March 10, 2023

The Honorable Gerald Connolly

2265 Rayburn House Office Building
United States House of Representatives
Washington, DC 20515

To the Honorable Gerald Connolly,

As a Registered Nurse working in Virginia, I wanted to express my unwavering support of bill

H.R.3165 Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2021 that
was introduced on May 12, 2021. Studies have demonstrated that nurse-to-patient ratios are a
critical component in determining the quality of care that we are able to provide to our patients.
Inadequate staffing can lead to an increase in medication errors, infection, falls, and mortality,
and therefore it is necessary that this subject is at the forefront of our concerns and objectives. 1
A recent study in particular found that there was a 14% decrease in risk for mortality for every
one less patient that a nurse had in a 24 hour span. 2This bill was introduced by Representative
Janice D. Schakowsky, and is supported by 88 cosponsors. I am urging you to consider
supporting this bill as it has the potential to transform our healthcare system into one that focuses
on promoting quality of care for not only the patients, but the nurses as well.

There is currently no federal mandate that regulates nurse-to-patient ratios, but there are two
states, Massachusetts and California, that have passed laws focusing on nurse staffing. Although
regulation can help improve patient outcomes, it can also reduce the nursing shortage we have
become so familiar with and subsequently create better working conditions for nurses. Studies
have shown that, among additional factors, nurse retention is directly related to staffing ratios
and nurse burnout. 3 It is imperative that nurse retention and quality of care is addressed, because
as nurses, we make up the majority of the healthcare profession. If we continue to ignore these
issues, the subsequent decrease in quality of care and nurse retention could be detrimental to our
healthcare system.

1
Adapted from “The Impact of Nursing Staffing Levels and Nurse’s Education on Patient
Mortality in Medical and Surgical Wards: An Observational Multicentre Study,” by F.
Haegdorens, P. Van Bogaert, K. De Meester, & K. Monsieur, K, 2019, BMC Health Services
Research, 19, Article 864 (https://doi.org/10.1186/s12913-019-4688-7).
2
Adapted from “The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute
specialist units: a systematic review and meta-analysis,” by A. Driscoll, M. Grant, D. Carroll, S.
Dalton, C. Deaton, I. Jones, D. Lehwaldt, G. McKee, T. Munyombwe, & F. Astin, 2018,
European Journal of Cardiovascular Nursing, 17, Article 1,
(https://doi.org/10.1177/1474515117721561).
3
Adapted from “Nursing Shortage,” by L. Haddad, P. Annamaraju, & T. Toney-Butler, 2022,
StatPearls Publishing.