Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2025
Sponsored By: Representative Schakowsky
Introduced
Summary
Minimum nurse-to-patient ratios would set national minimum direct-care nurse staffing levels, require hospitals to file prospective staffing plans, and add enforcement, transparency, and workforce programs to improve patient safety.
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- Patients and families: Would see lower nurse caseloads on many units, for example 1 patient per RN in trauma and operating rooms and 4 patients per RN on medical-surgical units.
- Nurses and trainees: Would participate in creating and annually reevaluating staffing plans, gain legal protections against retaliation and access to a reporting hotline, and benefit from new scholarships, stipends, preceptorships, and retention grants. RN ratio deadlines are within 2 years or 4 years for rural hospitals.
- Hospitals and federal health systems: Would have to comply to participate in Medicare and Medicaid, face civil money penalties up to $25,000 for a first knowing violation and $50,000 for subsequent violations, and receive Medicare payment adjustments aimed at offsetting net compliance costs.
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Bill Overview
Analyzed Economic Effects
6 provisions identified: 4 benefits, 0 costs, 2 mixed.
New nurse-to-patient limits
This bill would set specific maximum patients per direct-care RN for each hospital unit. It would require unit competence and orientation before an RN counts toward ratios. The bill would bar averaging across shifts and mandatory overtime to meet ratios. The Secretary could apply or raise ratios for similar units. Ratios would take effect no later than 2 years, and 4 years for rural hospitals.
Hospital staffing plans and records
This bill would require each hospital to submit a unit-level staffing plan within one year. Hospitals must keep shift-by-shift staffing records for at least three years. The Secretary would make submitted documentation public under rules. Hospitals must post a clear notice of staffing rights and complaint instructions, and give each inpatient the hotline number.
Nurse training, scholarships, and studies
This bill would expand grants to fund preceptorships, mentorships, and stipends for nursing students, new hires, and recent graduates. AHRQ must study LPN staffing and outpatient nurse staffing within one year to inform rules. The Secretary must set LPN staffing requirements within 18 months and make them effective within 2 years, or 4 years for rural hospitals. HRSA and HHS must report to Congress on staffing and retention at 2 and 5 years.
Federal hospitals must comply
This bill would apply the new staffing rules to VA, Department of Defense, Indian Health Service, and other federal hospitals. Contracted staff would count as employees for the rules. Federal employees could enforce the rules through negotiated grievance procedures where specified.
Enforcement, fines, and nurse protections
This bill would let the HHS Secretary investigate complaints and require corrective plans for violating hospitals. It would allow civil fines up to $25,000 for a first knowing hospital violation and $50,000 for later knowing violations. Individuals who knowingly violate could face up to $20,000 per violation. Nurses would get anti‑retaliation protections and a federal right to sue for wrongful discharge or retaliation. Collected penalties could be used to carry out the title.
Medicare and Medicaid payment rules
This bill would make hospital compliance with the staffing title a condition for Medicare participation and for Medicaid payments. MedPAC must report to Congress within 2 years on net costs and savings and recommend payment changes. The Secretary must adjust non‑federal hospital Medicare payments to cover net additional costs tied to compliance, taking MedPAC recommendations into account.
Sponsors & CoSponsors
Sponsor
Schakowsky
IL • D
Cosponsors
Rep. Doggett, Lloyd [D-TX-37]
TX • D
Sponsored 5/14/2025
Cohen
TN • D
Sponsored 5/14/2025
Del. Norton, Eleanor Holmes [D-DC-At Large]
DC • D
Sponsored 5/14/2025
Rep. Casar, Greg [D-TX-35]
TX • D
Sponsored 5/14/2025
Rep. Brownley, Julia [D-CA-26]
CA • D
Sponsored 5/14/2025
Rep. Kelly, Robin L. [D-IL-2]
IL • D
Sponsored 5/14/2025
Rep. Quigley, Mike [D-IL-5]
IL • D
Sponsored 5/14/2025
Khanna
CA • D
Sponsored 5/14/2025
Bonamici
OR • D
Sponsored 5/14/2025
Rep. Huffman, Jared [D-CA-2]
CA • D
Sponsored 5/14/2025
Ocasio-Cortez
NY • D
Sponsored 5/14/2025
Rep. Krishnamoorthi, Raja [D-IL-8]
IL • D
Sponsored 5/14/2025
Rep. McIver, LaMonica [D-NJ-10]
NJ • D
Sponsored 5/14/2025
Rep. Jayapal, Pramila [D-WA-7]
WA • D
Sponsored 5/14/2025
Rep. Chu, Judy [D-CA-28]
CA • D
Sponsored 5/14/2025
Rep. Tlaib, Rashida [D-MI-12]
MI • D
Sponsored 5/14/2025
Rep. Titus, Dina [D-NV-1]
NV • D
Sponsored 5/14/2025
Rep. Ramirez, Delia C. [D-IL-3]
IL • D
Sponsored 7/16/2025
Rep. Sykes, Emilia Strong [D-OH-13]
OH • D
Sponsored 7/16/2025
Rep. Omar, Ilhan [D-MN-5]
MN • D
Sponsored 7/16/2025
Rep. Pocan, Mark [D-WI-2]
WI • D
Sponsored 7/16/2025
Gomez
CA • D
Sponsored 7/16/2025
McCollum
MN • D
Sponsored 7/16/2025
Rep. Deluzio, Christopher R. [D-PA-17]
PA • D
Sponsored 7/16/2025
Thompson (MS)
MS • D
Sponsored 7/16/2025
Rep. Vargas, Juan [D-CA-52]
CA • D
Sponsored 7/16/2025
Rep. Thanedar, Shri [D-MI-13]
MI • D
Sponsored 10/6/2025
Rep. Waters, Maxine [D-CA-43]
CA • D
Sponsored 10/6/2025
Rep. Dingell, Debbie [D-MI-6]
MI • D
Sponsored 10/6/2025
Rep. Clarke, Yvette D. [D-NY-9]
NY • D
Sponsored 10/6/2025
Rep. Sherman, Brad [D-CA-32]
CA • D
Sponsored 11/12/2025
Rep. Harder, Josh [D-CA-9]
CA • D
Sponsored 11/19/2025
Rep. Pressley, Ayanna [D-MA-7]
MA • D
Sponsored 12/17/2025
Rep. Foster, Bill [D-IL-11]
IL • D
Sponsored 12/17/2025
Grijalva
AZ • D
Sponsored 3/16/2026
Rep. Takano, Mark [D-CA-39]
CA • D
Sponsored 3/16/2026
Simon
CA • D
Sponsored 3/16/2026
Rep. Frost, Maxwell [D-FL-10]
FL • D
Sponsored 3/16/2026
Rep. Torres, Ritchie [D-NY-15]
NY • D
Sponsored 4/9/2026
Kennedy (NY)
NY • D
Sponsored 4/14/2026
Pingree
ME • D
Sponsored 5/11/2026
Roll Call Votes
No roll call votes available for this bill.
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