To: Representative Dave Brat

From: Ms. Rebecca L. Yauchzy

Date: October 28th, 2017
Subject: H.R. 2392 To amend the Public Health Service Act to establish direct care registered nurse-to-
patient staffing ratio requirements in hospitals, and for other purposes.

The provision of quality health care will remain a constant demand both nationally and globally; thus,
requiring the appropriate distribution of registered nurses is vital to supplying said demand. Fortunately,
the Public Health Service Act implements measures to promote quality care and improve health care
delivery. I proudly support the H.R. 2392 Nurse Staffing Standards for Hospital Patient Safety and
Quality Care Act of 2017, a bill to amend the Public Health Service Act to establish nurse-to-patient
staffing ratio requirements. Hospitals in America should be required to follow federally determined,
minimum nurse-to-patient staffing ratios that are specified to the various levels of direct care.

Just as there is a constant need for health care provision, there is a correlating shortage of registered
nurses. While this nursing shortage can be attributed to a number of factors, a major influence is the
resulting burnout from unreasonable nurse-to-patient staffing ratios. Consideration must be given to one’s
ability to provide appropriate, quality, and safe care to a high volume of patients at one time. It is not
plausible to expect the absence or decrease of medical errors when no limits are set on nurse-to-patient
ratios within a twelve-hour shift. This issue must be addressed in order to increase nurse retention and
most importantly, to improve and maintain the provision of quality health care and ensure patient safety.

• In 2012, a study including 11 hospitals over the span of two years found that every 20% decrease
in nurse staffing that fell below the nurse-to-patient staffing ratio minimum correlated to an 18%
increase in reported medication errors (Frith, et. al., 2012).
• The Registered Nurse Safe Staffing Act (H.H. 20193/S. 1132) in 2015 concluded that the addition
of registered nurses to staffing ratios eradicated approximately 1/5 of all hospital deaths, and
decreased risk of negative patient outcomes (Kane, 2007).
• A study on the relationship between nurse staffing levels and hospital outcomes revealed an
increase in mortality rates with more patients per registered nurse: 6:1 instead of 4:1 led to 2.3
excess deaths per 1,000 patients and 8:1 instead of 4:1 led to 5.0 excess deaths per 1,000 patients
(Aiken, 2002).

Recommendation: Vote to amend the Public Health Service Act to establish direct care registered nurse-
to-patient staffing ratio requirements. As you can see, giving larger patient assignments to a smaller
nursing staff impinges on the ability of health care providers to ensure quality care and patient safety. It is
reckless to exhaust registered nurses with higher patient loads based off of a secondary gain for the
hospital to lower their staffing expenditures. I recommend that hospitals nationwide should not be
allowed to surpass the registered nurse-to-patient ratios outlined in Title XXXIV-Minimum Direct Care
Registered Nurse Staffing Requirement. I think that requiring all states to adhere to such ratios is vital to
the safety of patients and consequently, any hospital that fails to uphold the appropriate staffing ratios
should be reprimanded through means of reimbursement disqualification.

The quality of health care provision and national patient safety should never be dismissed, including the
quality and safety of health care providers themselves. I will continue to support H.R. 2392 to amend the
Public Health Service Act to establish direct care registered nurse-to-patient staffing ratio requirements in
hospitals, and for other purposes.
 References:

Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J. & Silber, J.H. (2002). Hospital nurse staffing and

patient mortality, nurse burnout, and job dissatisfaction. American Medical Association, 288(16),

1987-1993. doi:10.1001/jama.288.16.1987

Frith, K., Anderson, E., Tseng, F., & Fong, E. (2012). Nurse staffing is an important strategy to prevent

medication errors in community hospitals. Nursing Economics, 30(5), 288–294. Retrieved from:

https://www.nursingeconomics.net/necfiles/specialissue/2012/Frith_Staffing.pdf

Kane, R.L., Shamliyan, T.A., Mueller, C., Duval, S., & Wilt, T.J. (2007). The association of registered

nurse staffing levels and patient outcomes: systematic review and meta-analysis. Medical Care,

45(12), 1195-1204. doi: 10.1097/MLR.0b013e3181468ca3