[Congressional Record Volume 155, Number 73 (Wednesday, May 13, 2009)]
[Senate]
[Pages S5441-S5442]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mrs. BOXER:
  S. 1031. A bill to amend the Public Health Service Act to establish 
direct care registered nurse-to-patient staffing ratio requirements in 
hospitals, and for other purposes; to the Committee on Health, 
Education, Labor, and Pensions.
  Mrs. BOXER. Mr. President, as we mark the end of National Nurses 
Week, I want to express my heartfelt appreciation to the dedicated 
professionals who serve on the front lines of our health care system. 
Nurses are heroes--not just to their patients, but to the families and 
loved ones who rely on their compassion and care.
  While we celebrate nurses this week, we must also acknowledge that 
too many nurses are overworked because of staffing levels that are 
simply inadequate.
  Nurses treat patients not just in hospitals or emergency rooms but in 
homes, schools, community health centers and more. Nurses take on a lot 
of different duties and roles, but they all have at least one thing in 
common--they are all on the front lines of providing care to patients.
  For decades nurses have been telling us that there are not enough of 
them, especially in hospitals. Study after study has been done--we know 
there is a nationwide nursing shortage.
  By 2020, it is estimated that the demand for full time nurses will 
exceed supply by 1 million nurses.
  This is unacceptable. We must address a problem that affects the 
quality of care that patients receive and drives too many nurses away 
from the hospital bedside.
  That is why I am introducing the National Nursing Reform and Patient 
Advocacy Act, which will not only help address the nationwide shortage 
of skilled nurses, it will improve the quality of health care for all 
Americans.
  The National Nursing Reform and Patient Advocacy Act champions 
nursing rights, nursing ratios, and nursing reform.
  Specifically, this bill protects the rights of nurses to speak out 
for their patients and to speak out for themselves, without the fear of 
discrimination or retaliation, because if there is a problem in a 
hospital nurses should be able to talk about it.
  This bill sets minimum nurse to patient ratios, because you cannot 
give patients high quality care without giving nurses the time to 
provide it. It offers transparency in the process of establishing 
staffing plans in hospitals and puts forward the tools to report 
inadequate staffing or care.
  This bill reforms the role of hospitals not just in retaining nurses 
but also in training nurses. It creates a Registered Nurse Workforce 
Initiative that invests in the education of nurses and nursing faculty, 
because we will need many more nurses to meet the needs of our Nation--
especially after we expand access to health care.
  President Obama has made improving patient safety and quality care 
one of the cornerstones of the health care reform effort. You can't 
have high quality health care without a high quality nurse workforce to 
provide it.
  Ten years ago, nurses in California fought and won a major battle for 
their

[[Page S5442]]

patients and for themselves--and the results were minimum nurse to 
patient ratios in California hospitals.
  I am proud to bring this fight to Washington, DC and to pursue 
federal legislation that would extend these rights, ratios and reforms 
to nurses in hospitals across the country.
  Reports on California ratios have only begun to show what all of the 
nurses in this room already know--that setting a minimum standard for 
safe staffing can be the difference between life and death of patients.
  A 2002 study found that for every patient added to a nurse's workload 
there is a seven percent increase in the chance of death following 
common surgeries.
  In California, the hospitals that have seen the greatest effect in 
reduced mortality were the ones that started with the worst staffing 
ratios.
  We also know that hospitals are losing good nurses because of these 
staffing shortages. A poll of nurses nationwide found that almost half 
of the nurses who plan to quit their job say that inadequate staffing 
is the reason they are leaving. The cost of replacing these valuable 
workers has been estimated at $25,000 to $60,000 per nurse.
  Too many nurses get burned out by being overloaded with too many 
patients. Too many nurses have given up on serving in hospitals because 
the hospitals have given up on providing a better environment for both 
nurses and patients.
  We need to remind hospitals that by investing more in their nursing 
staff, they will save money by avoiding costly medical mistakes and 
providing better care for their patients--and most importantly, they 
will save lives.
  I strongly believe that health care reform cannot succeed unless we 
invest in our health care workforce. At 2.9 million strong, nurses are 
the largest health care workforce in our country, and this investment 
is long overdue.
  My new legislation builds on the success of California's historic law 
for registered nurse staffing ratios. Under the California ratios law, 
lives are being saved, nurses' ability to be effective advocates for 
their patients is stronger and more registered nurses are entering the 
workforce and staying at the bedside longer--which is easing the 
State's nursing shortage.
  Nurses are not just the face of the movement to improve health care 
in our country, they are the face of health care in our country. This 
bill is for them and the patients they so faithfully serve.
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