Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2025

A new part of federal health law would set the most patients one nurse can be given, unit by unit. The limits start two years after the law passes, or four years at rural hospitals.

Hospitals could not count video monitoring toward the nurse limits. A nurse would still have to see and assess each assigned patient in person every shift.

A nurse could turn down an assignment that breaks the limits or that they are not trained for. If the hospital punished them for it, they could sue for their job back, lost pay, and legal fees.

Every hospital would build its staffing plan with input from bedside nurses on each unit. Where those nurses have a union, the plan would have to be bargained with their representative.

The fine would fall on an individual employee, not just the hospital, and only for a knowing violation. Hospitals face their own fines of $25,000, or $50,000 for repeat violations.

Health officials would set staffing floors for licensed practical nurses too, after a one-year study. Those rules would apply within two years, or four years at rural hospitals.

Caps run from one patient in trauma and operating rooms up to six in well-baby nurseries. Hospitals could not average staffing across a shift to meet them.

Hospitals would have to hire or schedule enough nurses instead of forcing extra hours. Chronic understaffing and strikes also could not be treated as emergencies that pause the limits.

Hospitals could not write policies that discourage nurses from speaking out or reporting problems. Patients and other staff would also be protected from payback for filing complaints.

Medicare would pay non-federal hospitals the net added cost of meeting the nurse limits. A Medicare advisory panel would report on the real costs and savings within two years.

Meeting the staffing rules would become a condition of taking part in Medicare and Medicaid. State Medicaid plans would have to require it of every hospital they pay.

Health officials could fine a hospital $25,000 for a first knowing violation and $50,000 after that. They would also have to order a plan to fix the problem.

The notice would list the real nurse-to-patient numbers and the nurses on duty, where patients can see it. Hospitals would keep the underlying records for three years and open them to nurses and the public.

Health officials would name each hospital fined, and the violation behind the fine. Penalties would drop off the list a year after a hospital changes owners.

Every patient admitted would be told about the hotline and that they can report thin staffing. Anyone could also file a written complaint that health officials must investigate.