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The Quality Nursing Care of
2004 The American Nurses Association
(ANA) learned on December 5, 2003 that Representative Lois Capps (D-CA) will be
introducing the Quality Nursing Care Act of 2004, on Monday, December 8, 2003.
This federal legislation aims to ensure that patients receive safe, quality
nursing care in hospitals and other health care institutions. The legislation
mandates the development of staffing systems that require the input of
direct-care registered nurses (RNs) or where nurses are represented, with the
applicable recognized or certified collective bargaining representatives of the
registered nurses and provides whistle-blower protections for RNs who speak out
about patient care issues. The bill complements S. 991 which was introduced by
Sen. Daniel Inouye (D-HI) in May 2003.
ANA, which worked closely with Representative Capps' office on the bill, lobbied
for this legislation to protect patients and registered nurses, given the
absence of enforceable standards for nurse staffing in hospitals and the
widespread practice of health care facilities stretching their nursing staff
with unsafe patient loads, mandatory overtime, "floating" to specialty units
without training and orientation and other practices that undermine the delivery
of safe, quality care.
This legislation builds on more than a decade of research which shows that RNs
make the quality difference in patient care and that when RN care is
insufficient, patient safety is compromised and the risk of death is increased.
Most recently, an Institute of Medicine study released on November 4, 2003
highlights the importance of improved nurse staffing. This report, Keeping
Patients Safe: Transforming the Workplace Environment for Nurses, also
recommends that health care organizations involve nurses in decisions related to
staffing and patient care.
The Quality Nursing Care Act of 2004 amends the conditions of participation in
the Medicare program and establishes a requirement for minimum staffing
ratios. Rather than establishing a specific numeric ratio, the act requires
the establishment of a staffing system that "ensures a number of registered
nurses on each shift and in each unit of the hospital to ensure appropriate
staffing levels for patient care." Specifically, the staffing system must:
Be created with input from direct-care RNs;
Be based on the number of patients and level and intensity of care to be
provided, with consideration given to admissions, discharges and transfers that
nurses must handle each shift;
Account for architecture and geography of the environment and available
technology;
Reflect the level of preparation and experience of those providing care;
Reflect staffing levels recommended by specialty nursing organizations;
Provide that a RN not be assigned to work in a particular unit without first
having established the ability to provide professional care in such a unit.
In addition, the act requires public reporting of staffing information.
Hospitals must post daily for each unit and each shift, the number of licensed
and unlicensed staff providing direct patient care, specifically noting the
number of RNs. In addition, the act provides whistle-blower protections for RNs
and others who may file a complaint regarding staffing.
The RN Safe Staffing Act incorporates ANA's Principles of Nurse Staffing.
Rather than recommending specific numeric ratios, ANA developed the principles
in 1999 as a tool for nurses to better gauge appropriate staffing. The
principles not only take into account the number of patients, but also look at
other important staffing considerations, such as the experience level of nurses
on the unit, the severity of patients' conditions and the availability of
support services and resources.
Further information on the Quality Nursing Care Act of 2004 will soon be
available on the government affairs section of the ANA website. Questions on the
legislation can be referred to
Christopher Donnellan, Associate Director of Government Affairs, American Nurses
Association @ cdonnell@ana.org |
