May 7, 2007, 11:33 am

Federal Safe-Staffing Ratios: The SEIU Conference Call With Representative Jan Schakowsky


At 0930 Pacific Time, I had the pleasure of listening in on a national nursing conference call with Illinois Representative Jan Schakowsky. The topic? The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2005 (H.R. 1222), introduced by Rep. Schakowsky this week.

I decided to post after the call so that I could give all my attention to the content.

Nurses from New York to California, both Democrat and Republican were on the line for this call. One nurse was with 110 other nurses as she spoke!

Our host for the conference call was Ms. Cathy Glasson, President of the Nurse Alliance of SEIU.


Cathy Glasson: (Introduces self and welcomes callers) Cathy tells us she is an Iowa nurse with 24 years of experience and is with Representative Schakowsky in her Washington office. She introduces Jan Schakowsky.

Representative Schakowsky: (Is a member of the House Nurse Caucus – Ed note: I didn’t know there was a House Nurse Caucus!) Works closely with Representatives Lois Capps and Carolyn McCarthy, both of whom are nurses. Feels that safe staffing is a “cornerstone” issue. She thanks the nurses for all that they do. She states that our health care system is broken and that nurses are critical to safe patient care. She talks about how nurses are leaving the profession, citing a veteran nurse who had to retire because she could no longer deal with the compromised patient care, and a nurse who still worries about the care she gave in her hospital five years after leaving hospital practice.

National Nurses Week is acknowledged, but Rep. Schakowsky states that nurses need more than just flowers. The problems nurses face, such as working short staffed and mandatory overtime must be addressed. Statistics were cited, the most impressive being that if one, just one full-time nurse is added to a unit per day. the death rate in an ICU will decrease by 9% and on a med/surg unit by 16%.

The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2005 (H.R. 1222) would

  • Require hospitals to staff with minimal nurse-to-patient ratios as follows:
    • 1:1 in the OR
    • 1:2 in Critical Care
    • 1:3 in the Emergency Department
    • 1:4 on the Medical/Surgical unit
    • 1:5 in Rehab
    • 1:6 in Mom/Baby (three couplets)
  • In addition, the bill adds:
    • Whistle-blower protection for nurses who report safe-staffing violations
    • Protection for nurses who refuse to accept an unsafe assignment

Nurses are needed; we must speak out and take our stories and evidence to the public. Surveys show that RNs are the most trusted of all health care workers and it is our skills that make the difference. Rep. Schakowsky sends a big hug to the nurses and tells us she needs our help to build the momentum for safe staffing in every hospital!

Cathy Glasson: “2007 is the year for change!”

Question and answer period follows. There were lots of Cathys in the audience, so I will try to keep them straight!

Cathy, Nurse Alliance Member and RN from PA: (listening in a room with a group of 110 nurses!) What can we do to move the bill forward?

Rep. Schakowsky: Legislation moves votes in Congress!!! The Cadillac of legislative contact is to set up a meeting with your representative and tell our nursing stories. Invite members of the legislature to watch you work.

Talk to the media. Get our stories out to the public!

Nurses need to KNOW THEIR POWER!


Rebecca, RN from AL: If the US Congress passes a bill for nurse:patient ratios will it stick when it gets to the hospitals?

Rep. Schakowsky: The legislation will be overseen by the department of Health and Human Services (HHS). Hospitals will submit reports to the HHS. They will be required to meet with their nursing staff once a year to discuss patient care and staff needs. Hospitals in violation would be subject to corrective action, fines being one example.

Cathy Glasson: It will only be as strong as the nurses who make sure the law passes and then work with their employers to implement the law and report violations.


Kathleen, RN from Denver: Congresswoman, here in Colorado, we recently passed whistle blower protection for health care workers, Nurse Alliance members will work with the Governor to address staffing through a new Patient Care Task Force, and we’re working on a comprehensive health care reform initiative for Colorado.

When will Congress tackle nationwide health care reform?
And how do we, as nurses, make sure that higher standards for patient care are an important part of any national health care reform effort?

