In the past two decades, there has been a push for appropriate staff to client ratios. However, measuring client needs and nursing efforts have been around since 1922 (Lewinski-Corwin, 1922, pp. 603-606). The earliest recorded effort was by the New York Academy of Medicine. Superintendents and nurses from ten training schools documented the time spent providing bedside care. From complied information, the researchers revealed each client required an average of five hours and four minutes of care in a 24-hour period. From these observations, they evaluated staffing issues in New York City. At that time, none of the hospitals were sufficiently staffed (Lewinski-Corwin, 1922, pp. 603-606).
Still today, nurse staffing is a crucial health policy issue. Since the 1980s, the nursing profession has taken on more prominence in America with a large focus on research studies. In fact, U.S. Public Law 99-158, Health Research Extension Act of 1985, authorized the National Center for Nursing Research (NCNR) at National Institutes of Health (NIH) (Health Research Extension Act of 1985, 1985). With U.S. Public Law 103-43, NIH Revitalization Act of 1993, the NCNR was formally changed to the National Institute of Nursing Research (NINR) (NIH Revitalization Act of 1993, 1993). The NINR started constructing purposeful research projects, which produced a positive correlation between the number of staff and quality of care. However, the 1996 Institute of Medicine (IOM) report expressed, at that time, no significance between nurse staffing and clients’ outcomes in acute-care hospitals (Institute of Medicine Staff, Davis, Sloan, & Wunderlich, 1996, p. 9).
For a while, hospitals were cutting staff, using the IOM report in 1996 as evidence-based research. In addition, statistics showed a decrease in the average length of stay for clients resulting in a decline in the number of staffed beds, so hospitals began restructuring. The institutions began redesigning staffing schedules and care plans for clients to accommodate the decreased need (Institute of Medicine Staff, Davis, Sloan, & Wunderlich, 1996, p. 94). Most institutions restructured trying to reduce operating costs by changing work methods and roles of the staff. Between 1981 and 1993, full-time-equivalent (FTE) nursing staff declined by more than 7 percent nationally after adjusting for client days and case-mix complexity (Aiken, Sochalski, & Anderson, 1996, pp. 88-92). These changes were done without regard to better client outcomes, thus producing the current need for change.
Since the IOM report in 1996, more research has been done showing better client outcomes with more favorable staffing of registered nurses (Cho, Ketefian, Barkauskas, & Smith, 2003, pp. 71-79). Therefore, S. 991: Registered Nurse Safe Staffing Act of 2003, 108th Congress: 2003-2004 was introduced in the Senate. This bill was to amend part D (Miscellaneous) of title XVIII (Medicare) of the Social Security Act (SSA) to: