Registered nurse staffing legislation aims to improve patient and nurse outcomes by establishing minimum nurse-to-patient ratios. Research shows increased nurse burnout and job dissatisfaction, and higher patient mortality, morbidity, and falls, with fewer nurses per patient. Hospitals could save costs associated with complications by hiring more nurses, which also improves nurse retention. Proposed federal bills would require hospitals to develop staffing plans through nurse committees. This could help achieve national quality goals while benefiting nurses, patients, and the healthcare system financially and clinically.

1. 
Registered Nurse Staffing Legislation
Why registered nurse staffing benefits nurses, patients and the health care system
Roberto Rivera-Olmo
NU420: Leadership and management in the changing
health care environment
Barbara Findley
August 17th, 2015

2. Registered Nurse Staffing Legislation
Topic Description
Impact on Nursing and the Health Care System
Nursing Health Care Systems (HCS)
Research findings show a 23% increase in burnout and 15% increase in
job dissatisfaction in nurses per additional patient required to be cared
for.9
Research findings show a 7% increase in morbidity and mortality for
“each additional patient per nurse”.9
Research by Choi and Boyle demonstrated few patient falls and “better
patient outcomes” among RN’s with higher job satisfaction that was
contributed by higher staffing.10
HCS stands to save up to 2.5 times the cost of hiring additional RN’s per
patients in ICUs and society stands to save as much as $10 billion in
productivity benefits in patient potential life saved.8
By reducing staffing, RN’s are able to spend more hours on direct
patient care and thus shorten patient length of stay, thus reducing the
chances of adverse events during hospitalization.11 To increase patient
satisfaction and safety, clinicians must have ample time to engage the
patient/family into partaking in planning care.12
Increased nurse staffing improves retention and decreases turnover,
which can save HCS as much as 2x the cost of nursing salary which does
not include cost of marketing and recruitment spent on attracting
nurses apply for employment.13
Implementing legislation either mandatory staffing or staffing
committees, along side of removing nurses from room charges can lead
to further focus on the imperative work nurses do to the delivery of safe
and effective health care.14
HCS that are required to have a minimum nursing ratio would benefit
from nursing intensity billing by increasing funding for nursing services
rendered on DRG groups that require higher care.14 This can also assist
to better measure hospital performance in providing quality care.14
Nursing Leadership
Roberto A. Rivera-Olmo, RN
How are Nursing Leaders Involved
The American Nurses Association has written position statements
in supports safe staffing legislation as a way to improves patient
outcomes and quality of care.5
Health care system managers must weigh the cost of current
staffing to quality of care and profit and the cost/benefit of
additional staffing to quality of care and staffing.8
National Nurses United, the nation’s largest nursing union,
endorses legislation for safe staffing and point to the current
California staffing ratio law as basis for nationwide
implementation.6
The American Organization of Nurse Executives supports
development of staffing guidelines that are based upon evidenced
based research instead of a static ratio similar to the proposed
H.R. 2083 and S. 1132 bills.7
The United States House of Representatives and Senate are currently
considering bills that would require hospitals to implement either a
specified minimum nurse to patient ratios by specialty or a committee of
nurses as a safety standard.1
Who and what is involved? How do these bills impact nursing and the
health care system?What changes will and must occur?
Purpose
Workload Factors for Staffing
Assignment
To ensure safe staffing workload tools
must factor in treatment complexity,
medication administration, infection
control, cognitive workload, and
anticipated interventions, among others
into assignments.15
Changes
Nursing Intensity Billing
Billing for services rendered by nurses
for each diagnosis related group instead
of grouping nurses in room charges, can
allow hospitals to hire more nurses,
particularly in units that require higher
nursing intensive care.14
National Quality Strategy
Implementation by Affordable Care Act
Under this new mandate, HCS must
“improve the overall quality of
healthcare”, provide safer more reliable
care, improve the health of people and
communities, and reduce the cost of
care.16
HR. 2083
Registered Nurse Safe Staffing Act
of 2015
Amendment to Social Security Act to
increase patient protection by requiring
hospitals to implement a staffing plan
developed by a hospital nursing staffing
committee composed of nurse managers,
specialty unit nurses and a majority of
direct clinical nurses.2
S. 1132
Registered Nurse Safe Staffing Act
of 2015
H.R. 1602
Nurse Staffing Standards for
Patient Safety and Quality Care Act
of 2015
Amendment to the Public Health Service
Act to implement a staffing plan that
requires hospitals to have a minimal
number of nurse to patient ratio
determined in the law by unit type.3 1:1 in
trauma emergency & OR; 1:2 in CCU; 1:3
in step-down/tele; 1:4 in med-surg; 1:5 in
Rehab/SNF; 1:6 in Postpartum.3
Amendment to Social Security Act to
increase patient protection by requiring
hospitals to implement a staffing plan
developed by a hospital nursing staffing
committee composed of nurse managers,
specialty unit nurses and a majority of
direct clinical nurses.4
H.R. 2083 H.R. 1602 S. 1132
Table data reproduced from Shamliyan, Kane, Mueller, Duval & Wilt, 2009. Cost savings associated with increased RN
staffing in acute care hospitals: Simulation exercise (p. 302-314). Nursing economic$. Vol. 27/No. 5
$0 $200 $400 $600 $800 $1,000 $1,200 $1,400 $1,600 $1,800
Intensive care units
Surgical patients
Medical patients
Chart Title
Net benefit $ per 1,000 patients Cost of increased one RN FTE/Patient day per 1,000 hospitalized patients
Per thousands
Net Benefit and Benefit/Cost Ratio of Avoided Deaths Corresponding to an Increase in
RN Staffing in Acute Care Hospitals8

