Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2025
The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2025 would add a new title to the Public Health Service Act that sets federally mandated minimum direct care registered nurse (RN) staffing ratios for hospital units, tied to patient acuity and unit type. Hospitals would be required to develop and publicly document a staffing plan that assigns RNs to a specific number of patients per shift, with explicit rules to protect patient safety, prevent overwork, and ensure direct bedside care. The bill creates enforcement mechanisms, including audits and civil penalties, and provides for Medicare reimbursement adjustments to help cover the added costs. It also establishes provisions on transparency, whistleblower protections, and a process for studying licensed practical nurse (LPN) staffing and outpatient settings. There are phased implementation timelines, with stronger ratios generally due within two years (four years in rural areas), and an emergency-state exemption under certain conditions. In short, the bill aims to guarantee minimum RN-to-patient staffing levels in hospitals, require hospitals to plan, document, and publicly disclose staffing, and reinforce nurse protections and accountability, while offering potential Medicare-related cost offsets and ongoing workforce research.
Key Points
- 1Minimum direct care RN-to-patient ratios by unit
- 2- The bill requires a hospital staffing plan that assigns direct care RNs to no more patients than specified for various units (e.g., 1:1 for trauma ER; 2:1 for certain ICUs; 3:1 in ER pediatrics/stepdown; 4:1 on many medical-surgical units; up to 6:1 in postpartum/baby units).
- 3- Ratios apply per shift, with full ancillary and support staff, and acuity-based adjustments for high-need patients.
- 4- Highest acuity in acuity-adaptive units must be used for staffing when needed.
- 5Planning, transparency, and participation
- 6- Hospitals must develop and annually reevaluate a staffing plan, include unit-specific factors (acuity, admissions/discharges, specialized staff), and involve direct care RNs (and their bargaining representatives where applicable).
- 7- Staffing plans and the methodology used to determine ratios must be transparent and publicly accessible.
- 8Posting, records, and audits
- 9- Each hospital unit must publicly post RN-to-patient ratios and staffing details for each shift.
- 10- Hospitals must maintain unit-by-unit staffing records for at least 3 years and allow access to the Secretary, nurses and unions, and the public.
- 11- The Secretary is charged with periodic audits to ensure plan compliance and record accuracy.
- 12Enforcement and penalties
- 13- The Secretary may impose civil penalties on hospitals for violations (up to $25,000 for the first knowing violation; up to $50,000 for subsequent violations) and on individuals (up to $20,000 per violation) who knowingly violate the law.
- 14- There are complaint and investigation processes, corrective action plans, and public posting of penalties.
- 15Employee protections and rights
- 16- Nurses may object to assignments they reasonably believe violate the staffing requirements or endanger patients, without fear of discharge, retaliation, or retaliation-based complaints.
- 17- Hospitals may not retaliate against nurses for objections, and it is unlawful to interfere with nurses’ rights, including the right to organize or engage in concerted activity.
- 18Nurse workforce and LPN staffing studies
- 19- The act directs the Secretary to study licensed practical nurse (LPN) staffing and to develop LPN standards for hospital units, applying many of the RN provisions where appropriate.
- 20- An outpatient setting study is also required to assess staffing levels and patient care.
- 21Medicare reimbursement offsets
- 22- Medicare reimbursement to hospitals (non-federally operated) could be adjusted to offset net additional costs from implementing the staffing requirements.
- 23- A MedPAC report is due within 2 years, evaluating total costs and potential savings and guiding future reimbursement decisions.
- 24Definitions and scope
- 25- The bill defines acuity level, direct care RN, direct care LPN, nursing care plans, and related terms to operationalize ratios and staffing decisions.
- 26- It preserves state-by-state nursing practice and does not override more stringent state standards.
- 27State preemption and emergencies
- 28- The act does not preempt stricter state staffing standards and allows for states to maintain or exceed federal requirements.
- 29- An emergency state exemption allows temporary relief from staffing ratios during declared emergencies, with requirements to demonstrate efforts to maintain staffing and penalties for improper use of the exemption.