Safe Staffing

Safe staffing can be a matter of life and death, and achieving the right staffing levels requires nurses and management working together. 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 bleeding. Reducing medical errors is also important from a financial perspective, as the Centers for Medicare & Medicaid Services (CMS) has begun to implement value-based care models that incorporate risk-sharing with the potential to withhold payment for preventable hospital-acquired injuries or illnesses; private insurers are expected to follow suit.

Collaborative efforts among state hospital associations, nurse executives, and ANA-affiliated state nurses associations have resulted in balanced state-level staffing legislation that benefits patients, nurses, and hospitals. Seven states have already enacted safe staffing legislation using the Registered Nurses Safe Staffing Act's committee approach: Oregon (2002), Texas (2009), Illinois (2007), Connecticut (2008), Ohio (2008), Washington (2008), and Nevada (2009).

Federally, ANA continues to work with lawmakers and the current administration on this critical issue, supporting a bipartisan approach toward safe nurse staffing levels. Increasing the number of RNs per patient improves clinical and economic outcomes. 

ANA's approach takes into account:

  • 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.

This approach to staffing would:

  • Ensure 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 the secretary of Health and Human Services to impose civil monetary penalties for each known violation;
  • Include whistleblower protections; and
  • Require public reporting of staffing information.

This balanced approach promotes the development and implementation of valid, reliable, unit-by-unit nurse staffing plans to ensure robust patient safety and optimal health outcomes.