The issue with H.R. 3165 and S.1567 Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2021 is they do not specify maximum ratios for all specialties in nursing, some ratios specified are not supported by scholarly peer reviewed research/ professional organizations for those specialties, and it includes only nurses (excluding all other Allied Healthcare Professionals). While these Bills are absolutely an improvement should they become law, the language should be amended before the vote takes place in order to correct these shortcomings. The purpose of this petition is to be a tool to amend the language of these Bills prior to a vote. 

People receiving healthcare in facilities are at increased risk when Healthcare Workers have too many people to take care of. https://pubmed.ncbi.nlm.nih.gov/34880022/  Federal legislation to specify the maximum number of patients per Healthcare Worker is needed to increase patient and Healthcare Workers safety. Ratio caps reduce burnout, turnover and retirement from our Professions which decrease short staffing and overall costs.  

Intensive/ critical care 1 : 1-2 acuity dependent

Neonatal ICU 1 : 1-2 acuity dependent

Operating Room 1 : 1

Post-anesthesia/ Recovery 1 : 2

Well Baby Nursery 1 : 5 

Intermediate Care Nursery 1 : 3 

Pediatrics Medical-Surgical 1 : 3

Pediatric Intensive Care 1 : 1 

Pediatric Intermediate Care/ Step-down/ Telemetry 1 : 3

Emergency Room 1 : 3

Emergency Room ICU holds 1 : 1

Emergency Room Telemetry holds 1 : 2

Emergency Room Trauma 1 : 1

Step-Down/ Intermediate Care/ Telemetry 1 : 3 

Medical - Surgical 1 : 4

Coronary Care 1 : 2

Acute Respiratory 1 : 2

Burn Unit 1 : 2

Other Specialty Care Units 1 : 4 

Psychiatric all ages 1 : 3

Skilled Nursing Facility 1 : 5

Rehabilitation 1 : 4

All recommendations of AWHONN are included in this petition for the following areas: Antepartum, Intrapartum, Postpartum and Newborn Care and Minimum Staffing recommendations. 

All units will have Nurse Extenders ( Certified Nursing Assistants, Patient Care Technicians, Medical Assistants) at a ratio of 1 : 1.5 LPNs or RNs 

AND 

All units critical care areas will have a "resource nurse" staffed per shift who will step in to help in situations of of increased need. 

Dialysis Staff Ratios in Outpatient Care Settings (Previously California Senate Bill 349) :  

Former California Senator Ricardo Lara introduced a Senate Bill 2/14/2017 dubbed "The Dialysis Patient Safety Act" that would have greatly improved conditions for patients and Healthcare Workers in outpatient dialysis settings. Unfortunately, due to heavy lobbying by well funded groups, this Bill did not become law but is badly needed.

"(A) At least one nurse is providing direct care for every eight patients. A nurse shall only count toward this ratio during time periods the nurse has no responsibilities other than direct care. A nurse manager or charge nurse shall not count toward this ratio.
(B) At least one technician is providing direct care for every three patients. A technician shall only count toward this ratio during time periods the technician has no responsibilities other than direct care. Trainees shall not count toward this ratio. Nurses counted toward the nurse-to-patient ratio shall not count toward this ratio.
(2) Commencing July 1, 2018, a chronic dialysis clinic shall ensure that a social worker is not assigned more than 75 patients.
(3) The ratios described in paragraphs (1) and (2) shall constitute the minimum number of nurses, technicians, and social workers assigned to patients at all times. Additional nurses, technicians, and social workers shall be assigned to the extent necessary to ensure that an adequate number of qualified personnel are present whenever patients are undergoing dialysis so that the patient-to-staff ratio is appropriate to the level of dialysis care given and meets the needs of patients.
(4) Commencing July 1, 2018, a chronic dialysis clinic shall ensure that the transition time is at least 45 minutes.
(c) The department shall not issue a license to any chronic dialysis clinic unless that chronic dialysis clinic demonstrates the ability and intention to comply with this section.
(d) (1) Every chronic dialysis clinic for which a license has been issued shall maintain, and provide to the department on a form prescribed by the department, at a minimum, the following information:
(A) Actual staffing ratio and transition time data for the period covered by the submission, which shall include, at a minimum, daily totals of the total number and actual hours worked by nurses, technicians, and social workers, the total number of patients and actual hours receiving direct care, and the daily average transition time for each treatment station.
(B) Every instance, no matter how brief, during the period covered by the submission when staffing ratios or transition times did not meet the requirements of subdivision (b) and the reasons and circumstances therefor.
(2) The medical director and the chief executive officer or administrator of the chronic dialysis clinic shall both personally certify under penalty of perjury that each of them is satisfied, after review, that all information submitted pursuant to paragraph (1) is accurate and complete.
(3) The chronic dialysis clinic shall periodically submit the information described in paragraph (1) to the department on a schedule and in a format prescribed by the department, provided that the clinic shall submit that information no less frequently than four times per year.
(e) The department shall inspect each chronic dialysis clinic for which a license has been issued at least once per year, and shall conduct such inspections as often as necessary to ensure compliance with the requirements of subdivision (b), the accuracy and completeness of information provided pursuant to subdivision (d), compliance with corrective action plans, if any, approved under subdivision (b) or (d) of Section 1240.1, and the adequacy of the quality of care being provided.
(f) Within 60 days of receiving a complaint from an employee, an association of employees, a vendor, a contractor, a patient, an association of patients, or a family member of a patient of a chronic dialysis clinic that the chronic dialysis clinic has engaged in a staffing-related violation or gross staffing-related violation, as those terms are defined in subdivision (a) of Section 1240.1, the department shall investigate the chronic dialysis clinic and, if the evidence shows a violation has occurred, the department shall impose discipline pursuant to Section 1240.1."

