American Nurses Association

ANA summarizes the Safe Staffing
Safe staffing can be a matter of life and death and nurses and management working collaboratively is critical to achieving the right staffing levels. Adding additional registered nurse (RN) hours to unit staffing has been shown to reduce the relative risk of adverse patient events, such as infection and falls. Reducing medical errors is also important from a financial perspective, as the Centers for Medicare & Medicaid Services (CMS) continues to advance value-based care models that incorporate risk-sharing that withholds payment for preventable hospital-acquired injuries or illnesses. Increasingly, value-based care models are being adopted across all payers, including private insurers.

• Collaborative efforts among state hospital associations, nurse executives, and ANA-affiliated state nurses associations have resulted in state level safe staffing laws designed to benefit both patients and nurses. Seven states have enacted staffing legislation applying ANA’s hospital-wide committee approach: Oregon (2002), Texas (2009), Illinois (2007), Connecticut (2008), Ohio (2008), Washington (2008), and Nevada (2009).

  ANA continues to work with federal lawmakers and the Administration on this vital issue, supporting a bipartisan approach toward safe nurse staffing levels.

  Safe staffing approaches that increase the number of RNs per patient results in improved clinical and economic outcomes. Adopted approaches must recognize the unique characteristics associated with each hospital and unit within, including:

  •          RN educational preparation, professional certification, and level of clinical experience;

  •          the number and capacity of available health care personnel, geography of a unit, and available technology; and

  •          the intensity, complexity, and stability of patients.

  ANA continues to advocate for safe staffing approaches that:

  •          provide assurance that RNs are not forced to work without orientation in units in which they are not adequately trained or experienced;

  •          establish procedures for receiving and investigating complaints;

  •          allow for civil monetary penalties for known violations;

  •          include whistleblower protections; and

  •          require public reporting of staffing information.

  A balanced approach to promote the development and implementation of valid, reliable, unit-by-unit nurse staffing plans ensure robust patient safety and optimal health outcomes. More information, research, and data about nurse staffing advocacy is available on nursingworld.org. 

  ANA supports a legislative model incorporating nurse-driven staffing committees because this approach encourages flexible staffing levels. At least 55 % of staffing committee members should be direct care nurses.

  As of March 2022, 16 states currently address nurse staffing in hospitals through either laws or regulations:

  • Hospital-based: Eight states with committees comprised of at least 50% direct care nurses: CT, IL, NV, NY, OH, OR, TX, WA. One state where a Chief Nursing Officer develops a core staffing plan: MN.
  • Nurse to patient ratios/standards. Two states: CA, MA
  • Disclosure and/or reporting requirements. Five states: IL, NJ, NY, RI, VT

Staffing and the COVID Pandemic Impact