The bill has minimum staffing ratios, and they're as good as or better than what California passed. I know that's the case with the hospitals I've had clinicals at.
You still have a duty to your patients, and if your patient(s) require a higher ratio than exists, and Safe Harbor isn't an option in your jurisdiction, I don't know what you do. Then again, what do you do now?
These bills don't supersede state laws that provide for ratios that exceed the minimums in this law. If your ratios are already better, your ratio shouldn't change.
Read for yourself (From the Senate version, S. 864):
‘‘(b) MINIMUM DIRECT CARE REGISTERED NURSE-TO-PATIENT RATIOS.—
‘‘(1) IN GENERAL.—Except as otherwise provided in this section, a hospital's staffing plan shall provide that, at all times during each shift within a unit of the hospital, a direct care registered nurse shall be assigned to not more than the following number of patients in that unit, subject to para- graph (4):
‘‘(A) One patient in trauma emergency units.
‘‘(B) One patient in operating room units, provided that a minimum of 1 additional person serves as a scrub assistant in such unit.
‘‘© Two patients in critical care units, in- cluding neonatal intensive care units, emer- gency critical care and intensive care units, labor and delivery units, coronary care units,acute respiratory care units, postanesthesia units, and burn units.
‘‘(D) Three patients in emergency room units, stepdown units, pediatrics units, telem- etry units, antepartum units, and combined labor, delivery, and postpartum units.
‘‘(E) Four patients in medical-surgical units, intermediate care nursery units, psy- chiatric units, and other specialty care units.
‘‘(F) Five patients in rehabilitation units, and skilled nursing units.
‘‘(G) Six patients in well-baby nursery units and postpartum (3 couplets) units.
‘‘(3) RESTRICTIONS.—
‘‘(A) PROHIBITION AGAINST AVERAGING.—
A hospital shall not average the number of pa- tients and the total number of direct care registered nurses assigned to patients in a hospital
unit during any 1 shift or over any period of time for purposes of meeting the requirements under this subsection.
‘‘(B) PROHIBITION AGAINST IMPOSITION OF MANDATORY OVERTIME REQUIREMENTS.—A hospital shall not impose mandatory overtime requirements to meet the hospital unit direct care registered nurse-to-patient ratios required under this subsection.
‘‘© RELIEF DURING ROUTINE ABSENCES.—A hospital shall ensure that only a direct care registered nurse may relieve another direct care registered nurse during breaks, meals, and other routine, expected absences from a hospital unit.
‘(4) ADJUSTMENT OF RATIOS.—
‘‘(A) IN GENERAL.—If necessary to protect
patient safety, the Secretary may prescribe regulations that—
‘‘(i) increase minimum direct care registered nurse-to-patient ratios under this subsection to further limit the number of patients that may be assigned to each direct care nurse; or
‘‘(ii) add minimum direct care registered nurse-to-patient ratios for units not referred to in paragraphs (1) and (2).
