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National Safe Staffing Legislation Nears Introduction

Staffing

AFSCME staff and the AFL-CIO's Nurse Coordinating Committee continue to work with U.S. Rep. Jan Schakowsky (D-IL) on legislation to establish national minimum nurse-to-patient staffing ratios in acute care hospitals. It is expected that a bill will be introduced in early 2004.

In October, Reps. Henry A. Waxman (D-CA) and Schakowsky introduced the "Nursing Home Staffing Act of 2003" (H.R. 3355), a bill that would establish federal staffing requirements in nursing homes and provide federal resources to help fund them. The bill adopts staffing standards recommended by a study released last year by the U.S. Department of Health and Human Services. The bill would ensure that most nursing home residents would receive 4.1 hours of care daily from nurses and certified nursing assistants. Currently, more than nine in 10 nursing homes have insufficient staff to provide adequate care.

Mandatory Overtime

A bill that would restrict the ability of certain employers to require nurses to work mandatory overtime has been introduced by Sen. Edward Kennedy (D-MA) in the U.S. Senate and by Rep. Pete Stark (D-CA) in the House of Representatives. "The Safe Nursing and Patient Care Act" (H.R. 745/S. 373), allows a nurse to refuse mandatory overtime in excess of the regular work shift or beyond 12 hours a day or 80 hours in a two-week period. It prohibits discrimination or retaliation against a nurse for refusing overtime assignments. The legislation currently has 99 co-sponsors from both houses.

EMTALA

The federal government has announced changes in the regulations regarding the federal anti-dumping law, the Emergency Medical Treatment and Labor Act (EMTALA). The new regulations, which took effect in November, clarify the types of facilities and departments subject to EMTALA. They include any licensed emergency room, any facility or department understood by the public to provide emergency care without an appointment and any facility or department that provided emergency care in at least one-third of its outpatient visits during the previous year.

While the regulations are supported by the hospital industry, their impact on patient safety is a concern. The revisions mean that hospitals' obligations end once a patient has been seen and screened. Under the regulations first proposed in May 2002, obligations would have ended only after a patient had been stabilized. The regulations also allow hospitals greater "control" over developing on-call lists and permit doctors to be on-call simultaneously at more than one hospital.

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