Nurse Staffing Standards Act Is First Step in Solving Nursing Shortage

Nurses planning to leave the profession.

The nursing shortage continues, with no end in sight. In my current position as faculty in a university DNP program, I hear from students about caring for overwhelming numbers of patients and fearing for their patients’ safety and health. Nurses are suffering burnout because they are caring for so many patients they know nursing care is being missed. A recent survey found that job satisfaction has been dropping for nurses, while the percentage who say they may leave the profession is as high as 30% overall, with younger nurses most likely to say they may leave.

Nurse educators do our best, but we know that we are sending new graduates into the fire. Retired nurses worry about our family members (and ourselves) when we need nursing care.

Congress recently reintroduced the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act. This bill would mandate direct care registered nurse-to-patient staffing ratio requirements in hospitals. It has been introduced in several prior congressional sessions with little progress. We cannot let this window of opportunity pass.

Nurse staffing and patient outcomes.

Linda Aiken’s two decades of research demonstrate the effects of nurse staffing on patient outcomes. Despite legislative efforts in Massachusetts and New York, California is the only state mandates nurse-patient ratios. Federal and state legislative attempts have repeatedly failed because of the strong opposition of hospitals. Ignoring the pleas of their nurse employees, the American Organization for Nursing Leadership (AONL) has opposed staffing ratio legislation, in lockstep with their parent organization the American Hospital Association.

New report signals stronger ANA support for legislation.

When I worked at the American Nurses Association 10 years ago, I was in the very uncomfortable position of not supporting staffing ratio legislation. I am thrilled to see that the American Association of Critical-Care Nurses and the American Nurses Association have released a new document called Nurse Staffing Task Force Imperatives, Recommendations, and Actions.

The report names five “imperatives” and the recommended steps to make them happen, the third of which is “Establish staffing standards that ensure quality care.” One of the five recommendations in support of this imperative is as follows: “Advocate for state and/or federal regulation and legislation that advances meeting minimum staffing standards.” This is a first step. Supporting nurse-patient ratios is also mentioned in the document, although under the heading of “actions to consider.”

It’s hard to tell how strongly this document may influence the passage of safe staffing legislation. While legislating nurse-patient staffing ratios will not entirely solve the current and future nursing workforce shortage, it is a necessary first step.

With public attention strong, an ideal moment for change.

Kingdon’s three streams model nicely illustrates how the “problem stream,” “policy stream,” and “political stream” work together to effect policy change. The present moment has revealed a convergence of these three streams in relation to the question of safe staffing and presents a strong opportunity to pass this safe staffing legislation.

• Problem stream: Nursing burnout and nursing shortages have been prominently covered by the press in the past few years, along with much recent social media and many research articles addressing these issues.
• Policy stream: California outcomes data from implementation of nurse to patient ratio legislation has so far shown positive outcomes in terms of patient mortality and nurse retention. There is also widespread concern in the industry about predicted future nursing shortages, which should further strengthen institutional support for proposed staffing legislation.
• Political stream: We saw increased public awareness and support of nurses throughout the pandemic. The Congressional Nursing Caucus has relaunched with nurse and nurse practitioner vice-chairs Congresswoman Underwood and Congresswoman Kiggans.

Actionable steps for nurse readers to take.

• AJN readers can exert an influence by contacting their representatives and senators, making clear why this legislation is important, and requesting that their legislators cosponsor the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act.
• The American Nurses Association and other nursing organizations should advocate for
  this bill with the largest call to action in their history.
• Nurse influencers on social media should issue a call to action.

Large numbers of nurses cannot continue to leave the profession. Unknown numbers of patients cannot continue to be harmed because of inadequate staffing and substandard care. This bill will not solve the nursing shortage or remove all the pressures nurses are currently facing, but it is a necessary move in the right direction.

Andrea Brassard, PhD, FNP-BC, FAAN, CNE, is an associate professor at the University of Maryland School of Nursing.