·       ANA
·       State: Connecticut
·       19a-89e - Development of prospective nurse staffing plan by hospitals. c) Each hospital shall establish a hospital staffing committee to assist in the preparation of the nurse staffing plan required pursuant to subsection (b) of this section.
·       Registered nurses employed by the hospital whose primary responsibility is to provide direct patient care shall account for not less than fifty per cent of the membership of each hospital’s staffing committee.
·       In order to comply with the requirement that a hospital establish a hospital staffing committee, a hospital may utilize an existing committee or committees to assist in the preparation of the nurse staffing plan, provided not less than fifty per cent of the members of such existing committee or committees are registered nurses employed by the hospital whose primary responsibility is to provide direct patient care.
·       Each hospital, in collaboration with its staffing committee, shall develop and implement to the best of its ability the prospective nurse staffing plan. Such plan shall:
·        (1) Include the minimum professional skill mix for each patient care unit in the hospital, including, but not limited to, inpatient services, critical care and the emergency department;
·       (2) identify the hospital’s employment practices concerning the use of temporary and traveling nurses;
·       (3) set forth the level of administrative staffing in each patient care unit of the hospital that ensures direct care staff are not utilized for administrative functions;
·       (4) set forth the hospital’s process for internal review of the nurse staffing plan; and
·       (5) include the hospital’s mechanism of obtaining input from direct care staff, including nurses and other members of the hospital’s patient care team, in the development of the nurse staffing plan.
·       In addition to the information described in subdivisions (1) to (5), inclusive, of this subsection, nurse staffing plans developed and implemented after January 1, 2016, shall include:
·        (A) The number of registered nurses providing direct patient care and the ratio of patients to such registered nurses by patient care unit;
·       (B) the number of licensed practical nurses providing direct patient care and the ratio of patients to such licensed practical nurses, by patient care unit;
·       (C) the number of assistive personnel providing direct patient care and the ratio of patients to such assistive personnel, by patient care unit;
·       (D) the method used by the hospital to determine and adjust direct patient care staffing levels; and
·       (E) a description of supporting personnel assisting on each patient care unit.
·       (i) A description of any differences between the staffing levels described in the staffing plan and actual staffing levels for each patient care unit; and
·       (ii) any actions the hospital intends to take to address such differences or
·        adjust staffing levels in future staffing plans.
2016 Update:
•       (b) Each hospital licensed by the department pursuant to chapter 368v shall report, annually, to the department on a prospective nurse staffing plan with a written certification that the nurse staffing plan is sufficient to provide adequate and appropriate delivery of health care services to patients in the ensuing period of licensure.
•       Such plan shall promote a collaborative practice in the hospital that enhances patient care and the level of services provided by nurses and other members of the hospital’s patient care team.
·       More
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