3. References
1 Congressional Research Service (2015). Summary: H.R. 2083: 114th Congress 2015-2016. 114th Congress 2015-2016. Retrieved from https://www.congress.gov/bill/114th-
congress/house-bill/2083?q=%7B%22search%22%3A%5B%22registered+nurse%22%5D%7D&resultIndex=2
2 Capps, L. (2015). H.R. 2083: Registered nurse safe staffing act of 2015. 114th Congress 2015-2016: House energy and commerce, ways and means committee. Retrieved
from https://www.congress.gov/bill/114th-congress/house-bill/2083/text?q=%7B%22search%22%3A%5B%22registered+nurse%22%5D%7D&resultIndex=2
3 Schakowsky, J. (2015). H.R. 1602: Nurse staffing standards for patient safety and quality care act of 2015. 114th Congress 2015-2016: House energy and commerce, ways
and means committee. Retrieved from https://www.congress.gov/bill/114th-congress/house-
bill/1602/text?q=%7B%22search%22%3A%5B%22%5C%22nursing%5C%22+staffing%22%5D%7D&resultIndex=11
4 Merkley, J. (2015). S. 1132: Registered nurse safe staffing act of 2015. 114th Congress 2015-2016: Senate finance committee. Retrieved from
https://www.congress.gov/bill/114th-congress/senate-bill/1132/text?q=%7B%22search%22%3A%5B%22%5C%22nursing%5C%22+staffing%22%5D%7D&resultIndex=10
5 American Nurses Association. Registered nurse safe staffing bill introduced in congress; nurse staffing directly impacts patient safety; direct care nurses to drive staffing
plans. Safe staffing saves lives. Retrieved from http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/NurseStaffing/Registered-Nurse-Safe-
Staffing-Bill-Introduced-in-Congress.pdf
6 National Nurses United (2015). National campaign for safe RN-to-patient staffing ratios. Campaigns. Retrieved from
http://www.nationalnursesunited.org/issues/entry/ratios.
7 American Organization of Nurse Executives (2003). Policy statement on mandated staffing ratios. Mandated staffing ratios. Retrieved from
http://www.aone.org/resources/leadership%20tools/staffingratios.shtml
8 Shamliyan, T. A., Kane, R. L., Mueller, C., Duval, S. & Wilt, T. J. (2009). Cost savings associated with increased RN staffing in acute care hospitals: Simulation exercise (p. 302-
314). Nursing economic$. Vol. 27/No. 5
9 Aiken L.H., Clarke S.P., Sloane D.M., Sochalski J., Silber J.H.. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of the American
medical association. 2002;288(16):1987-1993. doi:10.1001/jama.288.16.1987.
10 Choi, J. & Boyle, D. K. (2013). RN workgroup job satisfaction and patient falls in acute care hospital units (p. 586-591). Journal of nursing administration. Vol. 43/Num. 11
11 Reeves, K. (2007). New evidence report on nurse staffing and quality of patient care (p. 73 & 78). Medsurg nursing
12 Lavoie-Tremblay, M.; O’Connor, P.; Harripaul, A.; Biron, A.; Ritchie, J.; MacGibbon, B.; Cyr, G. (2014). The perceptions of health care team members about engaging
patients in care redesign (p. 38-46). American journal of nursing.
13 Jones, C. B. & Gates, M. (2007). The costs and benefits of nurse turnover: A business case for nurse retention. Online journal of issues in nursing. ISSN: 1091-3734
14 Welton, J. M. (2007). Mandatory hospital nurse to patient staffing ratios: Time to take a different approach (p. 13). Online journal of issues in nursing Vol. 12/Num. 3
15 Connor, J. A., LaGrasta, C. & Hickey, P. A. (2015). Complexity assessment and monitoring to ensure optimal outcomes tool for measuring pediatric critical care nursing (p.
297-308). American journal of critical care.
16 Brooks, J. A. (2014). Quality counts: The new world of health care quality and measurement (p. 57-59). American journal of nursing. Vol. 114/No. 7