Clinical TopicsLegal & EthicsPatient SafetyStaffingUncategorizedWorkplace Management

Headlines from the Hill


ANA is excited about three legislative initiatives in the U.S. House of Representatives that would improve nursing and patient care.

Optimal staffing

The Registered Nurse Safe Staffing Act (H.R. 1821), a bipartisan bill, was reintroduced in May by Reps. David Joyce (R-OH) and Lois Capps (D-CA). ANA supports a system that will hold hospitals accountable for the development and implementation of valid, reliable, unit-by-unit nurse staffing plans, as identified in the ANA Principles for Nurse Staffing.

“This legislation encourages nurses and hospitals to work together to make sure the right number of nurses are there to provide the excellent care that each and every patient deserves,” said Capps, a registered nurse (RN) and member of the Health Subcommittee.

The Registered Nurse Safe Staffing Act would require Medicare-participating hospitals to establish unit-specific staffing plans utilizing a committee comprised of at least 55% direct-care nurses, along with physicians and other appropriate parties. The committee would be charged with establishing upwardly adjustable minimum ratios of direct-care RNs to patients for each unit and shift. The patient-to-nurse numbers would be based on several factors, such as acuity, skill mix, and the needs of the unit, giving the committee flexibility to decide what their system needs and adjust when necessary.

RN and patient safety

For almost two decades, ANA has led the fight to eliminate manual patient handling, such as lifting. Conventional practices of manual patient lifting, repositioning, and transferring have contributed to work-related injuries and musculoskeletal disorders (MSDs) in nurses and other healthcare workers. ANA, along with safe patient-handling experts, has developed a new set of national standards, found in ANA’s Safe Patient Handling and Mobility: Interprofessional National Standards.

Using the standards as a guide, Rep. John Conyers (D-MI) introduced in June the Nurse and Health Care Worker Protection Act of 2013 (H.R. 2480).

“This legislation provides important protections to nurses, nursing aides, and other healthcare workers who face frighteningly high rates of injury due to unsafe patient handling practices,” said Conyers.

ANA supports H.R. 2480, which would require the Occupational Safety and Health Administration to develop and implement a safe patient handling and mobility standard that would eliminate manual lifting of patients by direct-care RNs and healthcare workers no later than 2 years after its enactment. Healthcare employers also would be required to develop a safe patient handling and mobility plan within 6 months of promulgation of the final standard.

Home healthcare planning

In June, Reps. Greg Walden (R-OR) and Allyson Schwartz (D-PA) reintroduced the Home Health Care Planning Improvement Act of 2013 (H.R. 2504). This bipartisan legislation would allow advanced practice RNs (APRNs) to order home health services and meet the face-to-face requirement under Medicare in accordance with state law. Before certifying a patient’s eligibility for the home health benefit, the certifying physician must document that he or she, or an allowed nonphysician practitioner, has had a face-to-face encounter with the patient.

“This common-sense bill will reduce unnecessary and duplicative burdens on healthcare providers and patients in need of home health services,” said Walden.

Medicare has recognized the autonomous practice of APRNs for nearly two decades as allowed by state law, and these healthcare professionals see the majority of patients requiring home health care. Unfortunately, a quirk in Medicare law has kept APRNs from signing home health plans of care and from certifying Medicare patients for the home health benefit. In areas where access to physicians is limited, this prohibition has led to delays in home health services, as well as increased costs to the Medicare system when patients are left unnecessarily in more expensive institutional settings or are readmitted after discharge without the needed support at home.

To learn more and urge your members of Congress to sign on as cosponsors, visit

April Canter is an associate director of Government Affairs at ANA.

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