Running head: REGISTERED NURSE SAFE STAFFING ACT OF 2015 1

Registered Nurse Safe Staffing Act of 2015

Rebecca Nappi

Bon Secours Memorial College of Nursing

Business of Health Care in Complex Systems

NUR4240-201617-SP

Catherine Mikelaites MSN, RN-BC, CMSRN

March 7, 2017
REGISTERED NURSE SAFE STAFFING ACT OF 2015 2

Registered Nurse Safe Staffing Act of 2015

The landscape of health care has changed dramatically over the last several decades.

Focus has moved from quality patient care regardless of cost to insurance reimbursement vs cost

as the main priority. Health systems desire to accomplish both excellent patient care while

providing this care at the lowest cost for each service provided. This basic principle has made the

biggest impact on the largest group of providers in health care, which are the nurses. Hospitals

are being forced to reduce the number of nurses to help cut the overall cost of daily expenses due

to reimbursements by insurance companies decreasing. This safe staffing law being passed is

vitally important to the safety of patients and nurses everywhere. If passed, it would assure that

nurses would be supported in their role as patient advocates resulting in protection of patients in

every department or unit. If nurses are caring for too many patients at once the result is increases

in patient mortality and patient related adverse events.

Health Care Law

The healthcare law chosen for this assignment is the “Registered Nurse Safe Staffing Act

of 2015”. This act aims to require Medicare participating hospitals to put in place measures to

assure that each unit or department has adequate registered nurses on staff for safe patient care

and safe working environment for the nurses (Congress.gov, 2015). This safe staffing act was

introduced by Senator Jeff Merkley (D-OR) and Representatives Lois Capps (D-CA) and David

Joyce (R-OH) in April of 2015 (Sachs & Jones, 2015). Some interesting points within this bill is

the requirement for each hospital to formulate a nursing committee mainly made of direct patient

care nurses and specialty unit nurses working with management to determine safe nurse to

patient ratios for each unit. This ratio would be thoughtfully based on several safety factors, for

example, patient acuity, geography within hospital and educational status of the nurses. The bill
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has provisions within it to penalize hospitals that do not meet the requirements by having to pay

fines. It also protects whistle blowers from experiencing any retaliation. The bill requires each

unit to post how many licensed and unlicensed personnel are currently on for each shift in an

easily accessible area which would allow staff and patients to remain informed. The bill is very

detailed and well written for even the lay person to read and understand the requirements and

provisions. Currently the bill has been introduced in the house and the senate, this is the first step

in the legislative process (GovTrack, 2015).

Impact on Nursing Profession & Patients

This bill has an incredible impact on nursing since it directly involves the nursing staff of

a hospital that implements the requirements explained in this bill. It would force management to

allow direct care nurses to form a committee to create and implement safe staffing requirements

throughout the hospital rather than policy makers within leadership that are concerned mostly

with the hospitals budget and profit. This bill protects nurses as hospitals are continuously being

forced to cut cost everywhere due to numerous factors decreasing reimbursements from

insurance companies. This bill would protect nurses from being placed in unsafe nurse to patient

ratios which is likely to happen in any department of hospitals that do not already follow safe

staffing recommendations set forth by their state or governing agencies. It takes into

consideration the nurses clinical experience, educational level and certifications when

considering safe nurse to patient ratios for a unit, shift or department. The American Nurses

Associates supports this bill and encourages nurses to support it as well. The ANA has pointed

out that for every patient a registered nurse takes on during a shift that mortality increases by 7%

(Sachs & Jones, 2015).

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Financial Implications

This bill would appear to increase cost to a hospital by requiring more nursing staff but in

reality, it would cut cost to a hospital by providing safer nursing care thus reducing adverse

patient events and decreasing patient readmissions (American Nurses Association [ANA], 2015).

