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 comprehensive federal framework to guarantee direct care registered nurse (RN) staffing in hospitals. It would require hospitals to implement unit-by-unit, shift-by-shift RN-to-patient ratios tied to patient acuity, develop and annually reevaluate transparent staffing plans with nurse input, and post staffing information publicly. The bill also creates enforcement mechanisms (audits, complaints to the Secretary, penalties), provides whistleblower and patient protections, and links staffing adequacy to Medicare reimbursements. It additionally starts a process to require licensed practical nurse (LPN) staffing standards, pending aSecretary-commissioned study, and mandates related HRSA MedPAC reporting on costs, savings, and nurse retention. The aim is to improve patient safety and quality of care by ensuring adequate direct nursing care, while allowing state standards that are at least as stringent as the federal requirements.
Key Points
- 1Establishes minimum direct care RN-to-patient ratios by hospital unit and shift, with predefined caps (e.g., 1:1 in trauma ER or OR with a scrub requirement; 2:1 in CCU/ICU types; 3:1 in ER/pediatrics/stepdown, etc.), and applies acuity-based adjustments for units that are acuity adaptable. Includes safeguards against averaging, mandatory overtime, and allows higher ratios when patient acuity or care requirements demand it.
- 2Requires hospitals to develop, implement, and annually reevaluate a transparent staffing plan that accounts for patient acuity, admissions/discharges, unit-specific needs, and staffing of ancillary staff. Plans must be developed with direct care RN input and, if applicable, through collective bargaining; includes a formal process for posting and public accessibility of staffing methodologies and unit-level ratios.
- 3Creates robust enforcement and accountability: the Secretary can investigate complaints, require corrective action plans, and impose civil penalties. It also enshrines whistleblower protections and provides a complaint mechanism for nurses, patients, and others, including a required toll-free hotline and public notice of penalties.
- 4Initiates minimum direct care LPN/LPN staffing standards through a Secretary-led study (within 1 year) to establish LPN requirements by unit, with RN provisions to be applied to LPN staffing accordingly; timelines specify phased implementation (2 years generally, longer for rural settings).
- 5Ties staffing to Medicare payments: the Secretary would adjust Medicare payments to hospitals to offset net additional costs associated with meeting these requirements (for non-federally operated hospitals), with federal funding for federally operated hospitals and MedPAC reporting to Congress on costs, savings, and nurse retention. The bill also preserves states’ rights to maintain stricter standards where the Secretary determines they are at least as stringent as the federal requirements.