(HARRISBURG, PA) – Representative Tim Solobay and other members of the Pennsylvania House of Representatives stood with registered nurses, members of SEIU Healthcare Pennsylvania – the state’s largest union of nurses and other health care workers – to call for legislation requiring safe nurse staffing levels in hospitals.

House Bill 147 sets a standard the maximum number of patients that may be under a single nurse’s care for each of the various types of units in an acute care hospital.  The ratios must be adjusted down (fewer patients per nurse) to account for increased patient acuity (a greater need for nursing care.)

“As nurses, we want to be able to know at the end of the day that we gave our best care every hour, to every patient our hands touched,” said Deborah Bonn, Director of the SEIU Nurse Alliance of Pennsylvania. “We know that one nurse can give adequate, safe care to only so many patients. This bill sets a minimum acceptable standard, a baseline of safety, for every patient in our hospitals.”

Preventable medical errors that occur in hospitals cause 98,000 deaths according to the Institute of Medicine. Academic studies show that nurse staffing is a key factor in the commission of those errors.

“When I became a nurse 7 years ago, we had 19 beds on my unit. Now we have 26 beds, the same exact staffing levels, and our patients are much sicker than in the past,” said Kim Klinger, RN, a medical-surgical nurse in Wilkes-Barre, and a member of SEIU Healthcare Pennsylvania.  “I have to prioritize and make choices about what I do and what I don’t do. I provide the absolute best care that I can, but I can’t provide the highest quality or the safest manner of care when I have too many patients.”

Setting safe minimum RN staffing levels has also been shown to bring nurses back to the bedside. Similar legislation was passed in California in 1999.  Since then, California’s nurse vacancy rates in hospitals have plummeted, and the number or actively licensed nurses has risen by 10,000 nurses per year, up from 3,200 nurses prior to the staffing ratios legislation according to the California Board of Nursing.

“With ratios of one nurse to four patients, RNs who have left my unit would flock back to the bedside,” said Klinger.

• The following are ratios that would prohibit an RN from having more patients in their assignment.
Unit Type  Nurse to Patient Ratio

OR  1:1
Trauma Emergency Unit  1:1
Critical Care (Emergency Room Critical Care,  all intensive care 1:2
Labor and Delivery  1:2
PACU  1:2
Antepartem  1:3
ER 1:3
Pediatrics 1:3
Stepdown from ICUs 1:3
Telemetry 1:3
Intermediate Care Nursery 1:4
Medical/Surgical  1:4
Acute Care Psychiatric Units 1:4
Rehabilitation Units 1:5
Postpartum (3 couplets) 1:6
Well Baby Nursery 1:6

• The bill directs the Department of Health to set RN-to-patient ratios for other units not listed above, including psychiatric units, of acute care hospitals.

• Lower Ratios are Permitted and Required Based on Acuity:  Hospitals can develop a staffing plan that has RN-to-patient ratios that are lower (fewer patients per nurse) than the ratios above. The ratios above are maximum ratios—not a minimum threshold. 

• RN-to-Patient Ratios Must Not Reduce Non-RN Staff:  HB 147 explicitly recognizes the importance of all health care workers, including licensed practical nurses, social workers, nurse aides, monitor techs, etc, in ensuring quality patient care outcomes.  The bill spells out that the setting of staffing ratios for RNs is not to be interpreted as justifying understaffing of non-RN staff.

• Non-Compliance Risks Licensure and Penalties:  HB 147 bill ties hospital licensure to both the adherence to the RN-to-patient ratios and the recordkeeping to show compliance to ratios and patient acuity.  The bill also imposes penalties and sanctions on hospitals for non-compliance.