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

This bill sets safe minimum nurse-to-patient ratios in hospitals to improve patient care. For example, it requires one nurse for each patient in trauma ERs and operating rooms (with a scrub assistant), one nurse for every two patients in intensive care, one for three in emergency rooms and pediatrics, one for four in regular medical–surgical units, one for five in rehab and skilled nursing, and one for six in postpartum and well‑baby nurseries. Hospitals must create a staffing plan with input from bedside nurses, review it each year, and post the actual ratios for each shift in every unit, with records kept and available for public inspection. Plans must match patient needs; hospitals may not meet the rules by averaging across a shift, may not force mandatory overtime to meet ratios, and may not replace a nurse’s direct observation or judgment with video monitors or other technology. Nurses working a unit must be trained and oriented for that unit, including any temporary staff.

The bill also protects people who speak up. Nurses can refuse assignments they believe are unsafe, and hospitals may not retaliate. Patients and staff can call a toll‑free hotline and file complaints; the government can investigate and act. Hospitals that break the rules can be fined (up to $25,000 for a first knowing violation and $50,000 for later ones; individuals can face up to $20,000), and the government will post the names of hospitals with penalties online. These rules apply to hospitals that take Medicare or Medicaid and to VA, Defense, and Indian Health hospitals. Medicare payments can be adjusted to help cover added costs of meeting the standards.

• Who is affected: Hospital patients and bedside nurses at all hospitals, including VA, Defense, and Indian Health facilities; rural hospitals get extra time to comply.
• What changes: Minimum nurse‑to‑patient ratios by unit; staffing plans with nurse input; public posting and record‑keeping; no mandatory overtime to meet ratios; right to refuse unsafe work without punishment; complaint hotline; fines and a public list of violators; plus scholarships, mentorships, and other steps to grow and keep the nursing workforce.
• When: Staffing plans must start within 1 year; the ratios must be fully in place within 2 years (4 years for rural hospitals). There are temporary exceptions during declared emergencies.