https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB349

Sonographers scans will not exceed one per 75 minutes per recommendations of the Society of Diagnostic Medical Sonography (SDMS) industry standards established in 2003. Journal of Diagnostic Medical Sonography 2017, Vol. 33(5) 420 –426.

Specific legislation must be passed federally to improve safety and quality of care in facilities and protect Healthcare Workers. This affects all people and everyone should support it. 

Here is the language of the stalled Bills to compare to this petition.

"Introduced in House (05/12/2021)
Nurse Staffing Standards for Patient Safety and Quality Care Act of 2021

This bill requires hospitals to implement and submit to the Department of Health and Human Services (HHS) a staffing plan that complies with specified minimum nurse-to-patient ratios by unit. Hospitals must post a notice regarding nurse-to-patient ratios in each unit and maintain records of actual ratios for each shift in each unit. The bill also requires hospitals to follow certain procedures regarding how ratios are determined and other staff are prohibited from performing nurse functions unless specifically authorized within a state's scope of practice rules, among other requirements.

HHS must adjust Medicare payments to hospitals to cover additional costs attributable to compliance with these ratios.

Nurses may object to, or refuse to participate in, an assignment if it would violate minimum ratios or if they are not prepared by education or experience to fulfill the assignment without compromising the safety of a patient or jeopardizing their nurse's license. Hospitals may not (1) take adverse actions against a nurse based on the nurse's reasonable refusal to accept an assignment; or (2) discriminate against individuals for good faith complaints relating to the care, services, or conditions of the hospital or related facilities. HHS may impose civil monetary penalties on hospitals violating the ratio requirements and must publish the names of such hospitals.

The bill provides stipends to the nurse workforce loan repayment and scholarship program and expands the nurse retention grant program to include nurse preceptorship and mentorship projects."

https://www.congress.gov/bill/117th-congress/house-bill/3165?q=%7B%22search%22%3A%5B%22HR+3165%22%2C%22HR%22%2C%223165%22%5D%7D&s=1&r=1

Introduced in Senate (05/11/2021)
Nurse Staffing Standards for Patient Safety and Quality Care Act of 2021

This bill requires hospitals to implement and submit to the Department of Health and Human Services (HHS) a staffing plan that complies with specified minimum nurse-to-patient ratios by unit. Hospitals must post a notice regarding nurse-to-patient ratios in each unit and maintain records of actual ratios for each shift in each unit. The bill also requires hospitals to follow certain procedures regarding how ratios are determined and other staff are prohibited from performing nurse functions unless specifically authorized within a state's scope of practice rules, among other requirements.

HHS must adjust Medicare payments to hospitals to cover additional costs attributable to compliance with these ratios.

Nurses may object to, or refuse to participate in, an assignment if it would violate minimum ratios or if they are not prepared by education or experience to fulfill the assignment without compromising the safety of a patient or jeopardizing their nurse's license. Hospitals may not (1) take adverse actions against a nurse based on the nurse's reasonable refusal to accept an assignment; or (2) discriminate against individuals for good faith complaints relating to the care, services, or conditions of the hospital or related facilities. HHS may impose civil monetary penalties on hospitals violating the ratio requirements and must publish the names of such hospitals.

The bill provides stipends to the nurse workforce loan repayment and scholarship program and expands the nurse retention grant program to include nurse preceptorship and mentorship projects.

https://www.congress.gov/bill/117th-congress/senate-bill/1567?q=%7B%22search%22%3A%5B%22S+1567%22%2C%22S%22%2C%221567%22%5D%7D&s=2&r=4