H.R. 3415 — Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2025

This section cites the Act as the “Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2025”; provides a table of contents for its four sections; and states congressional findings on the federal interest in hospital nurse staffing standards to improve patient safety and care quality, including correlations between adequate registered nurse-to-patient ratios and better outcomes, reduced errors, and improved nurse retention.

This section establishes minimum direct care registered nurse-to-patient staffing ratios for hospitals by adding a new title XXXIV to the Public Health Service Act. Hospitals must implement a staffing plan ensuring adequate, appropriate, and quality health care services that protect patient safety, effective not later than one year after enactment; the minimum ratios take effect not later than two years after enactment (four years for rural hospitals, as defined in SSA §1886(d)(2)(D)). The staffing plan must assign, at all times during each shift with a full complement of ancillary staff, no more than the following patients per direct care registered nurse: (1) one patient in trauma emergency units; (2) one patient in operating room units (with at least one additional scrub assistant); (3) two patients in critical care units (including neonatal intensive care, emergency critical care, intensive care, labor and delivery, coronary care, acute respiratory care, postanesthesia, and burn units); (4) three patients in emergency room, pediatrics, stepdown, telemetry, antepartum, and combined labor/delivery/postpartum units; (5) four patients in medical-surgical, intermediate care nursery, acute care psychiatric, and other specialty care units; (6) five patients in rehabilitation and skilled nursing units; and (7) six patients (three couplets) in postpartum and well-baby nursery units. The Secretary may apply these ratios to similar units providing comparable care levels. Direct care registered nurses must demonstrate unit-specific competence and orientation; administrators, supervisors, and temporary agency nurses count toward ratios only if providing direct patient care without other duties; other personnel may assist per state scope-of-practice laws but not perform core RN functions; and additional staffing must reflect patient acuity and care plans. (Thus, the provision prohibits assigning nurses beyond their competence, averaging ratios, or relying solely on ancillary staff to meet minimums.)

This section requires hospitals participating in or receiving payments from specified federal health care programs to comply with minimum direct care registered nurse staffing requirements under title XXXIV of the Public Health Service Act, as follows: (1) conditioning Medicare provider agreements on such compliance; (2) conditioning Medicaid plan payments to hospitals on such compliance; (3) requiring Department of Veterans Affairs hospitals to comply and clarifying that enforcement may occur through negotiated grievance procedures notwithstanding certain labor-management provisions; (4) requiring Department of Defense uniformed services hospitals to comply; and (5) requiring Indian Health Service hospitals to comply. The section further amends federal labor-management relations law to clarify that such staffing requirements may be enforced through grievance procedures negotiated under such law.

This section amends nursing workforce development programs under the Public Health Service Act. (1) It revises the scholarship program under section 846 (42 U.S.C. 297n(d)) to also authorize stipends. (2) It revises nurse retention grants under section 831(c)(1) (42 U.S.C. 296p(c)(1)) by renaming them from "Grants for career ladder programs" to "Grants for nurse retention," making punctuation changes, and adding two new purposes: (A) implementing nursing preceptorship projects that provide practical and clinical experiences and training for nursing students, newly hired nurses, and recent graduates of direct care registered nurse degree programs; and (B) implementing mentorship projects that assist new or transitional direct care registered nurses in adapting to the hospital setting.