Adds a new title to the Public Health Service Act setting federal minimum nurse-to-patient ratios in hospitals — one nurse per patient in trauma and operating rooms, two in ICU and labor/delivery, three in ER and pediatrics, four in medical-surgical units, five in rehab, and six in postpartum and well-baby units. Hospitals must post actual staffing each shift, keep records for at least three years, and make them available to nurses, the public, and (for federal hospitals) under FOIA. Compliance becomes a condition of receiving Medicare and Medicaid payment, and also binds VA, Department of Defense, and Indian Health Service hospitals, with Medicare payments adjusted to cover added costs at private hospitals. Nurses get a federal right to refuse unsafe assignments and to sue in federal court for reinstatement, back pay, and attorneys' fees if a hospital retaliates. HHS can impose civil penalties up to $25,000 for a first hospital violation, $50,000 for repeat violations, and up to $20,000 against individual employees who knowingly violate the rules, with violator names published on the HHS website. Urban hospitals have two years to comply with the ratios, rural hospitals four years, and mandatory overtime cannot be used to meet the staffing levels.
Corporate Benefits
- Hospital civil money penalties — up to $50,000 per repeat violation
- Hospital staffing discretion — federal minimum RN ratios apply at all times
- Medicare reimbursement adjustment — covers added compliance costs at non-federal hospitals
Average Household Impact
- Minimum nurse coverage at bedside — federal ratios set per hospital unit
- Patient access to staffing data — actual ratios posted each shift
Civil Liberties
- Nurse anti-retaliation cause of action — federal suit for reinstatement and back pay
- Patient and worker complaint rights — toll-free HHS hotline plus posted notice
Transparency & Accountability
- Public posting requirement — actual nurse-to-patient ratios posted each shift
- FOIA access to staffing records — at federally operated hospitals
- HHS public listing — hospitals penalized for violations named on website
- Nurse and union records access — 3-year retention required
Congressional Summary
Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2025This bill requires hospitals to implement and submit to the Department of Health and Human Services (HHS) a staffing plan that complies with specified minimum nurse-to-patient ratios by unit. Hospitals must post a notice regarding nurse-to-patient ratios in each unit and maintain records of actual ratios for each shift in each unit. The bill also requires hospitals to follow certain procedures regarding how ratios are determined, and other staff are prohibited from performing nurse functions unless specifically authorized within a state's scope of practice rules.HHS must adjust Medicare payments to hospitals to cover additional costs attributable to compliance with these ratios.Nurses may object to, or refuse to participate in, an assignment if it would violate minimum ratios or if they are not prepared by education or experience to fulfill the assignment without compromising the safety of a patient or jeopardizing their nurse's license. Hospitals may not (1) take adverse actions against a nurse based on the nurse's reasonable refusal to accept an assignment; or (2) discriminate against individuals for good faith complaints relating to the care, services, or conditions of the hospital or related facilities. HHS may impose civil monetary penalties on hospitals violating the ratio requirements and must publish the names of such hospitals.The bill provides stipends to the nurse workforce loan repayment and scholarship program and expands the nurse retention grant program to include nurse preceptorship and mentorship projects.
Details
- Congress
- 119th
- Chamber
- House
- Status
- summarized
- Action
- Introduced in House
- Action Date
- 2025-05-14
- Date Added
- 2026-05-28
- Source
- Congress.gov →
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