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House Bill 106- Nurse-to-Patient Ratio Changes

On June 28, 2023, the PA House of Representatives amended the act of July 19, 1979, known as the Health Care Facilities Act with House Bill 106, known as the Patient Safety Act. The Patient Safety Act will make changes to the nurse-to-patient ratio across hospital departments such as the following:

  • Intensive care unit- a direct care registered nurse is assigned no more than 2 patients.
  • Intermediate care- a direct care registered nurse is assigned no more than 3 patients.
  • In-patient psychiatric unit- a direct care registered nurse is assigned to no more than 4 patients.
  • In-patient rehabilitation unit- a direct care registered nurse is assigned to no more than 5 patients.

The amendment plans to be applied to hospitals one year after the effective date and for Rural Hospitals or High Medical Assistance Hospitals it will be applied two years after the effective date.

There will also be penalties to those hospitals who don’t comply with the updated nurse-to-patient ratio, that will be at a minimum of $1,000, but not greater than $2,500 for each violation. According to Representative Kathy Rapp, “a hospital could rack up more than 50 violations per day, leading to fines greater than $125,000 per day.” 2 The intended use for the collected penalties will be to establish a grant program for recruitment and retention of registered nurses and will only be awarded to Rural Hospitals and High Medical Assistance Hospitals that apply for the grant program.

For the nurses, this amendment is intended to help with burnout, which in return will hopefully decrease the high turnover and will increase the safety of the hospital’s patients. It was noted that as of December 19, 2022, there were nearly 300 surgical patient deaths per year in Pennsylvania, which was the result of the increasing number of patients assigned to one nurse1.

For the hospitals, this amendment does not appear to be in their favor as the hospitals are already trying to recruit and retain their staffing by providing pay raises, bonuses, and different types of employee incentives. These amendment changes could potentially worsen the current staffing problem as the hospitals will need to recruit even more nurses to comply with the updated nurse-to-patient ratio. There is also the potential for smaller hospitals to be at risk of closing their doors as they try to comply by closing beds and reducing or eliminating services, which decreases their revenue stream; hire subcontractors to fill the void, which increases expenses; or face the unthinkable, breaking state law and continue with the current nurse-to-patient ratio with the risk of penalties and even worse, losing their license.

As of July 17, 2023, the amendment is still being reviewed by the Senate.

If you have questions about the information outlined above, McKonly & Asbury’s experienced professionals are here to help. Learn more about McKonly & Asbury’s Healthcare Practice by visiting our website or by contacting the Healthcare Practice Director, Janice Snyder, Partner.

About the Author

Kady Hand

Kady joined McKonly & Asbury in 2016 and is currently a Manager with the firm. As a member of the Audit & Assurance Segment, she focuses on providing client services, particularly in the areas of healthcare entity audits and single… Read more

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