; (2) recommendations of medical-specialty societies, other pediatric healthcare provider organizations, and family and patient groups, and (3) credible scientific evidence published in peer-reviewed literature that is generally recognized by the relevant health care provider community. 133. Safe staffing requirements (a) Minimum direct care registered nurse staffing requirements The Public Health Service Act ( 42 U.S.C. 201 et seq.) is amended by adding at the end the following new title: XXXIV Minimum Direct Care Registered Nurse Staffing Requirement 3401. Minimum nurse staffing requirement (a) Staffing plan (1) In general A hospital shall implement a staffing plan that— (A) provides adequate, appropriate, and quality delivery of health care services and protects patient safety; and (B) is consistent with the requirements of this title. (2) Effective dates (A) Implementation of staffing plan Subject to subparagraph (B), the requirements under paragraph (1) shall take effect on a date to be determined by the Secretary, but not later than 1 year after the date of the enactment of this title. (B) Application of minimum direct care registered nurse-to-patient ratios The requirements under subsection (b) shall take effect as soon as practicable, as determined by the Secretary, but not later than— (i) 2023