On March 1, 2022, in his State of the Union address, President Biden announced a historic initiative to protect nursing home residents and workers. After more than two years of public input, consultation with experts and careful deliberation, the president announced a minimum staffing standard for nursing homes that voluntarily choose to receive Medicare and Medicaid reimbursement.

In addition to implementing a minimum staffing standard, the rule would require increased transparency in Medicaid spending and to ensure all nursing homes were using evidence-based data-driven practices when assessing resident need, the most significant set of protections for nursing home residents and workers in decades.

That new nursing home staffing mandate is now under threat on Capitol Hill.

As we say here in Aroostook County, “Never put your wish-bone where your backbone ought to be.” That is why I am asking Sens. Susan Collins and Angus King to do the right thing and oppose the threats to the new nursing home staffing mandate – joint resolutions H.J. Res. 139 and S.J. Res. 91. If passed, these extreme resolutions will have dire consequences for nursing home residents – and the staff that care for them.

I am a registered nurse with more than 40 years of experience in my profession. Twenty years ago, in 2004, after 25 years of nursing experience in cardiac telemetry, neurosurgery and oncology, and working in the acute care settings of excellent teaching hospitals, I went to work at a for-profit nursing home.

With 40 patients under my care, I was shocked to find myself the only licensed provider for the entire shift. Even with capable, caring nurse’s aides, the nursing care of those forty patients was on me, on my license. I stayed for a number of months, learning how the for-profit nursing home business functioned, and I provided the best care I could. It was unsustainable and dangerous. What I was being asked to do was unethical and unsafe.


The American Nurses Association Code of ethics is the guiding light to practicing the art and science of nursing. Experiencing a direct threat to my ability to provide safe nursing care working in that for-profit nursing home job spurred me on to obtain a Ph.D. in nursing with a focus on health policy and gerontology.

From there, I was on faculty at a school of nursing and spent the next 12 years of my career teaching young nursing students to never, ever put themselves into the position I found myself in at that time. I had many years of experience and that was not enough to practice safely with such unsafe staffing. New nurses coming out of school, finding themselves the only RN for a patient load of 40, would be disastrous for both the nurse and the patients. If there are no nurses wanting to put themselves in this position, blame me and the many other voices of reason that come from nurses who have been put into such dangerous situations.

The new nursing home mandates were the help we have waited for and we celebrated. What is happening now is crushing to the spirit of every nurse I know.

Lawmakers in both chambers have introduced the joint resolutions under the Congressional Review Act to overturn the rule. The Senate measure, led by Sens. Jon Tester (D-Montana), James Lankford (R- Oklahoma) and Joe Manchin (I-W. Virginia) is reported to have a significant chance of passing the Democrat-controlled Senate.

Tester is reportedly running for reelection in a red state and is one of the Senate’s most vulnerable Democrats. He has been outspoken about the need to block the rule from taking effect. Last fall, he and Lankford led a letter to the Centers for Medicare & Medicaid Services, demanding the agency rescind the rule. That letter was signed by Democratic Sens. Maggie Hassan (NH), Jeanne Shaheen (NH), as well as by Sens. Collins and Sen. King.

The final rule provides nursing homes with numerous opportunities for waivers and hardship exemptions, and offers a lengthy phase-in period. The nursing home industry had many opportunities for input. The industry has also spent millions of dollars in advertising and lobbying to defeat the new staffing standards. Sens. Collins and King, please support nursing home residents and workers, have a backbone and do the right thing by rejecting these extreme resolutions.

Join the Conversation

Please sign into your CentralMaine.com account to participate in conversations below. If you do not have an account, you can register or subscribe. Questions? Please see our FAQs.

filed under: