Minimum Nurse Staffing Ratios Required for Nursing Homes in the United States

In April 2024, the Biden administration made nursing home care safer for ~1.2 million residents in Medicare- and Medicaid-certified long-term care facilities in the United States. The Centers for Medicare and Medicaid Services (CMS, 2024) issued the Minimum Staffing Standards for Long-Term Care (LTC) Facilities and Medicaid Institutional Payment Transparency Reporting final rule. Now all nursing homes will have federally required nurse-to-patient ratios and a registered nurse (RN) will have to be on site 24/7 (CMS, 2024). CMS (2024) plans to closely monitor enactment and require states to report staffing and financial data. Powerful organizations and lobbyists representing the nursing home industry tried to stop this rule, claiming costs were prohibitive (Rowland, 2024). The very name of the facilities, Nursing Homes, implies to residents and their family members that RNs are there providing care to their loved ones, yet in many nursing homes, RNs are not required to be on site 24/7. Now that CMS has stepped into regulating nurse-to-patient ratios for a vulnerable patient population in their later years, there is no longer a valid argument that keeping patients safe by requiring specific nurse-to-patient ratios is not within the realm of the federal government, specifically CMS. The maternity nurse staffing standards published by the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) in 2022 are based on years of rigorous evidence linking adequate nurse staffing to patient outcomes. There have been powerful forces lobbying against including an assessment of nurse-to-patient ratios during hospital quality accreditation processes by CMS, the Joint Commission, and others (Simpson, 2023). There are claims that hospitals cannot afford to staff safely. Health care systems and insurance companies have resources to pay their chief executive officers and other administrators millions of dollars each year in salary, bonuses, and other compensation (Herman et al., 2022; Wilson, 2024). "The average nonprofit hospital CEO makes eight times what hospital workers without advanced medical degrees make, but some make as much as 60 times the rate of other workers" (Garber, 2023, p. 1). CMS should now use their leadership on quality care for nursing home patients as a template for requiring safe nurse staffing for patients giving birth in America's hospitals and birth centers. Once CMS requires nurse-to-patient ratios as per the standard (AWHONN, 2022), the Joint Commission and other accrediting bodies will follow, and maternity care safety will be enhanced in the United States (Simpson, 2023). This issue should be at the forefront for all perinatal nurses in the United States as the major foundation for safe maternity care.