BOSTON – Legislation in Massachusetts to set nurse-to-patient staffing ratios in hospitals was stalemated last month, killing the initiative for the rest of this year.
Proponents of the legislation, which would require hospitals to have a pre-determined ratio of nurse professionals to care for patients, promise to seek legislative action next year.
So far, California is the only state to set nurse-patient ratios. But at least a dozen states are considering bills, as legislators react to concerns about patient safety and respond to criticism of working conditions in hospitals.
Facing outside pressure to set staffing levels is a huge concern for the nation’s hospitals, many of which already are having trouble offsetting rising expenses with revenue. The nation’s nurse shortage is getting worse, and hospitals are questioning how they would be able to meet staffing levels prescribed by legislation such as that proposed by Massachusetts.
In Massachusetts, some 130 organizations joined a coalition to support the nurse staffing requirements, said David Schildmeier, director of communications for the Massachusetts Nurses Association.
Nurses throughout the nation have become more vocal because of downsized nursing staffs over the last 10 years and an increase in mandatory overtime. Some nurse organizations contend that the shortage has been precipitated by poor working conditions, and that staffing ratios would improve the environment and stem turnover.
The Massachusetts assembly passed one version of a nurse staffing bill in May, but a different approach was included in a bill that passed the state’s senate in July and there wasn’t enough time to reconcile the two versions, Schildmeier said.
“Nurses have had it,” he said. “They have seen California pass this law and have heard the arguments over the last year and a half. There has been more research coming out, and the research shows that if hospitals invest in nursing care, they can save millions of dollars by providing the right care immediately.”
No large-scale studies exist for setting specific nurse-to-patient ratios, and the ratios established in California are based on a small number of studies, said John M. Welton, associate professor of the College of Nursing for the Medical University of South Carolina, Charleston.
Nurse-patient ratios tend to be favored by nurse associations with strong ties to organized labor, and some nursing organizations actually oppose setting such ratios, he said.
“Mandating ratios is actually worse, because it represents a ceiling rather than a floor,” he said. “It doesn’t address the underlying problem, which is the hospital needs to be able to identify the patients at greatest risk” and assign them the most nursing resources.
Schildmeier questions the arguments used to shoot down nurse-patient ratios. He notes that no hospitals in California closed as a result of costs associated with staffing requirements, and he contends that facilities underestimate the costs they incur in recruiting nurses to fill open positions, which studies have estimated at $46,000 to $100,000 per vacancy. Better working conditions, supported by better staffing levels, could cut turnover, he said.
A number of states have opted for a legislative approach that requires all stakeholders – nursing labor, hospital associations and other nursing groups – to reach a consensus on staffing.
That’s the approach espoused by the American Nurses Association, said Janet Haebler, associate director of state government affairs. So far this year, four states have opted for the collaborative model.