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State and Federal Nursing Bills


Nursing today is gaining momentum in the political arena. Indeed, various federal, state, corporate, and local entities have been coalescing around mounting concerns for the health of the nursing profession, the dependent health of the healthcare industry, and eventually the safety and welfare of patients (Smith, 2002). Due to these efforts and concerns, multiple bills regarding different issues presented by the nursing shortage are currently going through legislative processes or have already been passed. Two of these bills include the Safe Patient Care Act of Massachusetts and the Nurse Reinvestment Act. The present paper aims to provide an overview of the two bills, as well as their rationale and financial effects

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Overview of the Bills

At the state level, Massachusetts is attempting to pass the Safe Patient Care Act. Filed by state representative Christine Canavan with strong backing from Senator Marc Pacheco, the bill seeks to improve patient-to-nurse staffing ratio in an attempt to improve patient safety and save lives (Massachusetts Nurses Association, 2005). In essence, the bill “…would set limits on the number of patients a hospital nurse can be forced to care for at one time, leading to reductions in the incidence of medication errors, hospital-acquired infections, and other adverse patient outcomes” (Massachusetts Nurses Association, 2009, para. 1). These limits would be informed by scientific investigations and testimony from public inquiries and, once instituted, could be adapted in accordance with patients’ needs and demands using a standardized method accepted by Massachusetts Department of Public Health. Moreover, the Act will not only proscribe enforced overtime, such as forcing professional nurses to work additional hours or double shifts, but will guard against reducing other members of the healthcare team, including Licensed Practical Nurses, volunteers, and technical staff. Lastly, the proposed bill seeks to provide patients with the right to know and demand safe health limits from healthcare professionals (Massachusetts Nurses Association, 2009).

At the federal level, it is indeed true that the American Nurses Association (ANA) scored a major legislative victory when the Nurse Reinvestment Act was passed by Congress on July 22 2002 and signed into law by President Bush on August 1 2002. One of the major provisions of the law is to establish a National Nurse Service Corps program, which “…will provide funding for tuition, expenses, and a stipend for nursing students who agree to work in an area experiencing shortage for 2 years following their training” (Smith, 2002, p. 287). Other highlights of the bill include: 1) amending the Nurse Education Act to award grants to schools of nursing and healthcare providers to develop programs aimed at recruiting students to enroll into nursing, promoting re-entry into the nursing profession, and availing specialty training, 2) awarding the Faculty Loan Repayment Grants to masters and doctoral nursing students who teach in an accredited nursing school for 1 year after they complete their studies in exchange for a maximum repayment of 85 percent of their student loans, and 3) airing of public service announcements to promote the practice and profession of nursing (Campbell, 2005; Smith, 2002).

Rationale for the Bills

The major rationale for the Safe Patient Care Act revolves around enhancing health care quality and safety for patients in Massachusetts by improving the patient-to-nurse staffing ratio (Massachusetts Nurses Association, 2009). The care aspect is reinforced by Moore & Waters (2012), who note that “…all the research shows that quality of patient care is relative to registered nurse staffing levels” (p. 16). Available nursing literature demonstrates that improving the patient-to-nurse ratios would trigger positive multiplier effects, such as increased patient outcomes, decreased nursing shortages, and enhanced nurse recruitment and job satisfaction (Tevington, 2011). Support for Mandatory nurse-patient ratios in the state of Massachusetts is also drawn from the belief that better RN staffing will enhance the value of nursing profession and facilitate evidence based practice (Tevington, 2011). Lastly, the proposed Act will assist to significantly reduce costs associated with high incidence of medication blunders and hospital-acquired illnesses (Massachusetts Nurses Association, 2009).

The major rationale for introducing the Nurse Reinvestment Act stems from the need to address the looming nursing shortage crisis by getting more students into the pipeline through funding their education programs. Another rationale stems from the urge to provide quality nursing education by providing grants to encourage nursing schools to implement the American Nurses Credentialing Center (ANCC) Magnet Recognition Program criteria for quality and excellence in nursing services. While acknowledging that greater investment in nursing needs to be encouraged, it is indeed true that the Act is perhaps one of the most important regulations that could be used to address staffing shortages which continue to put patients care at risk. Pioneering research over a decade ago by Linda Aiken, Professor of nursing at the University of Pennsylvania, demonstrated that with each additional patient assigned to a nurse: 1) 30-day patient mortality increased by 7 percent, 2) failure-to-rescue rates went up by 7 percent, 3) the odds of nursing job dissatisfaction rose by 15 percent, and 4), the odds of nurse burnout increased by 23 percent (Moore & Waters, 2012). By dealing with the issues of nursing shortage and quality of nursing education, therefore, the bill will not only decrease mortality and incidences of lack of adequate care, but will enhance job satisfaction and significantly reduce burnout associated with working extra hours and double shifts.

Financial Effect of the Bills

Although the two bills may require substantial financial resources to implement, they will definitely have positive financial effects on stakeholders in the long-run. If passed into law, the Safe Patients Care Act may require millions of Massachusetts tax payer’s money to implement; however, implementation will mean nurses will remain in their work stations longer due to high job satisfaction, and patients will benefit immensely from higher quality of care (Massachusetts Nurses Association, 2009). The Nurse Reimbursement Act enhances nurse job satisfaction and reduces burnout, but also increases patient’s quality of care by pushing more nurses into the pipeline (Smith, 2002). Financially, therefore, health institutions will benefit as they will cease to use huge sums of money to recruit more nurses to meet turnover triggered by low job satisfaction. Equally, reductions in the incidence of medical errors and hospital-acquired infections will have far-reaching financial implications due to fact that these aspects are not only costly for the concerned health facilities in terms of impeding lawsuits, but may oblige the patients to expend extra funds in treatment.


Undeniably, therefore, the two bills discussed in this paper are a step in the right direction not only in addressing the issue of nurse shortage in the U.S., but also in enhancing quality care, reducing medical errors, curtailing the level of hospital acquired infections and overall mortality, as well as increasing nurse job satisfaction.

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Campbell, D. (2005). Overview of the Nurse Reinvestment Act Programs. Legislation. Web.

Massachusetts Nurses Association. (2005). Safe staffing: Public backs MNA’s safe staffing bill 3-1 over MHA legislation. Web.

Massachusetts Nurses Association. (2009). Patient Safety Act is focus of state house hearing on November 3. Web.

Moore, A., & Waters, A. (2012). Getting ratios right, for the patient’s sake. Nursing Standard, 26(31), 16-19.

Smith, A.P. (2002). Response to the nursing shortage: Policy, press, pipeline, and perks. Nursing Economic$, 20(6), 287-290.

Tevington, P. (2011). Professional issues: Mandatory nurse-patient ratios. MEDSURG Nursing, 20(5), 265-268.

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