Public Reporting of Nurse Staffing Measures

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Identifying and maintaining safe staffing levels and mix of nursing staff is critical to the delivery of quality patient care. Numerous studies reveal an association between higher levels of experienced RN staffing and lower rates of adverse patient outcomes. ANA is advocating with state and federal policy makers to hold hospitals accountable for the provision of adequate nurse staffing and skill mix through legislative and regulatory means. One way to hold hospitals accountable is to require hospitals to publically report nurse staffing on the Center for Medicare and Medicaid Services (CMS) Hospital Compare site for use by consumers, purchasers, and other stakeholders to make healthcare decisions.

Hospital Compare is a consumer-oriented CMS website that provides the general public with information about hospitals' performance. Current performance indicators include patient satisfaction scores, readmissions and mortality rates, and other quality measures. By making nurse staffing and skill mix publically reported, consumers, purchasers and other stakeholders would have essential information about the most important summary safety variables to make a choice in hospital care. Using CMS's understandable five star rating system, stakeholders could view understandable transparent reporting of nurse staffing and skill mix levels for hospitals. Consumers understand the safety research findings that higher levels of death and harm occur when hospital staffing and skill mix levels are low, the evidence for the importance of public reporting these measures. (See ANA's white paper)

Hospitals currently have varying nurse staffing levels and there is no national benchmarking gold standard set to date.  By publically reporting nurse staffing measures on a federal website, hospitals will be compared across the country to inform a national gold standard to inform future legislation. In the interim, the public reporting policy lever will incent reduction of current wide variance in nurse staffing and skill mix, particularly on medical-surgical units, to save lives and prevent harm. See state legislation updates regarding staffing, including public reporting at the link below, Nurse Staffing Plans & Ratios, ANA has advocated for public reporting of a staffing and skill mix measure at the national level through the National Quality Forum (NQF) and the CMS as described below.

ANA's Health Policy Advocacy Leadership Advancing Patient Safety: Public Reporting of ANA's Nursing Staffing/Skill Mix Measures

  • ANA's nurse staffing and skill mix measures were submitted to NQF in 2003
    • The measures were endorsed by NQF at the unit level in 2004 (see NQF Nursing Sensitive Hospital Safety Measures report)
    • Through ANA's advocacy in 2014 strong nursing voice was added to the NQF's "standing" Safety Measures Steering Committee that endorses measures for public reporting and pay for quality - five nurses were appointed
  • CMS Federal leaders approved these measures for evaluation as a priority for CMS's public reporting program, the Inpatient Quality Reporting (IQR) program viewed via Hospital Compare, by the NQF-convened Measures Application Partnership (MAP) 4/2014
    • Measures added to the MAP Measures Under Consideration (MUC) list
  • MAP's Hospital Workgroup (WG) reviewed the measures 12/2014
    • Through successful ANA advocacy, a "do not support" recommendation to the MAP WG was overturned with a 71% vote
    • A "conditional support" vote passed (MAP supported the measures with the condition that NQF endorse the measures at the new hospital-level reporting)
  • MAP's higher level Coordinating Committee finalized the "conditional support" vote 2/2015 (See MAP's report to HHS)
  • NQF endorsed the ANA's staffing and skill mix measures at the new hospital level reporting and re-endorsed the measures at the unit level 2/2016
  • ANA has worked closely with CMS to develop a feasible national reporting mechanism for timely uptake of these measures into public reporting via regulation, closely the loops on barriers ASAP such as
    • CMS is working on identifying national data standards and common data dictionary
    • Reporting solution - a web portal solution was discussed with the CMS team for reporting but has not yet been accepted by CMS leadership
    • ANA is advocating with CMS to add ANA's staffing and skill mix measures to IQR with ANA's comments on the IPPS FY 2017 proposed regulations