Health Law: Bill H.R. 2581 on Nursing Staffing


Bill H.R. 2581 seeks to regulate the nursing staff to patient ratio in hospitals to improve patient safety and the quality of care (“H.R.2392,” 2017). This bill is aimed at modifying the Public Health Service Act to ensure direct federal influence in the ratios between nursing staff and patients in hospitals around the country. The bill was sponsored by the Representative for the ninth Congressional district of Illinois, Janice Schakowsky, and was introduced to Congress on 8th May 2019 (“H.R.2392,” 2017).

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Major Provisions of The Bill

The provisions of the bill are grounded on the registered nurse staffing requirements and the quality of care. The bill requires hospitals to utilize employment plans that will provide adequate health care that will ensure the best patient outcomes (“H.R.2392,” 2017).

The bill requires that direct care registered nurses may be assigned a maximum of the following patients per unit (“H.R.2392,” 2017):

  • One patient in emergency trauma units.
  • One patient in surgical theatres provided that there is also a scrub assistant.
  • Two patients in high dependency units.
  • Three patients in, antepartum units, stepdown units, emergency room units, and pediatric units.
  • Four patients in acute care psychiatry units, medical-surgical units, and intermediate care nurseries.
  • Five patients in skilled nursing units and rehabilitation units.
  • Six patients in well-baby nursery units and postpartum units.

The bill has placed the following restrictions (“H.R.2392,” 2017):

  • Hospitals are not allowed to average the patients’ quantity and the absolute population of direct care nurses during any shift or period.
  • Hospitals are not allowed to impose overtime shifts to meet the required ratios.
  • Hospitals are not allowed to use video monitors or any form of electronic media to replace direct care registered nurse observation.

Background of the Bill

It is based on the following findings by Congress (“H.R.2392,” 2017):

  • It is the role of the Federal Government to promote quality care and improve the delivery of services to all Americans.
  • The changes that have been occurring in the model of health care delivery have resulted in increased patient acuity and, therefore, the need to improve the quality of care. The improvement of quality of care will help to reduce instances of medical errors.
  • The delivery of quality healthcare is in jeopardy due to inadequate and lack of proper monitoring of nursing staff and how they carry out their functions.
  • The ratio of nursing staff to patients has a direct impact on the patient outcome in that the better the ratio, the better the results, and vice versa.
  • The legislation of the nurse staffing ratios will assist to address the inadequacy of nurses in the country. This will be through the hiring of new nurses and also improve retention.

History of The Legislation

This bill was previously introduced by Janice Schakowsky in 2017 as H.R. 2392 to the 115th US Congress, but after passing through the house, committees died upon introduction to the house (“H.R.2392,” 2017). California is the only state that has enacted a safe nursing staff-to-patient ratio bill. The California Nurses Association sponsored the bill, and it took them 13 years to have it passed back in 2004 (National Nurses United, 2019).

Support and Opposition of The Bill

The main opposition to the enactment of this bill is the hospital industry, which does not want to employ more nurses to better the nursing staff to patient ratio. This is grounded on the fact that the hospital industry is more concerned about making profits rather than the best outcome for patients.

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The main supporters of the bill are Democrat representatives, of which 41 have co-sponsored the bill. California has the most cosponsors at 11, followed by Illinois at 3 (“H.R.2392,” 2017). The main opposition is the hospitals, which view the requirements of hiring more nurses as a threat to their profits.

Position of Key Stakeholders

The views of key stakeholders are as follows:

  1. The Nursing Profession: This bill is supported mainly because registered nurses found their argument on the results that have been witnessed in the State of California upon the improvement of nursing staff to patient ratios. Better nurse-to-patient ratios lead to reductions in the risk of acquiring infections in patients, a decrease in medication errors, and a reduction in stress in nurses. This bill, therefore, has an overall outcome of providing safe and high-quality healthcare for the American Citizen.
  2. Hospital Industry: The hospital industry is mainly opposed to this bill because it is a threat to their bottom line. The industry argues that the current nursing workforce is adequate to perform the required job.

Impact of The Bill on Nurses

Based on the results in California, this bill will improve service delivery as it will lead to the employment of more registered nurses and ensure each nurse takes care of patients that they can handle (“H.R.2392,” 2017).

Actions That Nurses Can Take to Assist the Bill

Nurses can show support for this bill by (Blitchok, 2019):

  • Sending letters to Congress, urging their support for this bill.
  • Contacting your local senators to apply pressure on them to support the bill.


Blitchok, A. (2019). Proposed Federal RN Ratios – What You Can Do About It. Web.

H.R.2392 – 115th Congress (2017-2018): Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2017. (2017). Web.

National Nurses United. (2019). National Campaign for Safe RN-to-Patient Staffing Ratios. Web.

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