Safe Staffing Bill to Address Hospital Nursing Crisis Reintroduced Into Congress

Following a wave of strikes, nurses brought their fight to Congress on March 30, 2023, to support a federal bill that they say will address the crisis of unsafe levels of nurse staffing in hospitals by establishing a minimum nurse-to-patient ratio for every hospital unit. The American Hospital Association opposes mandated nurse staffing ratios and called this approach ineffective.

The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act was introduced into Congress in 2019 and reintroduced in subsequent years but has not been enacted. The bill is authored by Senator Sherrod Brown (D-OH) in the Senate and Representative Jan Schakowsky (D-IL-09) in the House and also provides whistle-blower protections to ensure that nurses are free to speak out for enforcement of safe staffing standards.

National Nurses United (NNU) supports the bill and said that claims of a nursing shortage are untrue, noting that approximately 1 million RNs with active licenses are not working as nurses, largely because of unsafe staffing. This estimate is based on 2021 Bureau of Labor Statistics data and National Council of State Boards of Nursing data, according to NNU.

nurses staffing bill
NNU President Deborah Burger, RN, spoke at the rally. Credit: National Nurses United.

“This staffing crisis was manufactured by the hospital industry,” said NNU President Deborah Burger, RN. “Hospital executives claim there is a nursing ‘shortage’ but we know that many nurses have left the bedside because they are unwilling to risk their patients’ lives by being forced to care for them in an unsafe manner. This bill would bring them back to providing direct care at the bedside and in clinics by ensuring their patients receive proper, safe, optimal, and timely care.” 

“Numerous studies have shown that safe nurse-to-patient staffing ratios result in higher quality care for patients, lower health care costs, and an overall better workplace for nurses,” said Congresswoman Schakowsky.

American Hospital Association Calls Nurse Staffing Ratios Ineffective

“The American Hospital Association (AHA) and our affiliated American Organization for Nursing Leadership are committed to safe staffing to ensure hospitals and health systems provide quality care and optimal patient experience,” said Robyn Begley, DNP, RN, NEA-BC, FAAN, senior vice president of workforce for the AHA and chief executive officer of the American Organization for Nursing Leadership. “Mandated nurse staffing ratios are a static and ineffective tool that does not guarantee a safe health care environment or quality level to achieve optimum patient outcomes. Staffing ratios are usually informed by older care models and do not consider advanced capabilities in technology or interprofessional team-care models. These newer models incorporate not only nurses at various levels of licensure, but also respiratory therapists, occupational therapists, speech-language pathologists, physical therapists, and case managers.”

“Hospitals and health systems across the country are working to foster healthy practice environments, advance patient safety, affordability and enhance value by transforming health care delivery,” Dr Begley said. “Mandated approaches to nurse staffing limit innovation, reduce the flexibility needed to respond to patients’ changing care needs, and increase stress on a health care system already facing an escalating shortage of educated nurses.”

Federal Nurse Staffing Bill Is Based on California Legislation

The federal bill is mirrored after a California law, which took effect in 2004. Research has shown that the California law — A.B. 394 — is linked to significantly lower mortality among patients as well as lower burnout and job dissatisfaction rates. Other research suggests having more nurses on hospital units reduces the risk for medication errors, complications, falls and injuries, pressure ulcers, increased length of hospital stay, and readmission rates, NNU explained. Disparities in health care among people of color are also linked to lower staffing levels among hospitals that serve communities of color.

In an NNU survey of more than 2800 nurses conducted from September 22 through November 28, 2022, 56.8% percent of hospital nurses report that staffing has gotten slightly or much worse recently and nearly half of hospital nurses report that their facility is using excessive overtime to staff units. More than half of nurses (55.5%) surveyed reported that they have considered leaving nursing. 


Members of Congress to introduce safe staffing bill to address hospital crisis. News release. National Nurses United. March 29, 2023. Accessed March 29, 2023.

This article originally appeared on Clinical Advisor