I 
113TH CONGRESS 
1ST SESSION H. R. 1907 
To amend the Public Health Service Act to establish direct care registered 
nurse-to-patient staffing ratio requirements in hospitals, and for other 
purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 9, 2013 
Ms. SCHAKOWSKY (for herself, Ms. LOFGREN, Ms. NORTON, Ms. SCHWARTZ, 
Ms. MOORE, Mr. SHERMAN, Ms. LEE of California, Mr. ELLISON, Ms. 
CHU, and Mr. LYNCH) introduced the following bill; which was referred 
to the Committee on Energy and Commerce, and in addition to the Com-
mittee on Ways and Means, for a period to be subsequently 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 the Public Health Service Act to establish direct 
care registered nurse-to-patient staffing ratio require-
ments in hospitals, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS; FINDINGS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Nurse Staffing Standards for Patient Safety and Quality 
Care Act of 2013’’. 
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(b) TABLE OF CONTENTS.—The table of content for 
this Act is as follows: 
Sec. 1. Short title; table of contents; findings. 
Sec. 2. Minimum direct care registered nurse staffing requirement. 
Sec. 3. Enforcement of requirements through Federal programs. 
Sec. 4. Nurse Workforce Initiative. 
(c) FINDINGS.—Congress finds the following: 
(1) The Federal Government has a substantial 
interest in promoting quality care and improving the 
delivery of health care services to patients in health 
care facilities in the United States. 
(2) Recent changes in health care delivery sys-
tems that have resulted in higher acuity levels 
among patients in health care facilities increase the 
need for improved quality measures in order to pro-
tect patient care and reduce the incidence of medical 
errors. 
(3) Inadequate and poorly monitored registered 
nurse staffing practices that result in too few reg-
istered nurses providing direct care jeopardize the 
delivery of quality health care services. 
(4) Numerous studies have shown that patient 
outcomes are directly correlated to direct care reg-
istered nurse staffing levels, including a 2002 Joint 
Commission on Accreditation of Healthcare Organi-
zations report that concluded that the lack of direct 
care registered nurses contributed to nearly a quar-
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ter of the unanticipated problems that result in in-
jury or death to hospital patients. 
(5) Requirements for direct care registered 
nurse staffing ratios will help address the registered 
nurse shortage in the United States by aiding in re-
cruitment of new registered nurses and improving 
retention of registered nurses who are considering 
leaving direct patient care because of demands cre-
ated by inadequate staffing. 
(6) Establishing adequate minimum direct care 
registered nurse-to-patient ratios that take into ac-
count patient acuity measures will improve the deliv-
ery of quality health care services and guarantee pa-
tient safety. 
(7) Establishing safe staffing standards for di-
rect care registered nurses is a critical component of 
assuring that there is adequate hospital staffing at 
all levels to improve the delivery of quality care and 
protect patient safety. 
SEC. 2. MINIMUM DIRECT CARE REGISTERED NURSE 
STAFFING REQUIREMENT. 
(a) MINIMUM DIRECT CARE REGISTERED NURSE 
STAFFING REQUIREMENTS.—The Public Health Service 
Act (42 U.S.C. 201 et seq.) is amended by adding at the 
end the following new title: 
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‘‘TITLE 
XXXIV—MINIMUM 
DI-
RECT 
CARE 
REGISTERED 
NURSE STAFFING REQUIRE-
MENT 
‘‘SEC. 3401. MINIMUM NURSE STAFFING REQUIREMENT. 
‘‘(a) STAFFING PLAN.— 
‘‘(1) IN GENERAL.—A hospital shall implement 
a staffing plan that— 
‘‘(A) provides adequate, appropriate, and 
quality delivery of health care services and pro-
tects patient safety; and 
‘‘(B) is consistent with the requirements of 
this title. 
‘‘(2) EFFECTIVE DATES.— 
‘‘(A) 
IMPLEMENTATION
OF
STAFFING 
PLAN.—Subject to subparagraph (B), the re-
quirements under paragraph (1) shall take ef-
fect not later than 1 year after the date of the 
enactment of this title. 
‘‘(B) APPLICATION
OF
MINIMUM
DIRECT 
CARE
REGISTERED
NURSE-TO-PATIENT
RA-
TIOS.—The requirements under subsection (b) 
shall take effect as soon as practicable, as de-
termined by the Secretary, but not later than 2 
years after the date of the enactment of this 
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title, or in the case of a hospital in a rural area 
(as defined in section 1886(d)(2)(D) of the So-
cial Security Act), not later than 4 years after 
the date of the enactment of this title. 
‘‘(b) MINIMUM DIRECT CARE REGISTERED NURSE- 
TO-PATIENT RATIOS.— 
‘‘(1) IN GENERAL.—Except as provided in para-
graph (4) and other provisions of this section, a hos-
pital’s staffing plan shall provide that, at all times 
during each shift within a unit of the hospital, a di-
rect care registered nurse may be assigned to not 
more than the following number of patients in that 
unit: 
‘‘(A) One patient in trauma emergency 
units. 
‘‘(B) One patient in operating room units, 
provided that a minimum of 1 additional person 
serves as a scrub assistant in such unit. 
‘‘(C) Two patients in critical care units, in-
cluding neonatal intensive care units, emer-
gency critical care and intensive care units, 
labor and delivery units, coronary care units, 
acute respiratory care units, postanesthesia 
units, and burn units. 
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