Florida Legal Requirements for Nursing Home Patient to Staff Ratio

There is a shortage of trained nursing staff in Florida, as there is in other states. The Agency for Workforce Innovation estimates that between 2006 and 2014, there will be 7,440 openings for nursing staff in the state. Tensions also exist between the health care industry and others, particularly nursing organizations, on the need for nurse-staff ratios. The Nursing Home Reform Act 1987 laid down minimum staffing requirements for nursing homes, although the Act has often been criticized for being too vague.

Requirements

• The Nursing Home Reform Act stipulated that each Medicaid or Medicare-approved nursing home should have a director of nursing (DON) appointed. Residents should be provided with licensed nursing staff at all times. A registered nurse (RN) should be on duty at least 8 hours in 24, 7 days a week. A licensed nurse (LPN) should be on duty the rest of the time. Nursing aides should have at least 75 hours of training.

Florida

• Many states have moved beyond the federal requirements to enact their own minimum staffing laws. Chapter 400 of the Florida Statutes deals with this issue. Recently, Florida rules changed the amount and type of direct staff contact with residents. The daily requirement is 3.7 hours, and this remains the same, but now the amount of time spent with the resident by a certified nursing aide has decreased, and the amount of time spent with a licensed nurse (LPN) increased.

Standards

• Some federal requirements on staffing are unduly vague, but some checking systems do exist. The Online Survey Certification and Reporting System (OSCAR) is updated for each nursing home every 9 to 15 months. Also, the Florida Nursing Home Watch List, which includes staffing levels, published by the federal agency for health care administration, can be viewed online.

American Nursing Association

• Many nursing organizations favor more stringent enactment and enforcement of minimum staffing requirements. According to Linda Stierle, RN MSN, executive director and executive officer of the ANA, "minimum standards give nurses, health care workers, and consumers a reference point from which they can more effectively advocate for the well-being of patients."