1. Whittaker, Sue
  2. Kay, Margaret

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The ANA and state nurses associations are working together to promote legislation that would hold hospitals accountable for developing and implementing valid and reliable nurse staffing plans. These plans are based on the ANA's Principles for Nurse Staffing, which provides recommendations on appropriate staffing and requires that nurses be deeply involved in developing plans and making decisions on staff issues. The plans give hospitals the flexibility to tailor nurse staffing to their patients' specific needs based on such factors as the seriousness of the patients' illnesses and the experience of the nursing staff.


In 2004 Florida, Hawaii, Illinois, Massachusetts, Rhode Island, and Washington introduced legislation that would require health care facilities to develop nurse staffing plans. These bills require


* nurse administrators to adopt and implement a staffing plan with input from direct care registered nurses.


* daily postings of the numbers of nursing staff responsible for patient care.


* evaluation of the adequacy of the staffing plan by collecting data on quality and outcomes.


* that the ANA's Principles for Nurse Staffing serve as a basis for developing a staffing plan.


* enforcing penalties if institutions do not meet staffing levels.



Nurse-to-patient ratios.

Another approach to address nurse staffing is to mandate specific nurse-to-patient ratio legislation, such as that introduced this year in Hawaii, Iowa, and Tennessee, which would require specific ratios in hospitals and other health care facilities. These bills assign a numeric ratio to specific patient care units, such as pediatric recovery rooms, trauma units, and psychiatric units. Connecticut legislation calls for the commissioner of public health to adopt regulations establishing minimum nurse-to-patient ratios. Strict enforcement is another hallmark of these bills, with violations leading to any combination of the following: loss of hospital licensure, fines, termination of Medicaid reimbursements, private right of action, and civil penalties.