Citing staggering burnout, relentless resignations and standards under siege, a host of nurses have recently written letters to the editor in support of the passage of L.D. 1639, An Act to Address Unsafe Staffing of Nurses and Improve Patient Care.
The Maine State Nurses Association, a union that represents 4,000 registered nurses across the state, firmly supports the bill, which would establish ratios in law, minimum “nurse staffing requirements based on patient care unit and patient needs.”
The urgent need to correct staffing in hospitals is in zero doubt. But we are doubtful that mandated ratios, which run the risk of both backfiring and being worked around, are the best means of correcting it.
The letters from nurses who are hurting on the job paint a stark and concerning picture of working conditions in Maine’s hospitals. “I am constantly agonizing over being a part of a system inflicting harm by design,” writes one.
“If you are busier, you have less time with each patient, and you are more likely to make a mistake … It’s no wonder my bedside nurse colleagues are leaving in droves,” writes another.
“The days when I have too many patients, and am pulled in too many directions, are when hospitals are dangerous and patients’ lives are at risk,” writes a third.
The nurse ratio bill, like many similar proposals for mandates around the U.S., has been vigorously resisted by hospital management. Administrators say the Maine proposal will impede needed flexibility and, as a result of its rigidity, has the potential to backfire by forcing closures of beds or units when requirements cannot be met. They have also expressed alarm about what it would cost.
Concern about increased operating costs is not, in our view, reason enough to resist an attempt to improve working conditions for embattled nurses.
Indeed, operating costs are going to need to increase if staffing levels are to change and working conditions to improve. Nurses don’t meaningfully benefit from awards programs, freebies for International Nurses’ Day or offers of various interventions supporting “wellness.” They need better pay and more colleagues, something that can be achieved with better wages – just ask traveling nurses, who are paid at least three times as much as staff nurses in order to fill vacancies.
The American Nurses Association recognizes three means of addressing safe staffing: the creation of nurse-led staffing committees, made up mostly of direct-care nurses that are tasked with the creation of realistic staffing plans based on patient needs and staff skill and experience; mandated disclosure of staffing ratios to the public or another regulatory body, and ratios in regulation or legislation.
The association expressly supports the committee approach, “legislative models incorporating nurse-driven staffing committees … because this approach encourages flexible staffing levels.”
Eight states have taken the hospital-based committee approach. Five states have reporting requirements. Just two states have some form of nurse-to-patient ratios in place: California and Massachusetts. The Massachusetts law applies only to the intensive care unit (and includes a compromise whereby an “acuity tool” can be used to lift the 1:1 ratio to one nurse to two patients), whereas the California law applies to every hospital unit.
So far, Maine has nothing. That urgently needs to change.
Opponents of L.D. 1639 gesture at multiple existing staffing regulations that they say already apply in Maine. If any of those were effective, of course, we would need only one.
Studies on the outcomes of the California law, the law closest to what’s being proposed in Maine and the only one of its kind in the nation, are conflicting.
The groundswell of support for nurse-to-patient ratios among bedside nurses makes it painfully clear that radical change is overdue in our state’s units and wards. If we could dependably legislate against staffing shortages, however, it could conceivably also be done for teachers, bus drivers, public defenders and more.
Thankfully, other options are out there. We urge hospital administrators to take full responsibility for the safety of nurses and patients alike, and we urge state legislators to explore further and different means of holding those administrators accountable.
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