Nursing Unions Urge Congress To Pass Nurse-Patient Ratio Legislation

By Derrick Cain
Bureau of National Affairs
May 14, 2009

Members of major nurses unions urged Congress May 13 to approve legislation that would guarantee certain ratios of nurses to patients nationally.

Hundreds of unionized nurses from around the country participated in a National RN Day of Action in Washington, D.C., that included a conference focused on the their legislative agenda, a march and rally, and visits to their congressional representatives to advocate on various legislative issues.

The event was coordinated by the California Nurses Association/National Nurses Organizing Committee, the United American Nurses (UAN), and the Massachusetts Nurses Association, which announced in February that they plan to form a new national union of 150,000 RNs, with the major goal of organizing nurses across the nation (31 DLR AA-1, 2/19/09). The new union, to be called the United American Nurses-National Nurses Organizing Committee, is expected to have its founding convention in December.

Nurses from other unions representing nurses also participated in the event including those from the Pennsylvania Association of Staff Nurses and Allied Professionals, the New York State Nurses Association, and the Service Employees International Union Nurse Alliance.

Sen. Barbara Boxer (D-Calif.) introduced the National Nursing Reform and Patient Advocacy Act (bill number not yet available) May 13 after Rep. Jan Schakowsky (D-Ill.) reintroduced similar legislation, the Nurse Staffing Standards for Patient Safety and Quality Care Act (H.R. 2273), May 6 in the House.

Both bills would amend the Public Health Service Act to establish direct care registered nurse-to-patient staffing ratio requirements in hospitals.

The legislation also seeks to protect the rights of nurses to advocate on behalf of their patients, and to invest in training new nurses to address the current nationwide nursing shortage.

“We cannot guarantee high-quality health care to every American without a high-quality workforce of nurses to provide it,” Boxer said. “That is why I am proud to introduce legislation to help address our nationwide shortage of nurses. By investing in our nurses, we can help improve the quality of care in our nation's hospitals and save the lives of countless patients.”

Boxer's bill also would create a Registered Nurse Workforce Initiative within the Health Resources and Services Administration to invest in the education of nurses and nursing faculty.

The initiative would provide grants for: nursing educational assistance and living stipends for nursing students who agree to work for at least three years for a safety-net health care provider; graduate educational assistance for registered nurses who commit to serve as nurse educators for at least five years at an accredited nursing program; and training and mentorship demonstration projects.

Two-Year Deadline

The bill would require that all hospitals develop and implement within two years of the bill's enactment staffing plans that meet newly established minimum direct care registered nurse-to-patient ratios, and adjust staffing levels based on acuity of patients.

“Nurses and patients do not need another hospital committee, task force or working group to discuss the problem,” said UAN President Ann Converso. “If hospitals could be trusted to do the right thing without a law, they would have already done so. We need federal legislation to make sure that there is a minimum, basic level of RN care provided no matter where you go.”

Converso said that studies have shown when there are not enough RNs at the bedside, patient care suffers. In one analysis, she said, patients at hospitals with staffing ratios of four patients or more to one nurse suffered from cardiac arrest or shock 9.4 percent more often than patients at hospitals with ratios of 2.5 or fewer patients to one nurse. They also had 9 percent more urinary tract infections, 5 percent more gastrointestinal episodes, and 6.5 percent more cases of pneumonia acquired in the hospital, she said.

“RNs have choices in their careers, and many are electing not to put themselves, their families and their patients on the line by working understaffed,” Converso said. “We must make hospital nursing an attractive option again by increasing RN staffing levels.”

No Federal Standard

Currently, there is no federal law or standard requiring a minimum level of RN staffing. One state, California, has passed an RN staffing ratio law.

Hedy Dumpel, national director of nursing practice and patient advocacy at the California Nurses Association, said the legislation also contains whistleblower protections to protect nurses.

“There will be no fear of retaliation...and no layoffs of staff,” Dumpel said. “There will be no interference with our rights.”

H.R. 2273, with 23 co-sponsors, was referred to the House Energy and Commerce Committee and the House Ways and Means Committee.

Nurses Promote EFCA

The unions were also in Washington to promote the Employee Free Choice Act, legislation (S. 560, H.R. 1409) that would make it easier for workers to join unions.

EFCA, introduced in the House and Senate March 10 (45 DLR AA-1, 3/11/09), would amend the National Labor Relations Act to, among other things, establish a procedure whereby the National Labor Relations Board would certify a union as the bargaining representative of employees if a majority of employees of the unit signs valid union authorization cards.