When nurses are not over worked and not given excessive patient loads it also contributes to

decreased call outs and lower nurse turnover which is a huge money saver for hospitals. Nurse

turn over costs to a hospital vary greatly from system to system and from department to

department, for example, a nurse needing to be replaced in the intensive care unit or operating

room is much more expensive than a nurse in a low acuity unit like a pre-assessment department

where the orientation is only six weeks rather than six months. This proposed bill would also be

a money saver because it has been proved to decrease nosocomial infections and increased

earlier detection of patients becoming sicker. Seven states have already enacted safe staffing

legislation due to this positive patient outcomes and money saving results (ANA, 2015). The

initial implementation of a bill like this would increase financial cost to a hospital up front by

posting additional positions for nurses and the time and money it takes to interview and then

train a nurse, especially in a specialized department like interventional radiology or an operating

room when the orientation process for a new nurse is about six months but one readmission by a

patient that is not covered by insurance is extremely expensive.

Opportunities and Challenges

One of the biggest challenges in health care to implement this change would be the

growing nursing shortage in the United States. As America ages and health care becomes more

and more available to everyone through the affordable care act this has and will continue to put

an incredible strain on health care facilities of all kinds and in every state. Nursing schools are
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experiencing a tough time expanding at the rate that is needed to keep educated nurses hitting the

work force in a timely manner (American Association of Colleges of Nursing, 2014). Hospitals

have an opportunity to begin the changes that will need to be made to comply with such a law

being passed. This type of improvement is always easier to accomplish if you start earlier rather

than wait until you are being forced by fear of penalty. Encouraging nurses to be preceptors and

creating well written and easy to understand orientation manuals are two easy items that will

help greatly on the back end of hiring more nurses. The ANA already encourages hospitals to

voluntarily report current staffing numbers and the mixture of nursing staff currently employed

to be used as data for future legislation for safe staffing requirements. Hospitals participating in

public reporting of the number of registered nurses employed and their decreases of adverse

patient outcomes or patient readmissions, voluntarily, would help get laws passed by showing

policy makers the current evidence based data we need to get this bill passed (American Nurses

Association [ANA], 2016). This could result in patients being protected from negative outcomes

and improving health care everywhere by creating safe environments due to having adequate

staffing across America.

Conclusion

Having a safe number of nurses on each unit or in each department will keep patients

safe. This bill being passed is the first step to correcting a big problem that has been growing for

the profession of nursing across America. Nursing was first formed to care for those in need and

that is where it needs to return. Being good stewards of the finances is important but our priority

as health care providers needs to remain patient safety. If this bill is implemented patients will be

cared for more efficiently, protected more aggressively and will eventually result in savings to

the hospital.
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References

American Association of Colleges of Nursing. (2014). Nursing Shortage. Retrieved from

http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage

American Nurses Association. (2016). Public Reporting of Nurse Staffing Measures. Retrieved

from http://www.nursingworld.org/MainMenuCategories/Policy-

Advocacy/Federal/Agencies/ANA-Leading-Patient-Safety/Public-Reporting-of-Nurse-

Staffing-Measures

American Nurses Association. (2015). The Registered Nurse Safe Staffing Act. Retrieved from

http://www.rnaction.org/site/DocServer/Registered_Nurse_Safe_Staffing_Act_of_2015.p

df?docID=2361

Congress.gov. (2015). H.R.2083 - Registered Nurse Safe Staffing Act of 2015. Retrieved from

https://www.congress.gov/bill/114th-congress/house-

bill/2083?q=%7B%22search%22%3A%5B%22%5C%22hr2083%5C%22%22%5D%7D

GovTrack. (2015). H.R. 2083 (114th): Registered Nurse Safe Staffing Act of 2015. Retrieved

from https://www.govtrack.us/congress/bills/114/hr2083

Sachs, A., & Jones, J. (2015). ANA Commends Introduction of the Registered Nurse Safe

Staffing Act. Retrieved from

http://www.nursingworld.org/FunctionalMenuCategories/MediaResources/PressReleases/

2015-NR/ANA-Commends-Introduction-of-the-Registered-Nurse-Safe-Staffing-Act.html