Rep. Schakowsky: (Gives congratulations to the Nurse Alliance in Colorado for obtaining whistle blower protection and the Patient Care Task Force). The health care situation is at the “tipping point”. It will take a Democratic president before we see a National Health Care system in place. The current system doesn’t work for anyone. Our issues are patient issues. Nursing problems are actually “quality care issues” and directly affect the patient.


An RN from St. Louis: We have recently introduced and had a hearing on a similar bill, SB704, The MO. Health Care Report Card Act. Since The Illinois Hospital Report Card Act has become law, do you feel this has brought about awareness to the public concerning RN staffing levels, and will it help to move Federal staffing legislation?

Rep. Schakowsky: (Gives congratulations on hearing.) When the public has access to quality indicators, it shines a light on the need for nurse/patient ratios.

(Again, reinforces) State level legislation helps get legislation passed on the federal level!


Jane, RN from CA: The nurse-to-patient ratio bill here in CA doesn’t protect ancillary/support staff cuts, does this bill include such protections???

Rep. Schakowsky: Yes!!! The hospitals will be required to factor in all patient care needs that are met by non-RN staff. Health care is delivered as a team. Take away ancillary personnel and the workload of the RN increases. The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2005 (H.R. 1222) protects ancillary personnel.


Delores, RN from WA: How does working at the state level help pass legislation?

Rep. Schakowsky: (Gives example of how the federal needlestick bill was passed by the states giving the bill momentum. Notes that California put the pressure on other states to pass safe-staffing laws)

Nurses must get involved on the local, state and national fronts. Safe staffing saves lives.


Pam, RN from WA: Given the growing shortage of nursing educators and rising tuition costs, how will we recruit and train the nurses that will be mandated by this legislation?

Rep. Schakowsky: We need to increase training programs and education for nursing and fix the reasons nurses are leaving the profession. President Bush is cutting funds for nurses’ education [Ed note: from the 2008 budget}.


{Ed note: I think I was the only Republican on this conference call…..}


Cathy Glasson: This is National Nurses Week. Let’s celebrate by uniting behind this legislation.

Rep. Schakowsky: We need to let nurses know that we respect professionalism and create an environment that shows it. One where we can feel pride in our work. It’s a joy to work in partnership to deliver health care to our nation.

Cathy Glasson: Celebrate Nurses Week by getting involved. Tell a colleague about what you heard during this conference call. You can find out more by logging onto our website: Thanks and Happy Nurses Week.

Rep. Schakowsky: It’s been my pleasure.


  • Mother Jones RN

    May 7, 2007 at 2:00 pm

    Kim, thank you for covering the conference call and for reporting back to your readers. This is very important legislation, and I hope nurses get behind the bill and help push it through Congress.


  • Labor Nurse

    May 7, 2007 at 2:40 pm

    I wish I could have been present for this conference call. Do you know any more about how they came up with those RN:patient ratios? The 1:6 mother/baby couplets is atrocious! That is 12 patients for a postpartum nurse! Where would the teaching occur (one of the biggest part of postpartum nursing care). And is the labor and delivery RN:patient ration overlooked?

  • Candy

    May 7, 2007 at 3:56 pm

    Kim, I was on the conference call, too — nice to see the link to your page on the front of the page!

    The proposed mom/baby ratios are 1:3 couplets (1:6 total patients, unless there are multiples, then it’s a crap shoot). Here’s a link to a summary of Rep. Schakowsky’s plan:

    It sounds like there are nurses from across the country that are concerned about ratios. However, as Jane from Santa Barbara pointed out, the loss of aides and unit secretaries has been an unforeseen consequence of ratios in California. The language of Rep. Schakowsky’s proposed legislation is different from California’s in several key aspects: the “at all times” provision is absent in the proposed national ratios, and, while LVNs can make up to 50% of the mix in California, they will have their own ratios under this new plan, and will not be interchangable with RNs. The plan also calls for “an appropriate skill mix of other healthcare workers,” which one would hope would include aides and unit clerks, but is not spelled out. Additional federal dollars from Medicare and Medicaid are also included to cover costs, which might make this a very tough sell when the costs are made clear.

