The existing state of safe staffing legislation is problematic. The nebulous language of 42 C.F.R. § 482.23(b) leaves states with little guidance on what adequate staffing is and even less direction on how to achieve it. Additionally, Congress has failed to pass any of the proposed legislation aiming to both further define adequate staffing and provide guidance on how to achieve it.

Journal of Health Care Law & Policy; 2022, Vol. 25 Issue 1, p91-132, 42p

§482.23 Condition of participation: Nursing services. The hospital must have an organized nursing service that provides 24-hour nursing services. The nursing services must be furnished or supervised by a registered nurse. 42 CFR Ch. IV (10–1–11 Edition)

(a) Standard: Organization. The hospital must have a well-organized service with a plan of administrative authority and delineation of responsibilities for patient care. The director of the nursing service must be a licensed registered nurse. He or she is responsible for the operation of the service, including determining the types and numbers of nursing personnel and staff necessary to provide nursing care for all areas of the hospital.

(b) Standard: Staffing and delivery of care. The nursing service must have adequate numbers of licensed registered nurses, licensed practical (vocational) nurses, and other personnel to provide nursing care to all patients as needed. There must be supervisory and staff personnel for each department or nursing unit to ensure, when needed, the immediate availability of a registered nurse for bedside care of any patient.

(1) The hospital must provide 24-hour nursing services furnished or supervised by a registered nurse, and have a licensed practical nurse or registered nurse on duty at all times, except for rural hospitals that have in effect a 24- hour nursing waiver granted under §488.54(c) of this chapter.

(2) The nursing service must have a procedure to ensure that hospital nursing personnel for whom licensure is required have valid and current licensure.

(3) A registered nurse must supervise and evaluate the nursing care for each patient.

(4) The hospital must ensure that the nursing staff develops, and keeps current, a nursing care plan for each patient.

(5) A registered nurse must assign the nursing care of each patient to other nursing personnel in accordance with the patient’s needs and the specialized qualifications and competence of the nursing staff available.

(6) Non-employee licensed nurses who are working in the hospital must adhere to the policies and procedures of the hospital. The director of nursing service must provide for the adequate supervision and evaluation of the clinical activities of non-employee nursing personnel which occur within the responsibility of the nursing service.

(c) Standard: Preparation and administration of drugs. Drugs and biologicals must be prepared and administered in accordance with Federal and State laws, the orders of the practitioner or practitioners responsible for the patient’s care as specified under §482.12(c), and accepted standards of practice. §482.24 medical record must be maintained for every individual evaluated or treated in the hospital.

(1) All drugs and biologicals must be administered by, or under supervision of, nursing or other personnel in accordance with Federal and State laws and regulations, including applicable licensing requirements, and in accordance with the approved medical staff policies and procedures.

(2) With the exception of influenza and pneumococcal polysaccharide vaccines, which may be administered per physician-approved hospital policy after an assessment of contraindications, orders for drugs and biologicals must be documented and signed by a practitioner who is authorized to write orders by hospital policy and in accordance with State law, and who is responsible for the care of the patient as specified under §482.12(c).

(i) If verbal orders are used, they are to be used infrequently.

(ii) When verbal orders are used, they must only be accepted by persons who are authorized to do so by hospital policy and procedures consistent with Federal and State law.

(3) Blood transfusions and intravenous medications must be administered in accordance with State law and approved medical staff policies and procedures. If blood transfusions and intravenous medications are administered by personnel other than doctors of medicine or osteopathy, the personnel must have special training for this duty.

(4) There must be a hospital procedure for reporting transfusion reactions, adverse drug reactions, and errors in administration of drugs. [51 FR 22042, June 17, 1986, as amended at 67 FR 61814, Oct. 2, 2002; 71 FR 68694, Nov. 27, 2006; 72 FR 66933, Nov. 27, 2007] 

https://www.govinfo.gov/app/details/CFR-2011-title42-vol5/CFR-2011-title42-vol5-sec482-23/context

Please feel free to share the section about verbal orders at work to protect yourself from errors. 

We know that nurse to patient ratios impact the amount, quality and safety of care provided to patients. We know that ratios impact physical, emotional, psychological and other types of injuries to nurses, as well as burnout and compassion fatigue. We know that customer satisfaction  decreases with high ratios, while complaints, poorer outcomes, and lawsuits increase. If patients and nurses are unhappy and suffering due to the vague and widely open to interpretation of the language of existing regulatory legislation, it must be changed. As demonstrated in the main portion of this petition and in subsequent updates, current legislation is stalled in the House and Senate and is dire need of amended language before it is put to a vote. Not only do we need clarification of language, but we need it to represent real world needs. We need it to cover more nursing specialties than it currently does, have ratios that are backed by professional organizations and recent scholarly peer reviewed evidence, include more practice areas outside of the hospital, and include Allied Healthcare Professions outside of Registered Nursing. The stalled Bills in the House and the Senate fail to address these exceptionally important needs for the welfare of all patients and all Healthcare Workers. 

Legislation is by The People, For the People. Please sign this petition stating you want the existing Bills amended to reflect these needs, and to be passed into Federal Law and applied to all 50 states. Everyone needs and deserves this protection.