As a registered nurse working in Maine for more than 40 years, I can tell you that understaffing in our hospitals is a threat to patient safety. Too often, hospitals fail to ensure that there are enough registered nurses to provide our patients safe, competent, therapeutic and effective care. Many people do not know that there is currently no limit to the number of patients a nurse can be made to care for at one time in Maine. No limit.
Nurses know we cannot give our patients the best care when we have too many patients. It’s impossible. This is why we need the Maine Quality Care Act (L.D. 1639), which would limit the number of patients nurses can be assigned during their shifts and provide protection to nurses who report unsafe care conditions and advocate for their patients to ensure they get the care they need.
When hospitals under staff, it is unsafe for patients and for nurses. Unsafe patient care conditions due to short staffing is one of the top reasons nurses have been leaving direct-care nursing and the profession. RNs are responsible for monitoring vital signs, constantly assessing patients’ physical status, adjusting patients’ medications, coordinating care and so much more. When nurses have too many patients, essential, lifesaving nursing care is too often left undone. When nurses are overwhelmed, we may miss subtle signs that our patient may be experiencing a complication or are in danger of needing rapid escalation in lifesaving efforts.
As the president of the Maine State Nurses Association which represents 4,000 RNs across the state, I’ve talked to nurses from Portland to Presque Isle who say they are unable to provide the kind of skilled, vigilant monitoring of patients that can not only save their lives but also ensure that they go home without any preventable complications. Nurses report that there is little to no time to educate our patients and their families before they leave. We send them home with a packet of papers and hope for the best. We didn’t enter the nursing profession to provide minimal care. When we can’t provide the best care, we feel moral distress and moral injury.
Unsafe staffing drives nurses away. The Maine Quality Care Act would keep nurses at the bedside. When nurses know they will get an appropriate patient assignment that allows them to deliver timely care patients need, they will stay. You can recruit all the nurses you want but if they don’t stay, then you still have a staffing crisis. Retention is key.
Contrary to what the hospital industry says, there is no nursing shortage. According to data from the National Council of State Boards of Nursing and the U.S. Bureau of Labor Statistics, more than 12,000 licensed registered nurses in Maine were not employed as RNs in 2022. And this is a conservative estimate; the most recent BLS data on RN employment (released April 25, 2023) averages the number of employed RNs over three years (Nov. 2019–May 2022) while the NCSBN data shows sustained increases every year in the number of nurse licenses nationally since at least 2018. Clearly, the RN licensing pipeline is strong.
The hospital industry is also using scare tactics to stop the safe staffing bill, claiming that hospital units and hospitals will be shut down and ambulances will be lined up around the block if we pass a staffing bill that ensures safe patient limits. None of these things happened when California passed its safe staffing law. In fact, the data show that emergency room diversions decreased and new RN graduates, RN licenses and the number of RNs working in hospitals increased after California’s law passed.
We know that safe staffing improves patient outcomes. Studies show that when RNs are forced to care for too many patients at once, patients are at higher risk of preventable medical errors, avoidable complications, falls and injuries, pressure ulcers, increased length of hospital stay, higher numbers of hospital readmissions and death.
Safe staffing literally saves lives. Yet hospitals continue to staff at skeletal levels, forcing nurses to scramble when other RNs are out sick or there is a surge in patients. It all comes down to the bottom line, with hospitals prioritizing money over patients.
Maine nurses support the Maine Quality Care Act because we know that an enforceable safe patient limits law is the solution to our staffing crisis and safe, high-quality patient care. It’s common sense.
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