PA House Passes Bill to Mandate Patient-to-Nurse Staffing Ratios

The Pennsylvania House of Representatives recently passed House Bill 106, entitled the “Patient Safety Act” (Bill), which proposes specific patient-to-nurse staffing ratios, staffing plans and reporting requirements for Pennsylvania hospitals, as well as protections for nurses in noncompliant hospitals. The Bill now heads to the Pennsylvania Senate for consideration.

As drafted, the Bill would amend the Health Care Facilities Act and apply to all licensed hospitals in the Commonwealth, including private and public psychiatric hospitals. The Bill includes a detailed list of minimum patient-to-nurse staffing ratios by specific hospital departments and units. Although not exhaustive, the following list provides some examples of the proposed ratios. In each case, a “direct care registered nurse” (DCRN), a registered nurse engaged in direct patient care for at least 50% of the nurse’s working hours, can be assigned to no more than:

  • 4 patients or 1 trauma patient in emergency departments
  • 2 patients in an intensive care unit
  • 1 patient in an operating room
  • 4 patients in an oncology unit
  • 2 patients in a post-anesthesia care unit
  • 2 patients in a burn unit
  • 4 patients in an in-patient psychiatric unit

Restrictions are also proposed in maternity, post-partum and well-baby units, and are subject to specific limitations based on a patient’s stage of labor, whether the patient is experiencing complications and the patient’s type of procedure, as well as other factors.

To meet these staffing standards, the Bill also proposes that hospitals develop, and review annually, a hospital-wide written “Staffing Plan” for direct care and ancillary staff that meet the requirements of the Bill. In addition to requirements that certain patient staffing data be posted publicly by each hospital, a hospital must submit its Staffing Plan to the Pennsylvania Department of Health (DOH) once approved and within 30 days after any changes are made to the Staffing Plans. From there, the DOH would make hospital Staffing Plans publicly available on its website.

Finally, DCRNs would be granted a “safe harbor” that would protect a DCRN who accepts an assignment despite objections over the Bill’s required staffing ratios and/or the hospital’s Staffing Plan. Importantly, a hospital may not discharge from duty or retaliate against a DCRN who invokes a safe harbor or files a complaint with the DOH.

Failure to comply with the requirements of the Bill would impose significant penalties on hospitals. Not only does the Bill propose that DOH implement a publicly available complaint procedure and investigation process, but the penalties for noncompliance range from corrective action plans to civil penalties, and even suspension or revocation of a hospital’s license. While the Bill contains a caveat to a hospital’s duties in the event of an emergency, such as a mass casualty event or government-declared emergency, hospitals must still “demonstrate immediate and diligent efforts” to meet the Bill’s requirements during such an emergency, and it remains unclear how the DOH would measure compliance in this scenario.

Clearly, if the Bill becomes law, it will impose significant, and likely costly, obligations on Pennsylvania’s hospitals in order to comply with the numerous staffing, reporting and compliance mandates. We will continue to monitor the status of this legislation and will report on further developments.