I 
112TH CONGRESS 
1ST SESSION 
H. R. 876 
To amend title XVIII of the Social Security Act to provide for patient 
protection by establishing safe nurse staffing levels at certain Medicare 
providers, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 2, 2011 
Mrs. CAPPS (for herself and Mr. LATOURETTE) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committee on Ways and Means, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
for patient protection by establishing safe nurse staffing 
levels at certain Medicare providers, and for other pur-
poses. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Registered Nurse Safe 
Staffing Act of 2011’’. 
SEC. 2. FINDINGS. 
Congress makes the following findings: 
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(1) There are a number of hospitals throughout 
the United States that do not provide adequate reg-
istered nurse staffing to protect the health and safe-
ty of patients. 
(2) Research shows that patient safety in hos-
pitals is directly proportionate to the number of reg-
istered nurses working in the hospital. Higher staff-
ing levels by experienced registered nurses are re-
lated to lower rates of negative patient outcomes, in-
cluding falls, infections, medication errors, and even 
death. 
(3) Inadequate nurse staffing was found to be 
a contributing factor in 24 percent of all unantici-
pated events that resulted in patient death, injury, 
or permanent loss of function. 
(4) Registered nurses play a vital role in pre-
venting patient care errors, for example registered 
nurses intercepted 86 percent of medical errors be-
fore those errors affected patients. 
(5) As a payer for inpatient and outpatient hos-
pital services for individuals entitled to benefits 
under the Medicare program, the Federal Govern-
ment has a compelling interest in promoting the 
safety of such individuals by requiring any hospital 
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participating in that program to establish minimum 
safe staffing levels for registered nurses. 
(6) Adequate registered nurse staffing levels are 
necessary for the delivery of safe, quality care. Inad-
equate registered nurse staffing levels contribute to 
nurse burnout and exacerbate the current nursing 
shortage in the United States. 
(7) Nearly 25 percent of registered nurses indi-
cate that they are considering leaving direct patient 
care nursing due to inadequate nurse staffing, and 
nearly 60 percent of registered nurses report they 
know of another nurse who left direct care nursing 
because of concerns about inadequate nurse staffing. 
(8) The cost to a hospital to replace a direct 
patient care registered nurse is more than 101 per-
cent, and as much as 106 percent, of a registered 
nurse’s annual salary. 
(9) As a result of insufficient staff, registered 
nurses are being required to perform professional 
services under conditions that do not support quality 
health care or a healthful work environment for reg-
istered nurses. 
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SEC. 3. ESTABLISHMENT OF SAFE NURSE STAFFING LEV-
ELS 
BY 
MEDICARE 
PARTICIPATING 
HOS-
PITALS. 
(a) REQUIREMENT OF MEDICARE PROVIDER AGREE-
MENT.—Section 1866(a)(1) of the Social Security Act (42 
U.S.C. 1395cc(a)(1)) is amended— 
(1) in subparagraph (V), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (W), as added by section 
3005 of the Patient Protection and Affordable Care 
Act (Public Law 111–148)— 
(A) by moving such subparagraph 2 ems to 
the left; and 
(B) by striking the period at the end; 
(3) in subparagraph (W), as added by section 
6406(b) of the Patient Protection and Affordable 
Care Act (Public Law 111–148)— 
(A) by moving such subparagraph 2 ems to 
the left; 
(B) by redesignating such subparagraph as 
subparagraph (X); and 
(C) by striking the period at the end and 
inserting ‘‘, and’’; and 
(4) by inserting after subparagraph (X), as re-
designated by paragraph (3)(B), the following new 
subparagraph: 
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‘‘(Y) in the case of a hospital (as defined in sec-
tion 1861(e)), to meet the requirements of section 
1899B.’’. 
(b) REQUIREMENTS.—Title XVIII of the Social Secu-
rity Act (42 U.S.C. 1395 et seq.), as amended by sections 
3022 and 3403 of the Patient Protection and Affordable 
Care Act (Public Law 111–148), is amended by inserting 
after section 1899A the following new section: 
‘‘NURSE STAFFING REQUIREMENTS FOR MEDICARE 
PARTICIPATING HOSPITALS 
‘‘SEC. 1899B. (a) IMPLEMENTATION
OF NURSE 
STAFFING PLAN.— 
‘‘(1) IN GENERAL.—Each participating hospital 
shall implement a hospital-wide staffing plan for 
nursing services furnished in the hospital. 
‘‘(2) REQUIREMENT
FOR
DEVELOPMENT
OF 
STAFFING
PLAN
BY
HOSPITAL
NURSE
STAFFING 
COMMITTEE.—The hospital-wide staffing plan for 
nursing services implemented by a hospital pursuant 
to paragraph (1)— 
‘‘(A) shall be developed by the hospital 
nurse staffing committee established under sub-
section (b); and 
‘‘(B) shall require that an appropriate 
number of registered nurses provide direct pa-
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tient care in each unit and on each shift of the 
hospital to ensure staffing levels that— 
‘‘(i) address the unique characteristics 
of the patients and hospital units; and 
‘‘(ii) result in the delivery of safe, 
quality patient care, consistent with the re-
quirements under subsection (c). 
‘‘(b) HOSPITAL NURSE STAFFING COMMITTEE.— 
‘‘(1) 
ESTABLISHMENT.—Each 
participating 
hospital shall establish a hospital nurse staffing 
committee (hereinafter in this section referred to as 
the ‘Committee’). 
‘‘(2) COMPOSITION.—A Committee established 
pursuant to this subsection shall be composed of 
members as follows: 
‘‘(A) MINIMUM 55 PERCENT NURSE PAR-
TICIPATION.—Not less than 55 percent of the 
members of the Committee shall be registered 
nurses who provide direct patient care but who 
are neither hospital nurse managers nor part of 
the hospital administration staff. 
‘‘(B) INCLUSION
OF
HOSPITAL
NURSE 
MANAGERS.—The 
Committee 
shall 
include 
members who are hospital nurse managers. 
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‘‘(C) INCLUSION OF NURSES FROM SPE-
CIALTY
UNITS.—The members of the Com-
mittee shall include at least 1 registered nurse 
who provides direct care from each nurse spe-
cialty or unit of the hospital (each such spe-
cialty or unit as determined by the hospital). 
‘‘(D) OTHER HOSPITAL PERSONNEL.—The 
Committee shall include such other personnel of 
the hospital as the hospital determines to be ap-
propriate. 
‘‘(3) DUTIES.— 
‘‘(A) 
DEVELOPMENT
OF
STAFFING 
PLAN.—The Committee shall develop a hospital- 
wide staffing plan for nursing services furnished 
in the hospital consistent with the requirements 
under subsection (c). 
‘‘(B) REVIEW
AND
MODIFICATION
OF 
STAFFING PLAN.—The Committee shall— 
‘‘(i) conduct regular, ongoing moni-
toring of the implementation of the hos-
pital-wide staffing plan for nursing services 
furnished in the hospital; 
‘‘(ii) carry out evaluations of the hos-
pital-wide staffing plan for nursing services 
at least annually; and 
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