,” said Joyce. “Ensuring patient safety and care has always been a priority but has faced many challenges when nurses are over worked and hospitals are under staffed. As Co-Chair of the House Nursing Caucus, I am proud to introduce legislation that addresses the issue and protects our patients and nurses.”

“As the husband of a nurse, I know firsthand the many challenges nurses face and how critical their care is to patients,” said Merkley. “Safe staffing enhances the quality of patient care, reduces medical errors, and increases nurse retention.”

But introducing this bill is just the first step. We need your help getting more cosponsors for this legislation – let your Senators and Representatives know why safe staffing is so critical. Click here to send them an email asking them to support this bill and be sure to include a personal note on why nurse-driven ratios are so important.

On Lobby Waterfalls and Safe Staffing


Limousine service, upgraded television setsnurse-to-patient “scripts,” gourmet food service, nurse uniform requirements. Hospitals all over the U.S. are offering more “customer-centric” patient care in order to increase patient satisfaction scores, which are becoming ever more important to raise and maintain Medicare reimbursement amounts.

These efforts, however, often have unintended consequences.

In the first place, customer-centric interventions rarely (if ever) improve the quality of care patients receive. Rather, they merely improve patients’ perceptions of care.

Perhaps the biggest issue with this approach is that nurses have little control over the factors that research shows improve patient satisfaction scores the most. Quality of food service, wait times, physician attentiveness, even staff uniform colors are all factors in patient satisfaction scores—none of which nurses have control over.

Crucially, nurses also have little control over nurse staffing, which research demonstrates is a significant factor in patient satisfaction scores. Short staffing is inherently unsafe and puts patients at risk.

Contrary to gourmet food service, however, improving nurse staffing actually improves the quality of care patients receive, not just their perception of it. The literature shows that improving nurse staffing while controlling for variables (including physicians, LPNs, and nursing assistants) significantly reduces the risk of mortality, lowers the incidence of medication errors and other adverse eventslowers patient readmission ratesreduces nursing-sensitive negative outcomes, and even saves hospitals and insurance companies money—and that’s just the tip of the iceberg.

In an effort to mitigate the unintended consequences of patient satisfaction scores and improve nurse staffing, the American Nurses Association has long advocated for Medicare to include nurse staffing measures next to patient satisfaction scores on its Hospital Compare website.

By doing so, public reporting of nurse staffing on a 1-5 scale will push hospitals to staff more safely and shift patient care interventions from those that improve perceptions of care to those that actually improve care itself. Think about it: nurse staffing is perhaps the single greatest indicator of patient quality of care. Would you rather go to a facility with a five star rating on nurse staffing, or one with a three star rating on nurse staffing, two lobby waterfalls, great patient scripting, and state of the art flat screen tvs?


Give me the better nurse staffing every time.

Unfortunately, Medicare recently declined to include nurse staffing measures on Hospital Compare for Fiscal Year 2018. But the fight is not over. While ANA is proud that we were able to help generate 1,363 comments in support of these staffing measures, and is thankful for the 26 advocacy groups who co-signed our comment letter to the Center for Medicare Services, we are already gearing up for an even bigger grassroots movement next year.

But we’re going to need your help. Stay tuned for more: #nursesunite.

Protect Your Practice: Healthcare Bill will have Profound Impact on Nursing, Nurses, Patient Care


To many nurses around the country, the talk about healthcare reform in the nation’s capital is just that: a whole lot of talk. But if the current healthcare bill being considered by the Senate passes, are you ready for how it will impact your practice and the nursing profession as a whole?

Take hospital funding, for example. Love it or hate it, it’s a fact that “Obamacare” (or the  Affordable Care Act, “ACA”) drastically reduced the amount of money hospitals spend annually on uncompensated, or “charitable,” care.

In one state alone, Minnesota, hospitals have seen their uncompensated care costs decline by 17% since the implementation of the ACA, saving hospitals in the state about $53 million annually.

Such numbers are far from uncommon, and are probably similar where you live. The reason is simple: when more people have insurance, more people are able to pay their hospital bills. Unfortunately, the healthcare changes being considered by the Senate would leave 49 million people across the US without health insurance, once again increasing the need for hospitals to provide enormous (and enormously expensive) amounts of charitable and otherwise uncompensated care.

These increased costs will need to be accounted for in hospital budgets and will likely impact nurse staffing and care delivery—a critical issue which ANA recently addressed in a widely co-signed letter to the Center for Medicare Services.

But the healthcare bill will also impact nurses outside of the hospital setting. According to a recent survey of school administrators, over seventy percent of school districts turn to Medicaid to pay for the health professionals and school nurses needed to care for special education students. Since the senate healthcare bill would cut Medicaid spending by almost $800 billion and impose a cap on the amount of Medicaid-funded services any child could receive, school nurses and administrators are staunchly opposed to the bill.

Even if you don’t work in a hospital setting, and even if you don’t have children in school, it’s likely you will still be impacted by the healthcare bill being considered by the Senate. For example, we all have a vested interest in the health of our nation’s veterans. But of concern to veterans, VA nurses, and Veterans groups, 1.75 million vets stand to lose their Medicaid coverage under the healthcare bill, which in turn would impact the VA as more veterans seek care in that already overloaded and underfunded system.

Since Medicaid pays for most of the 1.4 million Americans in nursing homes, elderly Americans and nursing home nurses are also gravely concerned by the impact of the healthcare bill. The same goes for rural nurses and citizens, whose safety-net hospitals are projected to lose eighty-three percent of their net income by 2026 under the new bill.

The list goes on: whether or not you realize it, this healthcare bill will impact you and your practice, perhaps in ways that are unforeseen or unintended. That’s why the American Nurses Association is calling for a more thorough, nuanced, and bipartisan process for healthcare reform.

We urge the Senate to step back and approach this herculean task in a way that works for all Americans. For the sake of nurses and their patients, we can’t afford to get this one wrong.