    Hospitals will have 2 years after the legislation passes to implement the new ratios; rural hospitals will have 4 years. You’d be surprised what constitutes a “rural” hospital, too.

  • Nickie

    May 7, 2007 at 8:10 pm

    I read your blog because I like your writing, and I plan to be a medical social worker, and also deal with my own medical issues, and I wanted to say thanks. I think these are important issues for everyone to be aware of, and I’m glad you spent the time to write about them. Thanks!

  • Amanda

    May 8, 2007 at 6:12 am

    Excellent post. Yes I hope nurses get behind and get it through. Excellent job!


  • Jessica

    May 8, 2007 at 6:40 am

    Thanks so much, Kim, for your wonderful coverage of our nurses conference call! I’ve also enjoyed reading the thoughtful discussion that’s happening along this comment thread. I hope that folks who are interested will visit and join our campaign.

    Let’s make 2007 the year of change, nurses!

  • Jessica

    May 8, 2007 at 6:44 am

    p.s. The nurse who asked the question in Colorado is a rockstar on our campaign and–guess what–a Republican! You weren’t the only one! 😉

  • Kia Deuel RNC, BSN

    July 26, 2007 at 6:02 pm

    I have a perplexing staffing ratio issue. I have been relentlessly trying to find a guideline to give direction to our unique census population. I am the charge nurse of a 17 bed pediatric unit – 10 beds specific for peds, 5 used for adult med/surg overflow, and 2 hospice rooms. We typically schedule 2 day RN’s along with myself, a unit clerk, and we may or may not have a patient care tech. We have seasonal ups and downs and typically our summers are slower – but this year – not so much!! We have crossed trained staff that facilitate assistance between peds and OB and WBN, some are trained in level II nursery. It works to share staff – when one unit is slow and the other is busy – but what we are finding is a huge swing to OB deliveries lately – with no sign of stopping!!!! I was just curious at what would be considered a “safe” ratio between peds patients, adult med/surg, and hospice. I have yet to find this combination in any searching that I have done. And believe me – we sure feel alone!!! Thanks. Kia

  • Cindy

    September 8, 2007 at 11:04 am

    Hello Fellow Nurses,
    I have been an RN for 28 years, Currently working on my MHA and writing my thesis on mandated reporting of nurse staffing ratios. I would be very interested to know if your quality of care is improving, falls decreasing and if patient satisfaction scores are increasing related to implementation of mandated reporting. Also, any other websites that may have benefical info. Glad to have found this website and blog, since I am from IL and a Republican 🙂

  • Robin

    October 30, 2007 at 7:25 am

    What is the appropriate staffing ratio for pediatric patients? Our unit does total patient care (no CNA’s, techs or ward secretaries) is 3:1 still appropriate? Thanks.

  • mary

    October 30, 2008 at 5:18 am

    Pediatric ratios of 1:3 is appropriate in the general pediatric units. Ratios need to be flexed to meet the acuity of infants and children so there are times on the general unit a closer monitoring is required. The virual IMC or flexible rooms for this type of acuity should be maintained if there is no ability to transfere to a IMC unit.

  • shannon

    November 17, 2008 at 1:21 pm

    Hello, I’ve been a pediatric nurse for eight years and I’m currently on the safe staffing comity for my hospital. We have a 14 bed pediatric unit with mother baby overflow and gyn surgical pts. I have been having trouble with finding the right ratio with this combination. We can currently take 1:5 and 1;6 on nights. However, that does not include mother baby couplets. We could have two couplets, 2 peds and 1 new post op gyn at any given time, therefor giving you truly 7 pts to care for. Do you have any ideas on better staffing information so i could give that data to our safe staffing group. Thank you any information would be very helpful. We do have a unit clerk to help with orders and some v/s depending on age and about of pts.

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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