Nurse Staffing Standards and Quality Care Act of 2019

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Nurse staffing is among the main challenges in the US healthcare system that require appropriate legislation. The “Nurse Staffing Standards for Hospital Patient Safety and Quality care act of 2019” is an active bill that majors on nurse staffing in hospitals (Della Volpe, 2021). It provides guidelines on the minimum nurse-to-patient ratio based on the unit. The primary stakeholders of the bill are nurses and hospital administrators (Della Volpe, 2021). Therefore, this paper addresses the major provision of the bill, background, supporters and opponents, impacts, and actions that nurses can take to promote passage of the bill.

Major Provisions of the Bill

The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2019 mandates the hospitals to develop a staffing plan that adheres to the prescribed minimum nurse-to-patient ratios (Della Volpe, 2021). Every unit in a hospital must publish a notification about nurse-to-patient ratios and must retain records of actual ratios. The bill requires all healthcare organizations in the US to adhere to the set guidelines to determine ratios and prohibits other healthcare providers from performing nurse functions unless it is authorized. It also provides stipends for loan repayment and scholarship programs for nurses and expands the nurse retention grant initiative to include apprenticeship projects.

Background of The Bill

The bill was taken to Congress by US senator Sherrod Brown and Rep Janice Schakowsky in May 2021. It was first presented in Congress in 2019, but was not passed (Della Volpe, 2021). However, after two years after its rejection, the bill is being prepared for voting before the two houses. The bill has a lot of similarities to a California bill passed in 2004 that created nurse-to-patient ratios. The bill’s focus is to enhance the ratio between registered nurses and patients in hospitals (Della Volpe, 2021). Therefore, the bill is being enacted to solve the increasing need for quality care and poorly monitored registered nursing staffing practices.

Relevant History of the Bill

Nurse staffing has become an urgent matter that has had adverse effects on quality care and nursing staff retention. It became a matter of heated debate in the public domain because of varied views, especially among health providers (Della Volpe, 2021). The issue was brought before the policymakers in 2019, but failed to garner a majority to be passed. For a bill to become a law, pertinent votes from the house of representatives and Senate play an integral role. However, the same bill has been brought before policymakers two years later (Della Volpe, 2021). The bill must garner more than 218 votes to move to the Senate. It must also attain more than 51 votes in the Senate to pass. Previously, the bill failed because the policymakers did not understand the magnitude of the problem. The bill is likely to face hurdles because of two opposing views.

Key Supporters and Opponents of the Bill

The bill is loved and hated in equal measure among healthcare providers. The supporters of the bill are the National Nurses Union. The union has been emphasizing the benefits of the minimum nurse-to-patient ratio in ensuring appropriate care for each patient. According to the union, “hospitals have deliberately failed to staff units with enough nurses, leading many to quit out of safety concerns” (Muoio, 2021). The opponents of the bill are hospital administrators who believe that it negatively affects nursing practice and hospital development. In addition, hospital administrators share a view that the bill will drive the cost of healthcare because of the need to employ more nurses. Thus, both the supporters and opponents of the bill have contrasting views regarding the bill.

Positions of Key Stakeholders in The Bill

The National Nurses Union and nurses believe that the bill is a solution to the challenges experienced in the healthcare sector. One of the advantages of the position is that it promotes the provision of quality care to patients. Moreover, having adequate nurse-to-patient ratio increases service delivery to patients (Muoio, 2021). The other benefit of the position is nurse retention and reduced nurse burnout. However, one of the disadvantages of the position is the increase in hospital expenditure. Hospitals are required to hire more registered nurses, which increases the wage bill. Another disadvantage is an increase in the cost of healthcare cost to patients. Patients will be forced to pay more for healthcare services.

Hospital administrators advocate for flexible nurse staffing based on need rather than rigid numbers stated in the bill. The position helps hospitals maintain the current spending, especially in the wage area for nurses (Muoio, 2021). Having flexible nurse staffing means that hospitals only employ based on need. The bill will put more burden on patients as they will be required to pay more for healthcare. On the other hand, the position of hospital administrators on the bill acts against the interest of nursing in addressing the challenges that come with the nursing shortage.

How The Bill Impacts Nurse’s Ability to Provide Safe and Quality Care?

The bill will assist in promoting the nurses’ capabilities in offering safe and quality care to patients. First, the bill targets the promotion of the nursing workforce to enhance quality care (Della Volpe, 2021). The bill provides a mentorship program that can offer a hands-on clinical experience to nursing students. The bill also creates a training program to aid new as well as transitioning nurses acclimate to their new surroundings (Della Volpe, 2021). Second, the bill’s main focus is to increase the number of nurses, which is pertinent to the provision of safe and quality healthcare to patients.

Actions That Nurses Can Take to Assist with The Passage of the Legislation

Nurses’ actions can play an integral role in the passage or defeat of the bill. The first action is to talk about the benefits of passing the bill to relevant stakeholders. The main challenge to the passage of the bill is the adverse effects (Della Volpe, 2021). Based on this, it is important to deconstruct the negative view of the bill. The second action is to engage opinion shapers to influence public opinion. These actions are crucial in the passage of the bill.


The bill has a positive impact on the development of healthcare. It introduces standards on the nurse-to-patient ratio to improve the quality of healthcare and increase nurse retention rates. Although the implementation of the bill increase healthcare costs, hospitals can get financial support through Medicare. However, healthcare providers have varied opinions on the impact of the bill. Thus, nurses should become active campaigners of the bill to indicate its effectiveness. They should also guide discussions on the need for the bill to influence public opinion.


Della Volpe, K. (2021). Nurse-to-Patient Staffing Standards Bill Has Mixed Support. Clinical Advisor. Web.

Muoio, D. (2021). As NNU blames hospital cost-cutting for the labor shortage, industry groups keep the focus on COVID-19. FierceHealthcare. Web.

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