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Nurses back legislation to set minimum staffing levels | Bills and Laws


The American Nurses Association and union groups are backing measures in Congress, which have stalled in the past. Lawmakers have debated similar measures at the state level.

The Skinny

Lawmakers have introduced legislation that would set minimum staffing levels for nurses at hospitals nationwide.

U.S. Rep. Sherrod Brown, D-Ohio, left, and U.S. Rep. Jan Schakowsky, D-Ill., are sponsoring legislation that would impose minimum nurse staffing standards for hospitals and health systems. (Images: Congress)

U.S. Rep. Sherrod Brown, D-Ohio, left, and U.S. Rep. Jan Schakowsky, D-Ill., are sponsoring legislation that would impose minimum nurse staffing standards for hospitals and health systems. (Images: Congress)


U.S. Sen. Sherrod Brown, a Democrat from Ohio, and U.S. Rep. Jan Schakowsky, an Illinois Democrat, are the leading sponsors of the legislation.


The legislation would require hospitals and health systems to maintain minimum nurse-to-patient ratios at all times. Versions of the legislation are in the Senate (S. 1113) and House (H.R. 2530). The bills would also provide whistleblower protections to nurses who speak up about issues affecting patient safety, including staffing levels. The measures would also call for studies on proper nurse staffing levels.


The American Nurses Association said last week that they are endorsing the legislation.

Jennifer Mensik Kennedy, president of the association, says nurses are regularly working in conditions that make it difficult to care for patients. Too often, they are understaffed, she says.

“Nurses must practice in work environments where their professional and personal well-being is supported and protected. Policy coupled with other nurse-led staffing standards and solutions will improve nurses’ working environment and patient outcomes,” she said in a statement.

National Nurses United, a union representing nurses, has also endorsed the legislation. Jean Ross, president of National Nurses United, said in a statement that setting clear rules limiting the number of patients cared for by a nurse would help protect patients.

“Nurses know what our patients need, and one of the most common things we hear from our members is that their units are not safely staffed, which stretches nurses thin,” Ross said in a statement.

Other unions are backing the legislation, including AFSCME, SEIU, and AFL-CIO.

Dozens of House members have signed on as co-sponsors, and the Senate bill has several co-sponsors.


Advocates for nurses have been pushing similar measures for years, and lawmakers have introduced such proposals in the past but haven’t gained enough support for passage. Brown and Schakowsky introduced their respective bills in the spring.

In the past, hospitals and health systems have opposed legislative efforts to set minimum nurse-to-patient staffing ratios.

When President Biden’s administration introduced a proposal requiring minimum nurse staffing levels in nursing homes, hospitals joined long-term care facilities in their objections. Nursing homes argued the law is impractical when facilities are already having trouble retaining nurses. Hospitals say that if nursing homes operate fewer beds due to minimum staffing levels, health systems will end up housing more patients after they’re ready for discharge, and that’s already a significant problem.

California has had a law requiring minimum nurse staffing levels for years, and Oregon approved a law in September setting minimum nurse-to-patient ratios. Oregon’s nurse staffing ratios won’t take effect until next year. Nurses succeeded in winning legislative support, with some help from the Hospital Association of Oregon, which supported the legislation.

Lawmakers in other states have debated bills to improve nurse staffing, with mixed results.

In Washington state, Gov. Jay Inslee signed a bill in April that requires hospital committees to set staffing. A Minnesota bill that would have required hospitals to create staffing committees died in the legislature in May.

The Pennsylvania House of Representatives approved a staffing bill in June, but it still has to get through the state Senate. Kevin Mahoney, CEO of the University of Pennsylvania Health System, has spoken out in favor of minimum nurse staffing levels. In an op-ed for PennLive, Mahoney wrote, “We believe safe staffing standards will help to relieve nurse burnout, improve care for patients and create better work environments to attract and retain dedicated frontline caregivers.”

Several nursing unions have gone on strike this year, and while compensation has been a key issue, nurses have also fought for provisions to improve staffing levels before agreeing on new contracts. Staffing emerged as a leading issue when more than 75,000 Kaiser Permanente union workers went on strike last month.

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